The Effect of interest rate Liberalization on the risk of commercial Dissertation

The Effect of interest rate Liberalization on the risk of commercial banks in China - Dissertation Example The paper has discussed illustrates a mixed picture after interest rate liberalization and its associated risk on the commercial banks in China. Historically China is a strong believer in the planned economy where strict government intervention under a single party rule always has the last word regarding the policies to be prioritized and implemented. Though after the iron rule of Mao-era China has learned under Deng Xiaoping that FDI and capitalist exploitation is not the same thing but the people as well as the government are still skeptical about their nature of the operation. Over the past couple of decades, China has realized huge GDP growth through export-oriented international trade. This on one hand, strengthened the export based industries on the other weekend the indigenous industries especially those indulged in import substitution. Again amidst this prosperity, China has slipped down considering the GINI coefficient and that illustrates a rising inequality i.e. an increas ing gap between the rich and poor people. Eminent academicians hold the view that with China’s present model rich are becoming richer and poor are becoming poorer. The development is mainly urban centric and rural China is subject to stagnation and a much higher unemployment than the urban areas.... es cemented their feet under the strict rule of Mao Ze Dong who opted for self sufficiency and betterment of the common rather than external dependency and flourish of the few (Chi, 1992, pp.75-84; Buchanan, 2012, p.24). Mao believed in a closed door policy that meant isolation from the rest of the world regarding economic transaction. Though diplomatic relation with Soviet Russia along with many east European nations was encouraged but that never translated into economic exchange. During Mao’s rule the growth rate of China was stable but slow and often subject to stagnation. Though, such view has many opposing facts and evidences illustrated through literature. However after Mao’s death Deng Xiaoping became the most prominent figure in Chinese politics and soon realized the need to embrace the globalization in order to boost the Chinese economic growth. The current topic of discussion that refers to interest rate liberalization and risk to commercial banks is an import ant aspect to discuss. However, financial liberalization along with interest rate liberalization often considered by the economists as the last stage of liberalization process that have went through and met several other steps directed towards the liberalization of the economy (Chow, 2005). Welcoming FDI into an economy might be considered as the first step towards liberalization. In initial days China lacked both the legal frame work as well as their policy towards globalization was skeptic and the legal frame work governing the same was week. But the scenario started changing from mid 80’s and historically Hong Kong remained the prime source of foreign direct investment provider to China. Such investments were mainly towards labor intensive sectors and high end technological and capital intensive

Importance of Historical Perspectives Essay Example for Free

Importance of Historical Perspectives Essay The organised use of labour or Management as we now call it, is as old as time. However it was only in the 19th century that management and the idea of management thought emerged as an important element of political, economic and social development. I believe that historical perspectives have been critically important to the development of management thought through the centuries. Management ideas have been developed out of social and cultural circumstances, over time the social and cultural circumstances have radically changed and developed but the principle of management and management thought has been slow in keeping up with these developments. From my reading, I would argue that there have been three main phases that have fundamentally shaped management thought since ancient times. These phases are; the early autocratic management approach, the change in management thought following the reformation and thirdly, the new work practices required to support the industrial revolution. From my research, it is evident that major historical events have also had an important role to play in the development of different management styles and structures. In ancient times, management of people was purely autocratic. Many of the work force in these times were slaves. This early practise of management seen in ancient Egypt, continued through to feudal times. It was very effective in supporting some of the great construction projects which ancient Egypt is famous for, such as the building of the pyramids, the irrigation of the Nile and the building of the tombs in the Valley of the Kings. Similarly in ancient China, the building of the Great Wall of China. These great works provide us with evidence of a very organised and autocratic approach to the use of labour and also project management skills . This early autocratic period of management was heavily dominated by cultural values such as; fear of punishment, fear of god, where people had no sense of individual achievement and they could only look forward to a better life after death. This form of management continued through the middle ages and in these non-industrialised circumstances there was no â€Å"no need to develop a formal body of management thought†(Wren Bedeian, 2011: 37) As long as society was dominated by fear and oppression this form of management was sustained. As long as Christianity and the divine right of kings maintained their hold on society, management thought could not evolve and develop. However, these feudal times where religion was invincible and demanded total subservience ere coming to an end. The crusades were a major catalyst for change in these times and by weakening the strength of the catholic church they were the beginning of a cultural rebirth which led to the protestant reformation. With the reformation came the protestant work ethic which I would argue has transcended the history of management and has fundamentally changed work practises opening the door to completely different and new management styles and structures. Prior to this commerce was viewed as an evil that corrupted peoples’ minds and the idea of trade could undermine the obedience demanded by the catholic church. Max Weber in â€Å"the protestant ethic and spirit of capitalism† urges strongly that the spirit of capitalism grew out of Protestantism and the protestant work ethic. (Wren Bedeian, 2011: 26) It is clear that the transformation in attitudes in society due to the reformation brought with it the need for new management structures which would support creativity and competitiveness. These changes did not happen quickly, but they were pivotal in the fundamental shift to the organisation of labour being managed by many people and many different types of people rather than the autocratic few. These new managers began to think about personal gain and had to consider the best ways to achieve these gains. The shift to personal gain was accompanied by the strengthening of national economies in Europe and further afield as new countries and colonies were being discovered and established. The scene was being set for the industrial revolution. Historical perspectives were changing and along with them, new principles in management thought were emerging. Adam Smith was one of the evangelists of management thought during the early stages of the industrial revolution. One of Smith’s new thoughts on management was that the market economy would be se self regulating, that is to say that the market would be ruled by the â€Å"invisible hand†(Wren Bedeian, 2011: 34). His other contribution were his thoughts on the division of labour culminating in the substantial productivity that the use of technology brought to replace human man power. Smith’s principles are fundamental to modern management thought. The industrial revolution brought with it the move from agrarian life to urban living. Production became large scale and the increasing number of factories coming into production demanded more managers who would have to be capable of successfully organising and managing all aspects of these new work places. There is no doubt that historical perspectives have been mportant in bringing about great changes for the better in management thought as evidenced by the evolution of the three phased covered herein. However I would conclude, that despite the advantages of having historical perspectives, society and the management of society does not really learn from these perspectives. I think this is well summarised in Will Durant’s quote in â⠂¬Å"the story of civilization part 1† where he states that â€Å" a nation is born stoic and dies epicurean†(Durant, 1935: 259). There is no clearer example of this than in Ireland today. We have spent centuries struggling against the autocratic management of Irish society both by the catholic church and by British rule. The adversity of these times was eventually replaced by the development of new management structures bringing with them creativity and competiveness. However, as with many developing societies and civilisations, with this development came affluence and opportunism which in turn undermined the integrity of these management structures. Like the Epicureans, poor thought was given to how this would impact tomorrow. So as in Greece and Rome, the lack of long term prudent management and the lack of learning from the historical perspectives on management thought have meant that we have not escaped the Epicurean death blow that has been rendered to Ireland.

Nuclear power for future energy supplies

Nuclear power for future energy supplies Should Nuclear Power Be Developed For Future Energy Supplies? Introduction I am writing this essay to debate the idea of having nuclear power developed for future use by us. This takes on a major issue and covers many aspects of our nations energy use both in present and for the future. When we think about nuclear power we do not automatically think of it as a non renewable energy source. This is because it is not part of the fossils fuels; coal, oil and gas, which we all know will not last us as reliable energy sources for much longer. However, nuclear power is a non renewable energy source and has many dedicated power stations located around the UK. Nuclear energy is considered an important fuel to produce energy as it currently provides 28% of this countrys needs, compared to the feeble 1% of renewable energy used. How Is Nuclear Energy Made? Nuclear energy is obtained by processes of nuclear fission and fusion. In nuclear fission the energy is released by splitting the atom sending a neutron blasting through the nucleus, this makes other neutrons fly off at high speeds setting up a chain reaction. Nuclear fusion is the opposite by which the nuclei of two or more atoms fuse together, in the process mass is lost and this is then converted into energy. Production of energy takes place inside a nuclear reactor which consists of a core surrounded by a thick concrete shield, steam pipes, turbines and a final (electricity) generator. After the mining of the ore (this is mainly uranium or plutonium ore) has been done the pure uranium is turned into uranium dioxide which is made into pellets. Several of these pellets are placed inside fuel rods. Usually there are about 90,000 fuel rods placed in the core of a reactor. Nuclear fission takes place inside the core by which the isotope splits using the atoms in the uranium dioxide from the pellets. The immense heat produced by this is carried away by fluid circulating through the reactor core. Once the fluid becomes heated it is used to produce steam, this steam drives the turbines which in turn rotate the main electricity generators to produce clean, reliable electricity. During this process there is a massive amount of radiation and so this is why the core is surrounded by a thick concrete shield to absorb this radiation. Arguments For Using And Developing Nuclear Power To satisfy our general needs of heating our water, heating our homes, cooking our food, powering our appliances and lighting our rooms, we need to retrieve energy from the many many methods available to us. One of these choices is nuclear energy. There are very good reasons why it should be considered and developed further, to be used in the future. Firstly, by comparing it to the other non renewable energy sources (coal, oil and natural gas), nuclear power is a very clean energy as it does not produce any of the greenhouse gases such as carbon dioxide, which lead to the greenhouse effect or global warming. This problem is significant for the disintegration of the ozone layer when fossil fuels are burnt to release energy. Plus using this form of energy can save the reserves we have left of some of the precious fossils fuels like oil, which is said to run out within the next 50 years. Because nuclear power already supplies 28% of the UKs energy, it is also much more reliable at present than many of the renewable options we have available such as wind, solar and wave. A very important point and something that must be considered is that there can be huge amount of energy produced from just a small amount of nuclear element. Just one kilogram of uranium can produce as much energy as 3,000,000 kilograms of coal. Many people also feel that the ‘dumping of waste is a major issue. It is a concerning factor, but when looking at the real statistics, the nuclear power industry produces 2,000 tonnes of nuclear waste every year in the United States, whereas the coal fired power plants are producing a staggering 100,000,000 tonnes of ash and sludge which is blown into the atmosphere being breathed in by us plus contributing to global warming. Finally, with the nuclear energy economy being one of the safest in the world, producing the cheapest energy, development in the future can provide thousands of jobs and other opportunities of stable employment for many people. Arguments Against Using And Developing Nuclear Power As well as the very well argued points agreeing with the future use of nuclear energy, there is opposition to this expansion. There are many people and often groups that raise concerns about the safety of nuclear power. Nuclear waste that is produced from the nuclear power stations emits a very high amount of dangerous radiation that can stay radioactive for up to 25,000 years so it must be disposed of very carefully. Any accident is extremely dangerous and can kill any life in the surrounding area immediately. A case study that shows the extreme risk of development of nuclear power and what can happen if an accident occurs is the 1986 incident in Chernobyl, Russia. Here a nuclear reactor exploded killing 31 people, and around 140,000 people were evacuated as quickly as possible. This area around the explosion was contaminated by radiation and this will remain for a long period of time. The clouds of radioactive material that were also released by the explosion spread, reaching even as far as Sweden. The wind that blew from Chernobyl also came across to Britain and caused acid and other toxic rain that ruined farmland, making the soil radioactive. Farmers are still having problems in parts of Wales because of the radiation that has spread as a result of an accident at a nuclear power plant. Rather than looking at nuclear energys dangers, it also has a few faults. One of these are that a big part of the energy that is created must be blown away because it cannot be used. Nuclear power is also unable to adjust to a lower power production for night. These are faults which not only can cause problems but also inconvenience. Back to the issue of the nuclear waste, focusing away from its safety concerns, and more about where it can be disposed of without causing major problems. As it does stay radioactive for a very long time it must be discarded carefully. The pollution of this waste can cause serious effects on both people and the environment. An example of pollution has been in the Irish sea which was dreadfully polluted by the nuclear waste from the power plant at Sellafield in Cumbria. This fuel should ideally be stored in a safe environment either underground or in special concrete surrounded stainless steel liquid tanks. Another concern that is brought up with nuclear power is the potential for nuclear weapons to be developed. In these weapons would be uncontrolled nuclear fission where even if just a small amount of unstable uranium or plutonium is used, a bomb would explode. If more countries turned to the development of nuclear energy we could be at risk of production of these weapons by countries such those in the Middle East and terrorist groups, some believe it may even lead to a possible nuclear war in the future. Conclusion Looking at all of the arguments for and against the issue of whether nuclear power should be developed for future energy supplies, they are all valid reason that should be taken into account. As for my personal response, I feel that nuclear energy should not be developed as the building of more power plants could cause harmful effects, especially if accidents occur. I feel that the chance of accidents taking place are far more likely if this source of energy is developed. This can lead to the deaths of many lives due to the sheer amount of radiation. Plus looking at the locations of nuclear power plants in the UK, they are mainly in remote areas, for obvious reasons, and also near the sea. More of these can lead to their expansion in more populated areas putting many lives in danger. I also feel that instead of turning to another non renewable energy from fossil fuels, it is far better to invest and research into the development of renewable sources which will give us clean, cheap energy in the future. By looking at changing the technology for these alternatives now, we can help plan for the future. However, if the nuclear industry was developed then when reserves of uranium and plutonium ran out we would once again be searching for other ways. So overall I feel that nuclear energy, although cheap and reliable, is not the best option to be developed for future use, not just in this country but around the world.

The Lady of Shallot :: Lady of Shalott Essays

The Lady of Shallot Alfred, Lord Tennyson, was known for his pictorial poetry, characterizes as "painterly," "picturesque" with visual detail and images that represent mood, situation and carry emotion" (ENG 103 Lecture on Victorian Age and Literature). The imagery of emotion is especially evident in the poet's depiction of nature, in the form of melancholy. In examining "The Lady of Shallot," the sense of eminent gloom of destiny is illustrated. Through the personification of nature, a vivid glimpse into a lady doomed by her fate. A picture is illuminated in the description 0f where the lady dwells. The reader gets a feel for the separation of the lady and her threatening destiny, in the imagery of her natural surroundings. This can be seen with "Willows whiten, aspens whiten, aspens quiver, /little breezes dusk and shiver" (The Longman Anthology Of British Literature, p.1913, LL. 10-11). The fear brought on by "quiver" and "Shiver", suggests the nature elements know what lies ahead, which is Camelot. The fearful destiny of the lady can be visualized with the description of her isolation on an island, in which the river is "flowing down to Camelot." The melancholy brought about by the personification of nature is echoed in the constant imagery of death. The picture of the bringer of death preparing for funeral projects the melancholy associated with death. Nobody can see the lady, yet a few can her song. The few include a foreshadowing of a funeral attendant, a "Willow-veil and nature's influence with "by the moon the reaper weary" (19,33). Emotions develop through imagery of the changing weather. As the lady sees Lancelot, the sky is "All in the blue unclouded weather" (91). This may depict a happy attraction of the lady sees him likened by nature with "His broad clear brow in sunlight glow" (100). However the weather shifts with emotion after the lady discoveries her curse is a melancholic death, when she decides to leave Shallot in pursuit of Lancelot. The imagery, mournful of her destined death with heaven waiting in "The pale yellow woods were waning, /The broad streaming his banks complaining, /Heavily the low sky raining.

Evolution and History of Cooking Essay

The value of history is that it helps us to understand the present and the future. In food service, knowledge of our professional heritage helps us to see why we do things as we do, how our cooking techniques have developed and refined and how we can continue to develop and innovate in the years ahead. THE EGYPTIANS: †¢ First recorded instance of inn-keeping †¢ Generally managed by mother and father operations †¢ Most food was from their own gardens and flocks †¢ Meals consisted of mainly dates, figs, apricots, fish, chicken, duck, onions and red cabbage. †¢ Cooking media was largely olive oil. †¢ Poorer inns served predominantly ‘pulses’ that is soups made from a base of lentils. THE GREEKS: †¢ Ancient Greeks were the next who left written and pictorial records of eating, drinking and sleeping away from home †¢ Culinary world owes much of its knowledge to the Greeks †¢ Almost all of the foods purchased and prepared today, as well as many types of beverages, both alcoholic and non-alcoholic were used during middle and Late Greek times. †¢ The oldest cookbook preserved today is that of â€Å"Apicius† written sometime between400 BC and 100 AD depending upon the historical source. †¢ This book contains not only detailed instructions for preparing the cuisine of that day, but also rigid specifications for purchasing foodstuffs †¢ The art and cookery then spread to the Roman chefs of that day who were both negatively as well as positively motivated to learn the art of cooking food. †¢ The Greeks are also credited for developing the first comprehensive set of kitchen utensils and equipment †¢ Tools like frying pans, sauce pans, colanders, Bain Marie and butcher’s knives are being used even today. THE ROMANS: †¢ During this time, a group of scholars were sent to Greece to study literature and arts, including culinary arts †¢ Many of the finest Greek chefs were lured away and were treated as professionals worthy of the highest respect and esteem. †¢ The best of Greek culinary achievements were brought to Rome and were integrated into the Roman culture. THE FRENCH: †¢ The marriage of Catherine de Medici to King Henry has brought a whole battalion of Florentine cooks to France. †¢ In the 17th and 18th Century, the Royalty and high ranking people started taking great interest in foods and the cooks in gratitude started naming the dishes after them. †¢ By the end of the 19th century, French culinary art reached its peak, the highest point of perfection. †¢ Chefs like Escoffier and Prosper Salles etc published books on cookery, which had fat reaching importance and are known throughout the world today. †¢ France’s contribution to the international culinary repertoire is well known and has bestowed her own names on the majority of dishes creating technical terminology of international usage. †¢ Every ingredient speaks its own language. The most important role is to use only the best and perfect ingredients and proper blend of colour and taste of ingredients. †¢ Garnishes and accompaniments play a key role in French cuisine and dishes are identified by them. CHINESE COOKING: †¢ Chinese culture is the oldest continuous civilization in the world. †¢ In china, friendship and food are inseparably linked, a gathering without food is considered incomplete and improper. †¢ One thousand years ago, before BC, they were already experimenting with fancy cooking, recording their recipes on silk and bamboo. †¢ Considered the best in the Eastern world, they have been gastronomically courageous, setting no limits to their experiments. †¢ They put everything edible to use, finding wonderful ways to utilize strange plants and roots like lily buds, bamboo shoots, jasmine etc. †¢ Strong sense of artistry is expressed in Chinese cooking. †¢ Chinese cooking needs the shortest time, uses intense heat sealing the juices and preserving colour and texture. †¢ Regional cuisines of China include: Cantonese, Sichuan, Hunan, Fukien and Xhanhung. INDIAN COOKING: †¢ Indian cuisine can be said to have evolved along lines parallel to Indian history †¢ Bhima, the Pandava prince and Nala, a King in Hindu Mythology have been acclaimed to be the best chefs. †¢ Strong impact made on Indian cuisine was during the reign of Moghals in the 16th Century, who were fond of good living, eating and cooking. †¢ The regional dishes are influenced in different parts of India by religion, caste and old traditions and customs. †¢ The preparations of various dishes are handed over from one generation to the next †¢ Indian cuisine can be broadly classified into North Indian and South Indian Cuisines.

Mrs. Thomas: Holistic End of Life Care

Governors university Scenario A brief synopsis of the scenario explored in this paper will be forthcoming so the following observations and detail will have context. The key points in the scenario explored for Mrs.. Thomas, her husband and family are as follows. Mrs.. Thomas is a candidate for palliative care; In specifically hospice If she Is given a prognosis of six months or less. She has suffered breast cancer twice In the past year.A year ago she had a right mastectomy with removal of five auxiliary lymph nodes, with chemotherapy and radiation. Six months ago she had a second mastectomy on her left breast, followed by chemotherapy and radiation. After said treatment it was discovered that the cancer had metastasis's to her lungs and further surgery is not a feasible option. She has not been taking her pain medication as she does not want to procure an addiction problem. Her pain has Increased and she spends most of the time In bed crying.She had to leave her job, but has a small stipend via disability. She and her husband, a police officer, are struggling to make ends meet financially Her husband suffers from chronic depression that is being managed by medication, but he is resorting to take his medication often. He is a supportive and able caregiver however, he Is showing signs of caregiver strain and Job stress. In response Mrs.. Thomas Is worried that he Is becoming classical because of the circumstances of her condition and this In turn Is causing her further suffering. Core family support Is minimal.Mrs.. Thomas' close female relatives are dead from the very disease that is killing her. Because she is sick, she and her husband no longer socialize; she does not seek help from her female friends. Her sons live far away, and call often but they do not come to see her. Mrs.. Thomas is saddened that her sons are not here, but Quality of Life and Health Promotion This nurse believes that quality of life is defined individually for each patient. Each individ ual is unique and how they perceive life and what their life circumstances are define what is needed for end of life care.Quality of life during a time when aggressive treatment is no longer possible needs to be focused on comfort and support of the patient, caregivers and family. This nurse believes comfort (quality of life) includes the right to be free from pain, unless the patient chooses to experience main in trade for mental clarity. It includes the right to not participate in aggressive treatment or in clinical trials if the patient has no wish to do so. Quality of life to this nurse is helping the patient to do the best with the situation in life in which the patient finds themselves.It includes helping the patient with what he or she perceives as unfinished business and helping the patient conclude this business to the extent possible. Holistic end of life care includes care of all aspects of the patient (physical, social and spiritual) and care for those who love the one d ying?the family. The family is whatever blood or non-blood ties this entails; whatever â€Å"shape† of family the patient has at this time. This nurse believes that holistic end of life care encompasses not only physical comfort for the patient but promotion of healthy interactions for the patient with those who love and comfort them.These sensitivities are the goals of this nurse and if applied diligently may provide the best outcomes for the patient in this time of life. Strategies Four holistic nursing goals to begin to improve quality of life for Mrs.. Thomas, her husband and family are the nursing diagnoses: Pain Management, Addressing Anticipatory Grieving and Situational Low Self-Esteem, as well as, Altered Family Processes. First one must establish a rapport with the patient. By providing an open nonjudgmental conversation the nurse can encourage an open and realistic dialogue about what Mrs..Thomas is feeling. By reviewing past life experiences one can get to know th e patient and what interests her and establish trust. This trust is of most importance as all nursing care success depends on creating a team effort with the patient. Family involvement in this time needs to be proactive to help Mrs.. Thomas' mental state and via this her physical functional ability. Nurseries) A beginning conversation with Mrs.. Thomas needs to be about the importance of pain relief. By bringing the patient to an understanding of how this relief of pain will benefit those around her, Mrs..Thomas may be more likely to try the medication for said relief. This may be the initial hook with which one can get her to take said medication. The nurse must determine a comprehensive pain history, including frequency, duration and intensity using a scale dependent upon the patient's perception of pain throughout her life span. Zero pain for no pain; ten for the worst pain ever. This call gives the nurse a baseline from which to assess pain management. Her pain has been increas ing for the last six months and this nurse would designate that as chronic pain, perhaps with acute episodes.Also, the nurse must ask about and continue to monitor when said pain is occurring, as well as where and how much. Morning or when? Identifying precipitating factors of pain will help in its long term management. (Nurseries) Pain is what the patient says it is; we as nurses need to accept that premise. Within the realm of pain lie both physical and emotional response. Because Mrs.. Thomas is no longer seeking aggressive cancer treatment, he â€Å"variations of aggressive treatment† pain control will not be discussed.However, as her disease progresses it is most likely that her pain will increase. Which brings up another point?reluctance of the patient to report pain because of fear that the disease is worse or that the pain is deserved somehow. The nurse must also be aware of unmanageable side effects (like hallucination) which if experienced must be dealt with in a ma tter of fact fashion and by trying another medication regime. To address pain management with Mrs.. Thomas one must address her fear of addiction. By talking with Mrs..Thomas openly and honestly about the need for pain relief, it is hoped that she is lead to the conclusion that pain management and pain medication abuse are two different things. At the end of life, pain medication addiction is not an issue. This idea needs to be gently but openly professed. One could point to the relief of stress for her husband if she is not in pain; as well as the physical benefit (and hence mental benefit) of remaining pain free. If she remains pain free she will be more able to take care of herself and her activities of daily living.She will be able to live in this time instead of living in dread of each day. Once she is taking said pain medication it must be monitored, adjusted and changed as needed for optimal effect and to support the ability to participate in activities of daily living to the fullest as possible. Also discussing non-pharmacological comfort measures like massage and diversionary activities like music is in order. What does Mrs.. Thomas respond to; what does she like? What kinds of non-pharmacological pain intervention has worked for her in the past?Ask questions so that she can verbalize these things to help herself. Being able to relax will help her focus her attention. Encouragement of stress management skills and complimentary therapies (relaxation techniques, biofeedback, LAUGHTER, music, aromatherapy, acupressure, acupuncture and touch are a few) helps the patient to actively participate and enhances a sense of control. Heat and cold may also help by decreasing muscle spasms and inflammation. Pain makes stress, stress makes stiff muscles and increases self-focus which, unfortunately, increases pain.As the nurse interacts with the patient it is important that the patient comes up with ideas about care and becomes a proactive member of their healthcar e team. (Nurseries) Mrs.. Thomas is also suffering, â€Å"Anticipatory Grieving. This is related to loss of her physiological health and change in lifestyle. It is interconnected to the knowledge that she is going to die, for real, and most likely soon. This nursing diagnosis is needed because of her change in social activity level, her reluctance to tell her sons that she needs them?now.It is evidenced by her denial that she does need them and help and support in general from her friends. (Nurseries) Outcomes that are desired include the patient being able to feel her feelings and express them. By doing this she will hopefully come to the place where she is able to take one day t a time and continue her normal activities; even planning for the future. Being able to admit that she is dying, understanding and verbalizing the process is a beginning is done, she must feel supported in her grief work. One must beware of debilitating depression, the like of which is indicated by the sce nario.To address this the nurse must be frank and direct in asking questions about the patient's mind state. (Nurseries) Frequent visiting by the nursing team and care providers, family and social support of friends can help relieve feelings of isolation and abandonment. Her ones need to be contacted with a â€Å"for your information† talk about coming to see their mom (and dad) and possibly who could be of help with caregivers as it is needed. Mr.. Thomas is also a source to find out about who may be able to help with this care this, as well.The nursing diagnosis, â€Å"Situational Low Self-Esteem† is related to how Mrs.. Thomas feels about her disfiguring surgeries and subsequent treatment side effects (aliped, muscle wasting, and more) as well as feelings of self-doubt and lack of control in her life. It is about the doubt about being accepted by others–of still eyeing a human in the world. It is also about her anxiety and fear of her disease process. This is evidenced by her not taking responsibility for self-care (not taking pain medication; crying in bed all day. ) Acceptance of her situation is an outcome that is looked for.She needs to be able to develop mechanisms to cope with her problems and set realistic goals. What coping skills has she used in the past? She needs to be able to participate in her own life by learning to adapt. The nurse can help her through this process by asking proactive questions about how she feels and perceives her world. By getting her to voice where she's at, she will also perhaps start to voice how she can manage. (Nurseries) This diagnosis ties in with the aforementioned, â€Å"Anticipatory Grieving† diagnosis. By defining diagnosis and disease process beginning problem solving can occur.By anticipating what can happen, some measure of control can be taken. By working with Mrs.. Thomas and planning how daily activities can be managed, adaptation can occur. (Nurseries) Discussion about her roles in life, as a worker, spouse, and mother and problem solving about how to accomplish her goals for these roles may help reduce problems that interfere tit her self-esteem. It may help her to see how she can cluster activities at home to conserve energy but be productive. It may help her to be more able to reach out to those who love her for inclusion and support.The nurse must acknowledge troubles she is experiencing and validate the patient's reality; this opens the door to the patient being able to seek measures that are necessary to cope, like counseling, and support groups. The nurse should readily be able to supply information about said resources so as to facilitate the patient in procuring more support. If Mrs.. Thomas is n hospice the social worker of the interdisciplinary team can help facilitate and direct this work; but the nurse must always continue it during her visits. Holistic Nursing Plan Amongst personal revelation the nurse must explore who may be able to help Mrs ..Thomas with her activities of daily living. Her husband is doing the Job, but he is suffering from care giver strain and could use some help. It may be that the people she has cut herself off from socially miss her and would love the chance to be able to help in some way. Caregivers avenues and their affordability need to be explored before they are needed. These interactions; providing pain control, helping with grief and esteem issues, and helping the patient to discover what will work best to live disease state progresses, but before it is needed, preparation for a lesser level of self-care must be addressed.Medicare provides a â€Å"compassionate allowance† for hospice care for those of any age with a metastasis cancer with a prognosis of six months or less. She needs to apply for this care in the beginning of the nursing visits if she qualifies. To receive hospice care via Medicare she must be eligible for Medicare Part â€Å"A†, be certified as terminally ill a nd then apply for hospice care. This care would be in her home. By signing an election of benefits Mrs.. Thomas would be choosing hospice care in lieu of routine Medicare-covered benefits.Hospice would pay for pain medications and those required by her terminal diagnosis, as well as services included in the palliative plan of care. Often the hospice doctor confers with the patient's primary doctor and others on the hospice interdisciplinary team are included. (â€Å"Your Medicare benefits,† 2014) Hospice of Kits County provides an interdisciplinary team consisting of the doctor, the patient's primary provider and nurse practitioners, sitting nursing care, a medical social worker, a chaplain, a home health aide. Also provided are complementary services, which include massage and music therapies.Volunteers are also enlisted to help with such things as grocery shopping and the like or simply for company. These persons come to the patient's home for service. Hospice care differs with regional coverage. Durable medical equipment is also covered, so if Mrs.. Thomas is in need of a hospital bed, oxygen, bedside commode, wheel chair and so on, it will be provided at no cost to her family via Medicare coverage. Grief and loss counseling is also provided. â€Å"Hospice of kits,† ) Providers for home care must be explored as Mrs.. Thomas declines.Often the expense precludes coverage of duties in this way. Exploration of service providers and means of payment need to be explored as a way to cover Mrs.. Thomas' needs as she declines. Medicare covers the cost of a short term inpatient care in a Medicare approved hospice facility, or nursing home if the caregiver is suffering from caregiver strain (for up to five days) or if it is determined by the hospice physician that symptoms must be managed in an inpatient setting. Because Mrs.. Thomas has no Eng term care health insurance this care could be instrumental in providing for her final days. â€Å"Your Medicar e benefits,† 2014) The fourth nursing diagnosis, â€Å"Altered Family Processes† must be addressed for the holistic health of Mrs.. Thomas. This holistic care includes her husband as well as Mrs.. Thomas' sons and families. Situational crises can develop when a family member has a long term illness. There is a change in roles in caring for a parent and an anticipated loss of said parent. (Nurseries) Those involved need to learn to express feelings freely and demonstrate individual involvement. This individual involvement must include a problem solving process that promotes suitable solutions for the situation.Mrs.. Thomas' sons need to be contacted and requested to attend a family conference. If they are unable (because of finances or schedule) to attend then this could be accomplished via phone. They must understand the need of their mother to see them in person and will hopefully comply. The reality of the situation must be broached to them in a caring way. It may be that the Thomas' or Mrs.. Thomas can go and stay with them for more available for care and support of their mother. Speaking with family members in a caring, respectful manner and providing information both written and spoken helps promote feelings of empathy.It stimulates individual feelings of value and capability in ability to handle the present situation. In answering questions and providing information one can empower Mrs.. Thomas' loved ones. Identifying patterns of communication and interaction between family members is an important nursing intervention. It provides information about how active said communication is. It can also identify what problems may exist that interfere with the family in helping the patient and what problems there are in adjusting to the prognosis.Role expectations must be explored and how each individual sees the situation, in sharing these thoughts the family can promote understanding within its unit. Assessing the way members are expending their ene rgy with which to deal with the situation is needed so as to provide guidance in positive focus for the well-being of patient. Acknowledging the difficulty of the prognosis, as well as, encouraging appropriate expressions of anger helps resolution in the stages of grieving. The nurse must remain centered.Stressing the importance f continuing dialogue that is open and honest between the family members helps communication to remain open and thus facilitates problem resolution. Mr.. Thomas must be educated by the community health nurse as with regards to how anti- depressants need to maintain a certain blood level to be effective. If he is not taking them regularly this will not happen. To help achieve this goal, a pill box with days on it can be set up; perhaps an alarm set to the same time each day enlisted, so that he can remember to take his medication and thus be better able to function at this time.To provide holistic nursing care to Mrs.. Thomas her needs as a person must be add ressed. Physical, social and spiritual realms must be explored. Plans of action to provide for her physical care and the demise of her abilities must be explored; help must be sought out from the aforementioned sources. Method must be applied via nursing diagnosis and indications of said diagnosis. Desired outcomes must be planned, as well as nursing interventions to work toward these outcomes. Mrs.. Thomas must be approached with honesty and treated as a human being, with a life, in her time of need.