Impact of Dementia on Quality of Life | Intervations

Impact of Dementia on Quality of Life | Intervations Dementia and Incontinence An exploration of the impact that these conditions have on quality of life and a discussion of strategies that may be employed to manage the problem and/or enable the sufferer and carers to cope. Based on the 2001 census, it is estimated that the total number of people living with dementia in the United Kingdom (UK) is 775,200 and that this figure will rise to 870,000 by the year 2010 and to 1.8 million by 2050 (Alzheimer’s Society 2004). Dementia affects about one person in 20 over the age of 65 years. This figure rises to one person in three for people over the age of 90 years (Gow and Gilhooly 2003). Studies have estimated that 18,000 people with dementia are under the age of 65, and that the number of people in the UK with dementia in minority ethnic communities could be as high as 14,000 (Alzheimer’s Society 2004). Dementia is described as â€Å"a syndrome due to disease of the brain, usually of a chronic or progressive nature† (World Health Organization 2001). Dementia is associated with a range of symptoms including impaired memory, disorientation, poor concentration and difficulty in naming and use of language. Patients with dementia have an impaired ability to learn or recall learned information, difficulty in using motor skills and co-ordination, difficulty thinking in a clear and coherent way and in understanding or following a sequence (Jacques and Jackson 1999). The significant disabilities associated with dementia can be accompanied by personality and mood changes, and changes in judgement. The term â€Å"dementia† is an umbrella term used to describe a number of conditions in which these symptoms occur, and where a differential diagnosis has been undertaken to rule out other causes for these symptoms (Cheston and Bender 1999). These include Alzheimer’s disease, vascular dementia and Lewy body dementia. It is proposed that dementia commonly leads to incontinence of urine, faeces, or both. Urinary incontinence us up to four times more common in individuals with dementia than in people without dementia. Loss of continence may be more prevalent in Alzheimer’s disease than in vascular dementia, and becomes more common with increasing dementia severity (Skelly and Flint 1995). Men are more at risk than women, possibly because of associated prostatic problems. Faecal incontinence is less common than urinary incontinence, however both urinary and faecal incontinence are strongly associated with caregiver stress and possible premature entry to nursing and residential homes (Armstrong 1999). In fact, the rates of incontinence are particularly high among patients in hospitals, nursing homes and residential homes, where it is debated that approximately half might be affected (Irwin 2001). This essay will briefly discuss the pathophysiology of the different types of dementia and incontinence with a view to investigating how these linked conditions affect quality of life. There will also be a discussion about various strategies that may be employed to manage the problem and/or enable the sufferer and carers to cope. It is proposed that approximately 55 percent of patients diagnosed with dementia have Alzheimer’s disease, also known as Alzheimer’s dementia (Killeen 2000). It is a degenerative disease affecting the brain. This is a result of changes in the structure and function of two proteins, beta-amyloid and tau that cause the formation of plaques and neurofibrillary tangle form in areas of brain tissue, which destroy them (Burns et al 1997). The cause of this process is not yet fully understood. The temporal and parietal lobes of the brain are generally affected in Alzheimer’s disease, which can result in significant memory loss and an inability to recognise people and places. This can be extremely distressing, particularly if the person no longer recognises his or her image or that of friends and family (Kitwood 1997). As the condition progresses, basic skills and capabilities can be lost. Visual-spatial skills can become impaired, resulting in the patient becoming unabl e to put sequences of an activity or movement together (Jenkins 1998). The frontal lobe can also be affected and this can result in difficulties in communication and judgement resulting in disinhibited behaviour (Jacques and Jackson 1999). In Alzheimer’s disease the symptoms progress gradually but persistently over time (Burns et al 1997). Vascular dementia, also referred to as multi-infarct dementia, is another common type of dementia. It is caused by problems in the circulation of blood to the brain, which results in multiple strokes to brain tissue resulting in significant cognitive impairment (Sander 2002). These strokes can cause damage to areas of the brain responsible for speech or language and can produce generalised symptoms of dementia. As a result, vascular dementia may appear similar to Alzheimer’s disease. Vascular dementia can progress in an irregular manner with episodes of sudden loss. It can also take the pattern of gradual change, as in Alzheimer’s disease. The rate of memory loss and impairment of insight appear to progress at a slower rate than in Alzheimer’s dementia. Vascular dementia has been identified as a distinct condition in up to 20 percent of people with dementia (Miller and Morris 1993); however, as with all types of dementia it can co-exist with other forms of the co ndition. Vascular dementia is considered the second most common form of dementia in the western world (Nor et al 2005). Another common form of dementia is Lewy body dementia. Lewy body dementia is characterised by fluctuations of cognitive impairment, which are defined by episodic confusion and lucid intervals. These fluctuations in cognition can occur over minutes, hours or days. They can occur in as many as 50-70 percent of patients and are associated with shifting levels of attention and alertness (Archibald 2003). Patients with Lewy body dementia can experience visual and auditory hallucinations, secondary delusions and falls. These symptoms can result in the person presenting with behaviours that are challenging. Lewy bodies are tiny spots containing deposits of a protein called alpha-synuclein. These are found in the hippocampus, temporal lobe and neocortex in addition to the classic sites in the substantia nigra and other subcortical regions (Del Ser et al 2000). Lewy body dementia is ranked as the third major type of dementia. It is estimated that around 20 per cent of people with dementia wil l have the Lewy body form of the disease (McKeith et al 1995). However, this figure could be much higher, and it is estimated that up to 36 percent of people with dementia could have this type (Del Ser et al 2000). It is posited that continence is a basic function that should be maintained in healthy elderly people, regardless of age. Loss of continence can be interpreted as a dysfunction of either the lower urinary tract or bowel, or of some other system that participates in the maintenance of continence, in particular the nervous system (Crome et al 2001). Loss of continence in the patient with dementia is related most commonly to alteration in basic factors necessary for its maintenance or to use of medication (Ouslander 2000). People with dementia are also more prone to suffer delirium which is associated often with incontinence. Immobility can soon lead to loss of continence and the frequency, and severity of incontinence is strongly associated with dementia severity and incapacity to walk or make transfers (Skelly and Flint 1995). Resnick (1995) analysed the relationship between incontinence and a series of factors outside the lower urinary tract. He found that if patients maintained inde pendence to make transfers and to dress, even though their dementia was severe, they could maintain continence. The influence of sedative drugs, physical restrictions and other environmental or social factors must not be forgotten. Furthermore, the attitude of professionals, with over-use of absorbent or palliative products for incontinence, can itself lead to loss of continence. Since the aetiology of incontinence in the older person with dementia may be multifactorial, it is suggested that a multidimensional assessment is required to identify the pathogenic mechanisms involved. The diagnostic assessment should be individualised, depending on the characteristics of each patient (clinical, functional, life expectancy) as well as the impact of incontinence (Khoury 2001). Generally, it is accepted that the basic assessment should include several components such as a medical history, clinical type of incontinence, the severity of incontinence, and the timing of leakages. A functional assessment focusing on mobility (transfers, walking, and skill grade) and mental function should be undertaken and a formal assessment should be made of the severity and nature of the cognitive impairment and of any depression or behavioural disorders that could influence presentation, as well as management of incontinence. Finally, an environmental assessment would prove useful to detect the existence of barriers that could limit access to the lavatory (Alzheimer’s Society 2004). It is posited that incontinence has an adverse effect on the quality of life. Quality of life can be defined as the awareness of the capacity to meet personal, psychological and social needs on a daily basis. It is proposed that incontinence is very distressing and it can affect an individual’s sense of dignity and self-esteem especially if the person needs personal help from a carer or relative as a result of incontinence (DuBeau et al 2006). Treatment of urinary incontinence is based on various approaches, which should be used in a complementary way to obtain the best results. It is fundamental to establish realistic therapeutic objectives. However, it is argued that it will not be easy to obtain positive results in all patients, because of immobility and lack of co-operation. Trying to reduce the severity of incontinence and maintenance of patient well-being, good perineal hygiene and â€Å"social continence† may be a more realistic goal. Thus, an individual approach is essential, adapted to the characteristics and situation of each patient (Irwin 2001). It is proposed that treatment measures should include the identification and treatment of concurrent medical conditions, active management of constipation, hygienic-dietary recommendations (reduction of stimulant substances e.g. caffeinated drinks, modification of timing of fluid intake). An improvement in mobility, a review of usual treatment and change of drugs that are potentially involved in incontinence recommendations should be included in treatment measures. The type of clothes worn such as clothes with simple opening and closing systems can help with toileting and incontinence. Utilising environmental interventions such as; enhanced visibility by painting toilet doors bright  colours, signposting and good lighting, ensuring easy access to toilets, providing grab-rails and raised toilet seats, and ready availability of mobility aids, commodes and urinals, preferably with nonspill adapters, will be of immense help. Debatably, these measures might assist the dementia patient w ith any possible confusion as to where the toilet is (Alzheimer’s Society, 2004). Other strategies for the management of incontinence in the dementia sufferer could include behavioural techniques. These techniques attempt to promote a change in the patient’s (or caregiver’s) behaviour, trying to re-establish a normal pattern of bladder-emptying or to prevent the patient from being wet. Simple, non-invasive, behavioural techniques are relevant for almost all types of patients and incontinence, and can be used jointly with other therapeutic options, especially drug treatment (Khoury 2001). Two groups of techniques are differentiated: those performed by the patient (pelvic floor exercises, bladder-retraining, biofeedback) and those by the caregiver (micturitiontraining, scheduled voiding, prompted voiding). It is argued however, that the patient-dependent techniques require previous instruction as well as understanding and collaboration by the patient, so they may be impracticable  for people with advanced dementia. The most used behavioural techniques are prompted voiding, micturition training and scheduled voiding. Prompted voiding has the greatest scientific support. The objective  of this technique is to stimulate the patient to be continent through periodic assessments by the caregivers and positive reward systems. Several studies demonstrate the effectiveness of behavioural techniques in institutionalised elderly subjects with dementia, especially in reduction of incontinence episodes. However, most data report its effectiveness only in the short term (Eustice et al 2002, Durrant and Snape 2003). Dementia is a distressing long-term condition that affects both sufferers and their carer’s quality of life. Coupled with that incontinence can be humiliating for the individual with dementia and upsetting for their significant others around them. It is important to assess the person’s individual needs as incontinence in dementia is multifactorial. There are various strategies and treatments that can be put into place that will assist both the sufferer and their carer. Behavioural techniques such as prompted voiding, micturition training and scheduled voiding have been found useful as a treatment alongside environmental and current review of medical history. It is important to note that incontinence should always be viewed as associated with, rather than caused by dementia and therefore potentially treatable. References Alzheimer’s Society (2004) Policy Positions: Demography, www.alzheimers.org.uk/News_and_Campaigns/Policy_Watch/demography.htm,  (Last accessed: August 2006) Archibald C (2003) People with Dementia in Acute Hospital Settings: A Practice Guide for Registered Nurses, Stirling, The Dementia Services Development Centre Armstrong M (1999) Factors affecting the decision to place a relative with dementia into residential care, Nursing Standard, 14, 16, 33-37 Burns A, Howard R, Pettit W (1997) Alzheimer’s disease: A Medical Companion, Oxford, Blackwell Science Cheston R, Bender M (1999) Understanding Dementia: The Man with the Worried Eyes, London, Jessica Kingsley Crome P, Smith AE, Withnell A (2001) Urinary and faecal incontinence: prevalence and health status, Reviews in Clinical Gerontology, 11, 109-113 Del Ser T, McKeith I, Anand R, Cicin-Sain A, Ferrara R, Spiegel R (2000) Dementia with Lewy bodies: findings from an international multicentre study, International  Journal of Geriatric Psychiatry, 15, 11, 1034-1045 Durrant J, Snape J (2003) Urinary incontinence in nursing home for older people, Age Ageing, 32, 12-18 Eustice S, Roe B, Paterson J (2002) Prompted voiding for the management of urinary incontinence in adults, Cochrane Database Systemic Review Gow J, Gilhooly M (2003) Risk Factors for Dementia and Cognitive Failure in Old Age, NHS Health Scotland, Glasgow Irwin B (2001) Management of urinary incontinence in a UK trust, Nursing Standard, 16, 13, 15, 33-37 Jacques A, Jackson G (1999) Understanding Dementia, (3e) Churchill Livingstone,  Edinburgh Jenkins DAL (1998) Bathing People with Dementia: The Bathroom and Beyond, Stirling, The Dementia Services Development Centre Khoury JM (2001) Urinary incontinence: No need to be wet and upset, North Carolina Medical Journal, 62, 74-77 Killeen J (2000) Planning Signposts for Dementia Care Services, Edinburgh, Alzheimer Scotland Kitwood T (1997) Dementia Reconsidered: The Person Comes First, Milton Keynes, Open University Press McKeith IG, Galasko D, Wilcock GK, Byrne EJ (1995) Lewy body dementia: diagnosis and treatment, British Journal of Psychiatry, 167, 6, 709-717 Miller E, Morris R (1993) The Psychology of Dementia, Chichester, John Wiley  and Sons Nor K, McIntosh IB, Jackson GA (2005) Vascular Dementia: Series for Clinicians, Stirling, The Dementia Services Development Centre Ouslander J (2000) Intractable incontinence in the elderly, British Journal of Urology International, 85, 3, 72-78 Resnick NM (1995) Urinary incontinence, Lancet, 346, 94-100 Sander R (2002) Standing and moving: helping people with vascular dementia, Nursing Older People, 14, 1, 20-26 Skelly J, Flint AJ (1995) Urinary incontinence associated with dementia, Journal of the American Geriatrics Society, 43, 286-94 World Health Organization (2001) Alzheimer’s disease: The Brain Killer, Geneva, WHO Leadership and Management Case Study: Selfridges Leadership and Management Case Study: Selfridges Introduction 1.1 Company and Organizational Culture Selfridges is a well reputed department store chain in the UK which is targeting the high end customers. In the 1856 the company was founded by Harry Gordon Selfridge. They have opened the second largest flagship stores in London on 1909 and another prominent three stores opened recently. The company could be managed to come to the current position due to the perfect directions and leadership shown by the top management. This practice is already added in to the corporate cuture and values. (en/StaticPage/Our+Heritage/?msg=, 2010) The fashion retail industry is extremely competitive due to the highly saturated marketplace. It is therefore vital for retailers to develop a competitive strategy so they can position themselves in the market to attain a sustainable competitive advantage and increase revenue. Attaining competitive advantage is dependent on the careful construction of a clear vision and mission with perfect leadership that reflects and utilizes the competitive strategy and indicates the intended positioning while incorporating the values, culture and competencies of the company. By making the strategic direction of the company explicit with a set mission and values, all internal operations will have a clear foresight allowing them to position the company in a synergistic manner, achieving stated goals and objectives. Aligning an organizations leadership to achieve the mission and position is therefore fundamental in remaining strategically fit, and this report will assess the extent to which Selfridges stated mission, values and objectives reflect their intended positioning in the fashion retail market. 1.2 The Vision, Mission and Values of Selfridges As the initial step of the leadership, should have given perfect direction to the organization. Therefore it is necessary to have clearly defined vision, mission and values to achieve and adopt. Vision Statement To be the most innovative and fashion forward department store in Europe, offering the most exclusive brands to customers of all ages in an environment that is entertaining and inspiring. Mission Statement To operate stores filled with brands and events that inspire customers and staff, to deliver profitability. Values Selfridges have four stated values, which they uphold as a priority to maintain; Customers: Our challenge to fulfill the high expectations that customers have of Selfridges makes our stores unique, entertaining and fashionable. We house the best designer wear products in the world and offer our customers exclusive access to highly seek after collections. Employees: We recognize the importance of our employees, and how significant they are to the success of Selfridges. We strive to motivate, encourage and inspire our employees as they work to deliver objectives and push the boundaries of what Selfridges is capable of. Responsibility: We are one of the UKs top ten ethically responsible companys and we endeavor to continue looking after the environment and society. Innovation: We are an iconic brand because of our constant crusade to break boundaries, start trends and provide innovative in-store and online experiences for our customers. 1.3 How the Leadership Operates in the Selfridge Vision The vision statement is explanatory in what Selfridges want to achieve in the future, and this future vision will be useful to employees, as they will be aware of how the company plan to develop, and the direction they are pursuing. The language is clear and concise, and instills a sense of motivation for employees. The vision is available through a few internal distribution channels; intranet, notice boards, contracts, monthly departmental meetings and team meetings. That the vision is so easily accessible will make its clear aims resonate throughout the company, and will ensure that all operations are working with that ultimate goal in mind. Mission The mission statement is not extensive enough in its scope regarding their competitors, their geographical scope and their specified target customer groups for it to satisfy employees want for knowledge of the company. Despite this, it is very accessible. Like the vision, the mission is available via the intranet, notice boards, contracts, monthly departmental and weekly team meetings. The easy accessibility to the statement is certainly strength, however, the lack of clarity in what the companys mission is regarding such vital aspects like competitors and customers, makes its existence like a brief summary of the vision. Values Most employees at Selfridges, being among the best in the industry, will have most likely worked for a large company before settling at Selfridges. They will therefore know that a company, who addresses employees in their values, is a good company to work for as they consider their staff at the heart of their operations. This is what Selfridges are communicating in their values and their use of language such as importance if our employees and significance to the success of Selfridges are key words that will resonate well. The values are available via the intranet, contracts and staff guidebooks, yet they are not posted on notice boards in the same way the vision and mission are. Leadership Managing the Change 2.1 Leadership Style There are number of leadership styles identified based on the reactions, objectives and practical applications with their leadership qualities. 1. Autocratic leadership These types of leaders have higher powers compared to their subordinates and dominating the team. Other team members not propose their opinion and will not accept other suggestions. Due to this type of leadership employee turnover will increase and there is lots of absenteeism. This leadership is suitable for unskilled workforce to fore and get the task done. Anyhow this is not an acceptable method in the management. 2. Bureaucratic leadership Bureaucratic leaders mostly consider the systems and procedures and use the recorded style. They will direct to be conducting the whole process as per the stick process. It is very important in the high risk areas in the factories and serious safety areas. 3. Charismatic leadership This leader is very enthusiastic and energetic to bring their team to the established target. This person should have self confident about the leadership as well as the group achievements. They believe their team members and perfectly give directions to the target. There is a personal rapport between the leader and subordinates. If the leader left the company will affect to the organization. This type of leadership shows bigger responsibility compared to others and the leader has to spend more time and give the maximum commitment to the team. 4. Democratic or participative leadership Get the decision contribution from the other members and leader will take the final accurate decision. This style will increase the soft skills and talents of the team members and creating enthusiasm. Team members feel as they are important people to the organization as giving personal views and decision making involvement. To take a decision will take long time, but the decision accuracy is perfect. As the result will be a common idea it will be a quality decision. 5. Laissez-faire leadership Give the individual responsibilities and take decision to team members and leader will monitor the progress. Leader should maintain effective communication with each member as he is responsible to each decision made by team members. These types of leadership required, when the team members are well qualified and experienced of their job responsibilities. The manager / leader should apply sufficient controls and closely monitor the decisions and routine work of the each team member. 6. People-oriented leadership or relations-oriented leadership The leader will not drive task oriented controls. They consider the people oriented achievements without forcing to the task. Some task oriented leaders are give directions to achieve the responsibilities without concern the major activities. People oriented leaders try to maintain their goodwill and not pressurized on team members. 7. Servant leadership If the leader ready work on requirements of the team named as a servant leader. The entire team will participate in the decision making. Team members prefer to the leader as the person represent the whole team requirements. But the leader should maintain the gap between normal team member and the leader. 8. Task-Oriented leadership Leader required achieving the task only. Mainly force all member to go for given targets and closely follow-up and monitor the progress. Task oriented leaders not care about the well-being of the team members and consider only the achievements. This leadership is similar to the autocratic leadership and members will be not satisfied. Leader is trying to show his / her achievements to the top management and not bothering to think about the fellows. 9. Transactional leadership All the members should obey to the leader and do their jobs properly. They cannot comment on the given responsibilities and leader is having authority to punish who fails to achieve the targets. Also the leader can give incentives and rewards to the successful members of the team. Mainly should be awarded the members who could achieve the management expectation and not the actual achievement. This is purely a management style and cannot accept as the leadership method. 10. Transformational leadership Leaders are encouraging team members to go to the target and achieve the organizational expectation. Always the leader giving advices to each team member and solve minor issues will arise. Always the leader will look after the initiatives and add values. (pages/article/newLDR_84.htm, 2010) 2.2 Feedback from Employees (3600) This is a well accepted human resource management measurements to measure the actual attitude, talents, strengths and weaknesses of the any stage of the employee. Let the employee to set in to a circle / disclose all information and get feedback from manager, supervisors, peers, subordinates and top management. Also get the feedback from external parties such as customers, suppliers, and other stake holders who are the people deal with this person. Self assessment gives to do a self evaluation and find key aspects personally. Managers will give their feedback in traditional report format and other stake holders will just explain their comments in an email or telephone call to the relevant evaluator. 360 feedback methods shows the adequate areas of the person and easily advise and give proper training to develop his / her attitudes, talents and skills. If the result is very satisfied management can give promotions, financial as well as non financial rewards for the excellent performance and it will be a motivational factor to job satisfaction. This approach is mainly focusing to get personal development and add value to the organization. As this is a open policy can clearly identify adequate areas of the each person without considering the rank or the level of the employee. It is necessary to conduct this methodology once per annum to get the maximum result. Also should not de-motivate single employee and show the importance of this application. 2.3 Tuckmans model Under the Tuckmans method there are main four areas realized and Forming, Storming, Norming and Performing in the team development stage. This is the well reputed team building methodology. Forming Stage This is the initial stage of the task and team members are not clear about the objectives and time limitations. Therefore the leader should clearly explain the team objectives, the way of planned approach, available resources and limitation. Team members will have several problems about the target and will raise lot of questions and tolerance. The leader should perfectly and specifically explain the team goals and the requirement to each employee. Storming Stage Even the objectives received team not aware that how to achieve them. There is some confusion in this stage as uncertainties. Team members are having issues about the individual responsibilities and how to arrange the process orderly. There are lots of negotiations, discussions and ideas will come in this stage. Supervisors and team leaders are required to negotiate this situation and minimize confusion. Most of the time tem leaders and managers should avoid this sage as time consuming and create personal issues with team members. Under a clear direction will be possible to neglect the confusion and achieve the target. Norming Stage In this stage team members should be clear about the target and the task. Team functions should be created by giving single responsibilities to the each person. As specifically nominate team members to the responsibilities can clearly identify the role they have to play in the team. After that team managers should link the all tasks together and make specified individual responsibilities to each member. All team members should give their maximum support to achieve the final objective. Performing Stage The all team members will be clear about themselves and others job responsibilities and tasks. Under the clear supervision the team will goes to the target maintaining a shared supervision. If is there any problem the team members will solve the issue inside the team as they are having mutual understanding and clear about the target. At this stage team members no need help / assistance in instructions and guidelines. The leader has to set team objectives and the way of the achievement. Team members need help only in their personal and interpersonal developments. (tuckmanformingstormingnormingperforming.htm, 2010) Work Delegation Managers can get more effective team performance by work delegation. But this task should be conducted in proper way. As he lack of knowledge number of managers are reluctant to give work delegation to team members. The disorganized and inflexible management may be the major cause of not delegating work effectively. The insecurity in the work place and confusion about who is ultimately responsible are the other barriers for effective delegation of work. Managers cannot avoid their responsibility by delegating their difficult tasks to subordinates. They are always accountable for the allocated responsibilities for their designation. Accordingly, managers are responsible for the actions of their subordinates. This may results some managers reluctant to delegate their works. There are different types of subordinates that can be experience by the managers. While some work hard to complete their task effectively, there are some people who would like to avoid their responsibilities and let their managers to make all decisions. Through effective delegation, these barriers can be overcome. Guidelines for effective Delegation: In order to practice effective delegation it is important to keep working relationships alive. Rather than completing a task solely, delegation has a better chance of succeeding. The following are some situations where ethics comes to bear in day-to-day organizational activities. Prerequisites: The basic prerequisite for effective delegation is the willingness of the managers to give freedom to their subordinates to accomplish delegated tasks. This means let them to choose methods and solutions to complete their tasks. This allows employees to make mistakes and learn from their mistakes. Mistaken should not discourage the delegation. Mistakes should be identified as the requirement for training support. The second prerequisite for delegation is open communication between managers and employees. In order to delegate tasks effectively, managers should know the capabilities of each employee. Some employees are prefer to accept many responsibilities if their managers are willing to appreciate and reward them. The third and last prerequisite for delegation is in the managers ability in some specific areas such as corporate objectives, the way to achieve the target, employee capabilities and etc. Tasks of effective Delegation: Clearly define the exact delegation areas specifically based on the requirement, delegating person and the time requirement. Should careful the secrecy and the importance on the particular task before the delegation. Delegate the correct person will be easier and perfect. Have to consider that the task required any special competencies or developmental experience. Also better to check the previous records of the person to identify the special competencies available. Provide required resources and special instructions accordingly. Organisation should have contingency arrangements and financial budget to give resources and trainings immediately. Managers should provide all required date efficiently and effectively. Also necessary to maintain good communication with the delegated person and make further arrangements to get cleared sufficient details. Feedback system reacquired to monitor the progress of the accuracy of the delegation. (4760-barriers-to-delegation/, 2010)