Economic Analysis Of The Jamaican Economy Economics Essay

Economic Analysis Of The Jamaican Economy Economics Essay Economic growth  is a term generally measured by the amount of production in a country or region over a certain period of time. It can also be described as the increase of per capita  gross domestic product  (GDP) or other measures of aggregate income, typically reported as the annual rate of change in real GDP. Economic growth is primarily driven by improvements in  productivity, which involves producing more goods and services with the same inputs of labour, capital, energy and materials. For the purpose of this project we will be concentrating on economic growth in the long run FY 2012-2014. Jamaicas economy faces major long-term problems: a significant merchandise trade (imports and exports) deficit, large-scale unemployment and underemployment, and a public debt-to-Gross Domestic Product (GDP) ratio of almost 130 per cent. Jamaicas onerous public debt burden the fourth highest per capita is the result of government bailouts to ailing sectors of its economy, most notably the financial sector in the mid-to-late 1990s, and hinders government spending on infrastructure and facilities and social programs as public debt servicing accounts for nearly half of government costs. Inflation rates rose noticeably in 2008 and have kept on increasing as a result of high prices or pricing for imported food stuffs and oil and gas. High unemployment continues to aggravate the major problem of crime and violence, which includes the gang violence that is fuelled by the drug trade (imports and exports). The Golding led government faces the difficult prospect of having to achieve financial discipline in order to sustain public debt repayments while simultaneously attacking a major and expanding crime problem that is hampering growth of the economy.   The Jamaican Economy has faced many economic challenges over the pass years especially during the recent recession period. The economy is still recovering from the direct hit which the country sustained in 2009 where exports and capital inflows weakened leading to negative growth. A steep depreciation of the nominal exchange rate has raised the cost of servicing variable rate debt, as well as the cost of rolling over existing loans. Amid volatility, macroeconomic policy remained tight despite the downturn. For the Bank of Jamaica (BOJ), defending the currency had to take precedence over inflation targeting and stimulating GDP growth. Such global crisis has also negatively affected the fiscal accounts, with lower revenue and a significantly higher interest bill. The government implemented a new Debt Management Initiative, the Jamaica Debt Exchange (JDX) on January 14, 2010 to control future economic downturns, which they had experienced in past years (2007 to 2009), which had resulted in a negative growth period for the country. The initiative would see holders of Government of Jamaica (GOJ) bonds returning the high interest earning instruments for bonds with lower yields and longer maturities. The offer was taken up by over 95% of local financial institutions and was deemed a success by the government. The economic situation of Jamaica has worsened considerably, with the ongoing world financial crisis which has had devastating effects on the economy. The mining sector has been the hardest hit, while tourism and remittances flows have been on the decline. Most foreign exchange comes from remittances, tourism, and bauxite. Remittances account for nearly 20% of GDP roughly equivalent to tourism revenues. Three of Jamaicas four bauxite firms suspended operations in 2009 due to falling demand amid the global economic downturn. The country will continue to lose valuable resources from its exports in 2012-2014 while these firms are out of operation. This decline in remittances, and a contraction of consumer demand led to a deep recession with stubbornly high unemployment and underemployment. With such hardship the government of Jamaica had no choice but to turn to the International Monetary Fund (IMF), a multilateral lending agency. The government of Jamaica, with help from multilateral bodies, is resolved to addressing the nations challenges more effectively, thereby creating a sustainable growth path for increased foreign investments in the new decade. On the 4th of February 2010 the International Monetary Fund (IMF) approved a US$1.27 billion Stand-By Facility loan agreement for a period of 3 years to underpin structural reforms and help Jamaica to withstand spill-overs of global financial storms that impacted main revenue streams. The IMF noted: The government has successfully completed a domestic debt exchange operation, which has contributed to a more equitable sharing of the burden of the overall fiscal adjustment. The exchange has also struck an appropriate balance in terms of delivering necessary cash flow savings while taking appropriate account of the need to ensure financial sector stability which should continue for the FY2012-2014. With such great assistance from the IMF, the government believes The upgrade sends a significant signal to international and local investors and will help in reinforcing confidence in the market for Jamaicas debt. This first step in the recovery of Jamaicas ratings reflects the governments aggressive policy actions as put forward in the economic programme, and the positive impact and success of the JDX. Economic outlook The launch of the Jamaica Debt Exchange Offer (JDX) in early 2010 has been seen as a positive step in the right direction, and the appreciation of the Jamaican dollar since it hit a low of J$89.73 in February 2010 has been slight but steady. The government has begun implementing much needed structural reforms, which should improve the fiscal balance by over 5% of GDP in FY 2010-2014 and onwards. Among them, a debt-swapping plan aimed at achieving interest savings of about 3% of GDP and two-thirds reduction in the amount of maturing debt over the next three years has been successfully implemented, with an acceptance level of almost 97% of bondholders. Governor of the Bank of Jamaica, Wynter B. (2010), stated that The exceptionally high participation rate in the exchange makes the Jamaica Debt Exchange one of the most successful debt exchanges in the world. The JDX replaces 350 high priced government domestic bonds with 24 new bonds, priced at a lower (12.5%) interest rate with longer maturities, providing annual savings of J$40bn. The Governor further stated that Additionally, the magnitude of maturing debt is expected to decline by 65 percent over the next three years, and the significant reduction in the governments refinancing needs will ease the crowding-out effect of the government debt and the upward pressure that this would have placed on domestic rates. Jamaicas four-year programme for the financial year 2010-2014 focuses on four key objectives: To strengthen government finances by reforming public enterprises and passing a new fiscal responsibility law. Reforms of the financial sector to reduce systemic risks and enhance the countrys capacity to better withstand external shocks. A pro-active debt management strategy to eliminate debt overhang and reduce debt servicing costs. Jamaica spends J$182bn (US$2.1bn) on annual interest payments, which in turn, crowd out capital expenditures. Make the tax structure more efficient, whilst improving tax collection and administration. That would increase resources for targeted social projects. Despite the launch of the Jamaica Debt Exchange Offer (JDX), this has been seen by analysiss as a positive step in the right direction, and with the marginal appreciation of the Jamaican dollar in February 2010. The tourism sector, which comprises a sizable chunk of Jamaicas economy, was badly hit by the global economic crisis, but a marginally more favourable crime rate as well as new marketing strategies being developed by the Jamaica Ministry of Tourism and their counterpart throughout the Caribbean region bodes well for the industrys slow recovery over next five years. The IMF however is saying that they dont foresee Jamaica changing its growth patterns in the near future, stated Charles Ross. The debt has itself become an obstacle for growth because the country has to allocate so much of government resources into servicing the debt that very little is left for public investment in infrastructure that would facilitate growth. The island of Jamaica however has proven itself resilient by surviving the steepest contraction in world trade since the 1930s, and its macroeconomic fundamentals are slowly but surely improving. The government of Jamaica, with help from multilateral bodies, is resolved to addressing the nations challenges more effectively, thereby creating a sustainable growth path for increased foreign investments in the new decade. The 2010/11 budget provides for increased social spending while reducing recurrent expenditures. Fitch, the European rating agency, upgraded Jamaicas long-term local and foreign currency Issuer Default ratings to B- (with stable outlook). Also, Standard Poors and Moodys have upgraded Jamaicas sovereign ratings, reflecting strong commitment to tackling fiscal imbalance and the successful outcome of the Debt Exchange (JDX) programme. The government believes The upgrade sends a significant signal to international and local investors and will help in reinforcing confidence in the market for Jamaicas debt. This first step in the recovery of Jamaicas ratings reflects the governments aggressive policy actions as put forward in the economic programme, and the positive impact and success of the JDX. Economic theory suggests that sustainable increases in real income must be based on increases in productivity. Productivity may be defined as the amount of output produced (in terms of goods or services) per unit input used. Commonly applied measures include labour productivity as output per worker or output per labour-hour, and total productivity as output relative to all inputs used. Both measures have been used in recent years to explore the dynamics of Jamaicas economic performance. Jamaica continues to rank favourably on a number of indices of competitiveness and business climate. The 2010 Index of Economic Freedom, published by the Heritage Foundation (US), ranks it the 57th freest market of 179 countries, surpassing established EU members such as Portugal, France, Poland, Greece and Italy. The country has a track record of implementing micro-reforms that help encourage private enterprise and foreign direct investment (FDI). Reforms of trade regime and tax administration for the upcoming period 2011- 2014 should improve Jamaicas global ranking in the future business indicators. This reform is aimed at reducing tariffs, import fees and some import/export bans and the latter is geared toward simplifying tax payment procedures. Jamaicas relatively flexible labour regulations could be further improved to increase job creation and productivity growth in coming years Dr Williams D. (2010) of the University of the West Indies. The government aims to boost the export sectors contribution to GDP from its current one-fifth to one-third by 2013 through expanding volumes and higher value addition in priority sectors as well as seeking new markets, thereby reducing over-reliance on North America, which in 2008 accounted for 50% of Jamaicas exports. The latest projections by international financial institutions (IFIs) show the economy stabilizing in FY 2010/11 and thereafter (2012-2014). Output is expected to grow at 2%, with inflation abating to 6%. Higher Foreign Direct Investment (FDI) in mining, tourism and other sectors will increase imports. However, continued FDI and gradually rising foreign exchange reserves (forex reserves) should offset the impact of current account deficit on the balance of payments. The IMF envisages the external deficit falling to 5% of GDP over the medium-term. The currencys depreciation in real effective terms has improved the competitiveness of exports both visible and invisible (i.e. services). The government aims to cut the budget deficit by half by 2014/15, whilst reducing the net public debt to GDP ratio. In short, Jamaica is putting its house in order. The countrys first long-term development plan Vision 2030 Jamaica (launched in 2008) inspires to attain developed country status by focusing on four core areas: a vibrant macro-economy; effective governance; world class education and training (especially science/technology); and greater security and safety. Jamaica has a realistic chance of achieving its national goals by 2030. However for the period 2012-2014 the three industries which are expected to perform well are the financial sector, the tourism industry and the Manufacturing industry. Industry Analysis Financial Sector The financial services industry in Jamaica consists of commercial banks, merchant and trust banks, credit unions, building societies and licensees under the Financial Institutions Act as well as non-deposit taking institutions including insurance companies, development banks and securities dealers. In 2008 there were 129 licensed financial institutions in Jamaica including 7 commercial banks, 46 credit unions, 17 insurance companies and 48 securities dealers, as well as 4 building societies, 3 FIA institutions and 4 development banks. Consistent with the current trend in developing countries, there are also a large number of foreign exchange Cambios, remittance and money transfer companies and bill payment companies that facilitate transactions between the domestic and international markets. There has been a reduction in the total number of institutions operating in the financial sector over the past decade, from 189 in 1996 to 129 in 2008. The lower numbers reflect closures, mergers and downsizing, with the effect of the most efficient institutions emerging. Commercial banks are the largest sub-group within the financial sector. In 2008, assets of commercial banks accounted for approximately 76.0 per cent of total assets of the financial system, with Building Societies at 19.0 per cent and FIAs at 5.0 per cent. The Financial Services Commission (FSC) was established in 2001 and there were several substantial amendments to the Bank of Jamaica Act, Banking Act, Money Laundering Act and Financial Institutions Act. The regulatory framework for the supervision of pension funds and credit unions also has been strengthened. The Jamaica Deposit Insurance Corporation (JDIC) was incorporated in August 1998 to provide insurance against the risk of loss of deposits held in insured financial institutions. The JDIC receives premiums from insured financial institutions at a rate of 0.15% of their total insurable deposits and the funds are invested to build the Deposit Insurance Fund. After such severe restructuring the financial sector regained some buoyancy which has seen its share of GDP climb to 10.8% to GDP in 2008 and the total assets of deposit-taking institutions in the financial sector increase from J$238.9 billion in 1999 to J$715.8 billion in 2008. However, much of this financial activity has been fuelled by the explosion of domestic debt, which also has seen the increased growth of the Jamaican money market as an intermediary between individual holders of capital and the government securities market (approximately half of the dealers funds under management are with retail clients). This has reduced the ability of the sector to provide the capital needed by the private sector for productive investments. As the sector restructures and the market becomes more competitive, financial institutions continue to refocus their attention to their core functions, as evidenced by increased loans to the productive sectors. Jamaica has considerably strengthened financial system oversight following a costly financial crisis in 1996-97. The financial system is deep and well-developed, the regulatory framework has in many respects been brought into line with best international practices, and supervision appears to be implemented in a systematic and professional manner. Remaining regulatory gaps and weaknesses in the financial infrastructure are well recognized by the authorities, who have implemented important reforms. Regulatory capital has also increased in most financial institutions to levels that permit a reasonable degree of resilience against macroeconomic shocks. However, data limitations prevented a full system-wide quantitative analysis of risks. During 2000-2008 the total stock of loans and advances increased by 587 percent and 308 percent, for commercial banks and FIA institutions, respectively. However, the volume of government debt held by these institutions decreased. The Bank of Jamaica and the Financial Services Commission continued to strengthen their respective regulatory framework in order to maintain stability within the industry and to conform to new developments in international standards. As at 31 March 2009, the seven commercial banks and two merchant banks (at the time) had total assets of J$582,515,204 billion with liabilities of J$516,216,670 billion resulting in total capital of J$35.649 billion. Manufacturing Sector The Manufacturing Sector represents a critical component of the economies of many developing countries including Jamaica. Jamaicas manufacturing sector is diverse and modern. Products encapsulated under this sectors activities are: beverages, processed foods, chemicals, plastics, cosmetics, pharmaceuticals, nutraceuticals and apparel. The island also produces spices and condiments, canned ackee and callaloo, as well as natural juices, soft drinks, beer, wines, spirits, and liqueurs. The manufacturing sector accounts for 12.8% of GDP per annum, employs approximately 7% of the labour force and is second in terms of sector contribution to real GDP. Jamaicas manufacturing sector grew during 2007 and contributed approximately 12.6% to total GDP, with total revenues exceeding US$700mn. Manufactured exports grew by 7.3% in 2007 to US$705.8 million, a reflection of higher export earnings from both non-traditional and traditional manufactured products; and  total investment in the manufacturing sector facilitated by Jamaica Trade and Invest amounted to J$3.6 billion during 2007. These investments spanned several sub-sectors including agro-processing, plastics, petrochemicals and cement. The petrochemical sub-sector was positively impacted by the development of an ethanol dehydration facility at Port Esquivel, St. Catherine. Further expansion also took place in the plastics sub-sector and in the cement sub-sector through modernization and upgrading of clinker and cement production facilities.  However, this overall picture of growth during 2007 was complemented by the Governments focus on increasing productivity in order to impact growth. Government implemented programmes that facilitated international competitiveness included worker skills training, technology upgrading, research and development, the Private Sector Development Programme (PSDP) and the Quality Jamaica Project, which includes training in Hazard Analysis Critical Control Point (HACCP). Manufactured exports represent approximately 12.6% of GDP in 2007, while the sector employs about 6.1% of the total labour force. Exports grew by 7.3% in 2007 to US$705.8 million, a reflection of higher export earnings from both non-traditional and traditional manufactured products. The global economic crisis in the last quarter of 2008, spurred by the financial collapse in the United States emerged, which had implications for the productive sector. Devaluation of the dollar, high interest rates, reduced domestic and export sales, credit crunch, high inflation, soaring oil prices, and skyrocketing input costs of raw material were some of the challenges experienced in the face of the world financial crisis. For the year 2008, the Jamaican economy contracted by an estimated 0.6%. Real Gross Domestic Product (GDP) for the Goods Producing Sectors contracted by 3.0%, while the Services Sectors grew by 0.3%. The performance of the economy was adversely affected by the sharp rise in commodity prices, the subsequent decrease in commodity prices due to the global financial crisis, decline in external demand for Jamaican goods and services, sharp decline in the availability of capital for fiscal budgetary support and private sector investment as well as the lingering effects of hurricane Dean and tropical storm Gustav. The sector contributed 8.5% to GDP and the total employed labour force grew by 3.5% to 80,100 persons. For the period, total manufactured exports also increased amounting to US$1,224.75 million, an increase of 37.5%. This was attributable mainly to increased export earnings from Non-traditional Exports of US$1,094.7 million. However, the sector declined by 1.2% due to a challenging environment and the global financial crisis which contracted the performance of the Food, Beverage and Tobacco and Other Manufacturing components of the industry by 2.4% and 0.2%, respectively. Tourism Industry Jamaicas economy relies heavily on tourism, which has become the countrys largest source of foreign exchange. Most tourists remain on the island for several days or weeks, although increasing numbers disembark only briefly from cruise ships at Ocho Rios, Montego Bay and the newly renovated and opened Falmouth Pier. These and other towns on the northern coast, as well as Kingston, are the tourist sectors main bases of activity. Jamaica is famous for its pleasant climate, fine beaches, and superb scenery, including the waters of Montego Bay and the majestic Blue Mountains. Industry Performance The tourism industry has shown strong and sustained growth since Independence. The total number of visitor arrivals to Jamaica has grown from some 271,692 in 1962 and 670,202 visitor arrivals in 1982 to a total of 2,860,544 visitor arrivals in 2008, an annual increase of 5.3% over the 46 year period. The island saw a record 3,016,898 visitors in 2006. The islands tourism accommodation stock increased from 10,327 rooms in 1982 to 29,794 rooms in 2008, while total receipts from tourists grew from US$337.8 million in 1982 to US$1,975.5 million in 2008. The development of the tourism sector over this period has seen an increase in the relative importance of cruise passenger arrivals which grew from 29% of total visitor arrivals in 1982 to 38 % of total arrivals in 2008. There also has been the emergence of globally competitive Jamaican-owned all inclusive hotel chains such as Sandals, SuperClubs and Couples, and the diversification of tourism markets including growth in arrivals from the United Kingdom, Europe and the Caribbean in addition to the traditional North American markets. As one of the best-known island destinations, Jamaica enjoys significant competitive advantages in Tourism and Travel Services. Based on its strong brand image, an appealing natural environment and human and cultural assets, the Jamaican Tourism industry has been identified as one of the key industrial clusters deemed capable of driving sustainable economic growth in the long term. Jamaica has had a long experience as a tourist destination, being a favoured retreat for travelers from Europe since the eighteenth century. The tourism industry, however, started in earnest in the late nineteenth to early twentieth century, with the first systematic efforts by Government to promote the industry, and by private investors to establish large hotels. The emergence of the industry coincided with the rapid economic growth of the United States, which has remained the main source of visitors up to the present. Jamaica has been one of the best-known resort vacation destinations in the world for decades. Originally known for its stunning physical beauty and as a playground for the rich and famous, the island has since seen its tourism industry experience significant growth and diversification. Jamaica currently boasts one of the most diverse visitor accommodation sectors in the Caribbean, including world-famous all-inclusive resorts, upscale hotels and villas, and a range of distinctive tourist accommodations and attractions. While the tourism sector is a major earner of foreign exchange there is a relatively high leakage of these benefits through imports of goods and services and payments of interest and investment income to overseas providers of capital. In order to retain more of the value added by the tourism sector linkages between the tourism and the other sectors of the economy, including agriculture, manufacturing and services need to be enhanced. In-depth analysis of the manufacturing industry Manufacturing Sector The Manufacturing Sector represents a critical component of the economies of many developing countries including Jamaica. Jamaicas manufacturing sector is diverse and modern. Products encapsulated under this sectors activities are: beverages, processed foods, chemicals, plastics, cosmetics, pharmaceuticals, nutraceuticals and apparel. The island also produces spices and condiments, canned ackee and callaloo, as well as natural juices, soft drinks, beer, wines, spirits, and liqueurs. The manufacturing sector accounts for 12.8% of GDP per annum, employs approximately 7% of the labour force and is second in terms of sector contribution to real GDP. Jamaicas manufacturing sector grew during 2007 and contributed approximately 12.6% to total GDP, with total revenues exceeding US$700mn. Manufactured exports grew by 7.3% in 2007 to US$705.8 million, a reflection of higher export earnings from both non-traditional and traditional manufactured products; and  total investment in the manufacturing sector facilitated by Jamaica Trade and Invest amounted to J$3.6 billion during 2007. These investments spanned several sub-sectors including agro-processing, plastics, petrochemicals and cement. The petrochemical sub-sector was positively impacted by the development of an ethanol dehydration facility at Port Esquivel, St. Catherine. Further expansion also took place in the plastics sub-sector and in the cement sub-sector through modernization and upgrading of clinker and cement production facilities.  However, this overall picture of growth during 2007 was complemented by the Governments focus on increasing productivity in order to impact growth. Government implemented programmes that facilitated international competitiveness included worker skills training, technology upgrading, research and development, the Private Sector Development Programme (PSDP) and the Quality Jamaica Project, which includes training in Hazard Analysis Critical Control Point (HACCP). Manufactured exports represent approximately 12.6% of GDP in 2007, while the sector employs about 6.1% of the total labour force. Exports grew by 7.3% in 2007 to US$705.8 million, a reflection of higher export earnings from both non-traditional and traditional manufactured products. The global economic crisis in the last quarter of 2008, spurred by the financial collapse in the United States emerged, which had implications for the productive sector. Devaluation of the dollar, high interest rates, reduced domestic and export sales, credit crunch, high inflation, soaring oil prices, and skyrocketing input costs of raw material were some of the challenges experienced in the face of the world financial crisis. For the year 2008, the Jamaican economy contracted by an estimated 0.6%. Real Gross Domestic Product (GDP) for the Goods Producing Sectors contracted by 3.0%, while the Services Sectors grew by 0.3%. The performance of the economy was adversely affected by the sharp rise in commodity prices, the subsequent decrease in commodity prices due to the global financial crisis, decline in external demand for Jamaican goods and services, sharp decline in the availability of capital for fiscal budgetary support and private sector investment as well as the lingering effects of hurricane Dean and tropical storm Gustav. The sector contributed 8.5% to GDP and the total employed labour force grew by 3.5% to 80,100 persons. For the period, total manufactured exports also increased amounting to US$1,224.75 million, an increase of 37.5%. This was attributable mainly to increased export earnings from Non-traditional Exports of US$1,094.7 million. However, the sector declined by 1.2% due to a challenging environment and the global financial crisis which contracted the performance of the Food, Beverage and Tobacco and Other Manufacturing components of the industry by 2.4% and 0.2%, respectively. Economic outlook for the Manufacturing sector A more economic perspective for the Jamaican manufacturing is to see interest rates trending down, Banks beginning to make loans and sustained stability in the exchange rate. This sector is showing some renewed buoyancy and has shown significant growth over the last two quarters. Despite the tough economic conditions, manufacturing is predicted to contribute positively as this area will be a focal part for the government as this area should harness more growth and development. The government expects to boost this sector to create employment through the money it receives from the International Monetary Fund (IMF). We expect that this will continue, as this is a very important sector representing a large chunk of overall GDP. So whatever happens to manufacturing will have an overall impact on the economy. These are some very good investment opportunities for the manufacturing sector for the coming years. Agro- processing: Canned vegetables and canned fruit present good opportunities for investment in the food processing sector. Chemicals and chemical products: Reference is being made particularly to aluminium sulphate, detergents and paints, which showed steady growth in 2007. This is expected to continue as the construction industry is projected to grow by 4.5 percent in 2008 which will be facilitated by the growth in Non-residential and hotel sectors as well as expansion of the sea and airports. Bio- technology: Jamaica is blessed with a number of indigenous herbs which can be used in the promotion of health and wellness. Food processing, Beverages and Tobacco: The food processing sector grew by 3.3 per cent in 2007, while growth in the beverages and tobacco sun-sectors stood at 1.8 per cent. These sectors are expected to grow due to the anticipated increase in the food production. For the Manufacturing Sector in Jamaica the identification of strengths and weaknesses represents the internal assessment of the sector while the consideration of opportunities and threats represents the analysis of the external environment for the sector. STRENGTHS Sourcing and Procurement Current availability of high quality raw Jamaican materials (including agricultural products, limestone, cement) Strong international supply relationships Reduction of duties on imported raw materials Production Largest contributor to GDP of all goods-producing sectors World-class enterprises in several manufacturing subsectors and industries (including food processing and beverage industries, paint, plastic containers) Ability to make high quality products Numerous small and diverse production facilities allowing for a range of focused niche markets and products Environment Availability of some green raw materials Limited use of environmentally friendly/clean production technologies Finance Downward trend in deposit interest rates making equity investments in manufacturing relatively more attractive Human Resources Large employer of labour Pool of trainable workforce Innovativene

Foreign Policy Essay

Tension between the need for a peace without victory and the nightmare of a mighty European super-state subject by one power formed a fundamental dynamic of liberal internationalism with regard to the First World War. These contradictory, yet oddly complementary, principles and self-interests necessitated the formation of the American Expeditionary Force (AEF). American politico-military policy in the Great War, as marked by presidential decision-making, was aimed at securing the mainly desirable peace while preventing a German victory. This combination of idealism and realism created the basis of Wilsonian foreign policy, and neither can be completely isolated from the other in explaining American involvement. Traditionally, American defense and foreign policies were in agreement both were predicated on the Monroe Doctrine. They assumed separation from European politico-military commitments and concomitant activism in the Western Hemisphere. Ever as the nation’s decisive victory in the Spanish American War, Americans had considered they a great power whether or not the U.S. was renowned as such in Europe. By 1914, the U.S. was the world’s leading industrial power and provincial force, but a century of inertia kept the nation’s compass set firmly on isolation. At the same time, America was not usually regarded by the great powers of Europe as a member of the club. European politicians usually were ignorant of American affairs and not mainly interested in learning (Erald A. Combs, 1983). In the second place, the Spanish Republic was not a democratic Republic in our sagacity of the word â€Å"democratic.† (Walter Lafeber, 1993)In the United States, violence is the last alternative of a small group of disgruntled citizens. In Spain, though, the majority believed in violence. The liberal minority which believed in Anglo-American or in French traditions was swept aside. But democracy should mean something more than majority rule. Democracy, if it is to have any moral force at all, should include the idea of civil rights and of protection of minorities. In Spain, the liberals who did believe in civil rights and in defense of minorities were forced from power. President Azaà ±a, a liberal, went into a type of retirement from public life and despaired of the Republic he had helped to set up. Azaà ±a wrote, â€Å"With most Spaniards it is not enough that they themselves can admit and believe what they like. They are offended, they are outraged, and they rise in revolt–if the same liberty is approved to anyone who thinks in a different way from them.† Salvador de Madariaga, the great liberal philosopher and historian, agreed with President Azaà ±a. Madariaga went into voluntary exile and refused to support either side in the Spanish Civil War. Other liberals lost their authority. Some were executed. Though supporters of General Franco have exaggerated the so-called â€Å"Red Terror† in Republican Spain, it is however a fact that–once the civil war had begun–the Republic was no longer competent or willing to guarantee freedom of speech, liberty of the press, freedom of religion, trial by jury. Throughout the Civil War, few Spaniards who dissented from government policy have the liberties which you and I think of as a essential part of a democratic society. When groups dissented from the Popular Front, they were ousted from the association government. When the groups were small enough, they were suppressed–as was the Trotskyite P.O.U.M. In short, the Republic was not all its American backers thought it to be. And, as Communist influence improved in Spain, as the Communists wrested power from liberals and socialists, the Republic became continually less democratic. Winston Churchill stood apart from his own Conservative Party and destined Neville Chamberlain’s devastating policy of appeasement. Anthony Eden resigned his post as Foreign Minister because he could not in good conscience persist to serve that disastrous policy. The Labor Opposition troubled for a change in policy if not in government. The Department of State is not lawfully bound to follow the Foreign Office’s lead. If Cordell Hull and Franklin Roosevelt chose to tag on the British, it was their choice. Whatever Hull believed, Roosevelt believed the British were wrong. We cannot excuse him by blaming the British. In the second place, the isolationists’ role can be overstates or misunderstood. Yes, the isolationists called for the embargo. No, the isolationists did not demand that the embargo be maintained. Senator Nye, the most significant of the isolationists, introduced, on May 2, 1938, a decree to lift the embargo. He saw the consequences of the embargo and determined that it was intervention against the Republic and not impartiality at all. Charles Beard, another leader of isolationist opinion, cynically denounced the embargo as the overturn of neutrality. Edwin Borchard and William P. Lage, two scholarly advocates of neutrality, Neutrality for the United States, that the embargo was erroneous: â€Å"This was thought to be neutrality legislation. In fact, it was the specific opposite.† The embargo was a form of involvement against the recognized government of Spain. In short, the leaders of American isolationism changed their minds on the embargo. Had Roosevelt joined their effort to sway public opinion, had he used his office to urge repeal on Congress, had he dared–as Henry Stimson suggested–lifting the embargo as part of executive prudence, the leaders of isolationism would have rallied to his side? He ignored the prospect. Nye’s bill never left committee. (Akira Iriye, 1993) In international affairs the USA displays growing unilateralism. International development policies have been forced by the Washington consensus. The United States fails to sign on to major greening protocols. Until lately the USA was perennially in arrears in United Nations dues. On numerous occasions (such as Nicaragua and Panama) the USA has not followed international legal standards and it ignores the International Court if its decision goes against it. American policies put in to the enduring stalemate in the Middle East. Take any global problem and the United States is both the main player and major bottleneck. It is a rational question to ask whether this is just a matter of current US administrations or whether more reflective dynamics are at work. If we take seriously global problems and therefore also the requirement for global reform (such as the condition of global public goods and the regulation of international finance) and then turn to the question of political implementation we obviously arrive at the door of the United States. Progressive social forces and international institutions the world over make proposals for global reform, whose list is significant and growing, but without US cooperation they stand little prospect of being implemented. The world leader, then, turns out to be the global bottleneck and in this light American conditions and problems become world problems. The difficulties are to evade mistaking American ideologies for realities, to avoid the trap of impressionism based on unawareness when everyone thinks they ‘know’ the USA on account of its large cultural radius, and to be brief while the data are vast. The literature on ‘America’, the largest and foremost developed country, is vast and multimodal. This part of the treatment is meant as a prà ©cis planned in brief vignettes. The second part probes the international consequences of American exceptionalism. This is less widely talked about and tucked within specialist literatures on international relations and international political economy (including transnational enterprises, the Washington consensus and military affairs). Twinning the themes of American exceptionalism and global implications is the pioneering element in this inquiry. The terrain is large, the literatures are wide-ranging and so this treatment is pointed, focusing on American exceptionalism and global ramifications. The closing section criticizes American exceptionalism as a self caricature and considers potential counterpoints. (Gruber, L. 2000) The whole world must adopt the American system. The American system can endure in America only if it becomes a world system. Americans who wanted to bring the blessings of democracy, capitalism, and constancy to everyone meant just what they said – the whole world, in their view, must be a reflection of the United States. There is no contradiction that several features of American exceptionalism shape modern globalization; yet developing this argument entails several hurdles. First, intrinsic in the notion of ‘Americanization’ is an element of methodological populism. To which unit of analysis does this apply – to which America, whose America? The USA is the fourth largest country in the world in terms of population, quite varied, and local differences play a significant part. American corporations with decentralized headquarters and offshore tax reporting cannot be merely identified with the United States either. Besides, international flows do not run just one way but in multiple directions; there are also trends of Europeanization, Asianization and Latinization of America, economically and culturally (regarding foreign ownership, management style, consumption patterns). Transnational Diasporas have been changing the character of ‘America’ all along and this bricolage character is part of its make-up. What then is the actual unit at issue? Is it a set of ’organizing principles’ that remain incessant over time, as Lipset would have it, or, at another extreme, is America a site, a place of transnational synthesis and bricolage? Since waves and layers of Diasporas, from the Irish to the Latino, have been shaping ‘America’ it is not feasible simply to refer back to the founding fathers in order to identify American fundamentals. It would not be productive either to rework the dà ©fi Amà ©ricain type of argument; that would place the argument in a setting of national comparisons and competitiveness, à   la Michael Porter. This national focus is in part overtaken by the dynamics of stepped up globalization and is not appropriate to an analysis of the relationship between AE and globalization. (Duclos, D. 1998) A second problem is to put up historical variation in US politics, or the association between structure and politics. AE does not quite match the definite profile of US administrations and is not essentially intrinsic to American politics; to argue otherwise would be to essentialism American politics. Wilsonian internationalism was also element of US foreign policy and American contributions to world order comprise the establishment of the UN and Bretton Woods system, the Marshall Plan, support for European union, and policies in favor of human rights and democracy. While these contributions are under disagreement they show that there is greater disparity to American foreign policy than just the profile of the past decades. As the emphasis here is on American policies in relation to modern globalization this serves as a note of caution. In the latter days of the Clinton administration there were several changes in the picture (mitigation of the embargo on Cuba, settlement of arrears in UN dues), some of which, such as US endorsement of the permanent International Criminal Court, were upturned by the next administration. In recent years much discussion on Americanization has focused on cultural dynamics, or what Nye calls ‘soft power’: the responsibility of media, popular culture and transnational consumerism, examined in cultural studies. It is also another type of populism for it is rarely effectively correlated with other dimensions of American influence: economic, financial, international and military. This lack of enunciation between soft and hard power is problematic. The question of AE and globalization differs from the conformist cultural imperialism thesis. Overall American impact is to a considerable extent a matter of what Galtung (1971) called ‘structural imperialism’: shaping other societies through structural leverage rather than just through direct political involvement. This includes but goes beyond popular culture, the cultural industries and the familiar litanies of Coca-colonization, McDonaldization, Disneyfication, Barbie culture and American media conglomerates. as these are high-visibility and receive irresistible attention, the more significant impact of AE perhaps concerns economic policies and international politics and security. These too are ‘cultural’, but covertly rather than obviously so and less visible in everyday life. They concern not just relations among advanced countries but relations across development ascents that affect the majority world. It may assist to differentiate several levels of analysis: Structural dynamics. This comprises scientific and technological changes forged by and exported from the USA. Eventually, however, these symbolize an inter-civilizational heritage. Fundamental dynamics which are universal to industrialized countries. Here the leading package offered by the country that founds these trends affects all; yet these dynamics are not essentially peculiar to that country. This brings us to the junction thesis of modernization theory according to which industrial societies would finally converge. In this category belong trends such as mass production, mass utilization, mass media, car culture, and suburbanization and information technology; that is, they are not ‘American’ per se but since the USA was the first comer they take an American gloss. American corporations and cultural industries request to draw monopoly rents from their provisional lead ‘by means fair or foul’. This is a general business practice with ample pattern in history. The British destroyed the Indian textile manufactures and trade and sabotaged incipient industrialization in Egypt, Persia and the Ottoman Empire. During international leverage (international financial institutions and the WTO) and regional arrangements the US government seeks to combine its lead and institutionalize the benefit of its multinational corporations. It follows that the center questions of global Americanization are the last two points: drawing monopoly rents and their institutionalization through superpower leverage. That the line between domestic and international politics is distorting is a familiar point in international relations literature. Often the importance falls on the international influencing the domestic. A major US export has been its brand of capitalism, as in Taylorism, Fordism, high mass-consumption, free trade, and American company and business practices. Another major policy take on by western countries is a â€Å"war on terrorism† that is not a foreign policy; it is an goal of a foreign policy. Western’s world way must reach beyond the curse of terrorism. We should offer an inclusive vision of hope and affluence for all nations, and thinking the interests of our friends and allies, as well as those peoples around the world who need to be our friends and share in our exposure. Beliefs, standards, values, and prospect are all part of a foreign policy, but they are not foreign policy. They are enriching blocks of foreign policy. It has become a maxim to state that September 11, 2001 â€Å"changed everything† as well as that â€Å"nothing will ever be the same again.† In fact, little has changed in the imperialist tendencies of American foreign policy since the founding of the United States of America in 1789. The war on terrorism possesses features that influence west to operate in direct confrontation of accepted norms of international law, and to overlook the deficiencies and the crimes of its cobelligerents. The new war is a messianic, apocalyptic struggle of blameless good against consummate evil. Its motivation is not the real world with its shades of gray (and indeed, relevant histories and grievances), but the type of struggles that used to play out in the cowboy movies. Little reveal is made of the fact that the primary enemy is religious, in fact intensely so at times to the point of prejudice, bigotry, and terror, and not atheist as the previous enemy was. There is no need to attempt to understand that this new enemy regards Israel as a state that practices state terrorism and that by supplying military and economic aid, Washington is an accomplice. Or to try to understand that this enemy believes that Washington should cut off this aid and declare war on state terrorists as well as private ones. Those on â€Å"our side† are seen as being good, or at least infinitely better than the enemy. It is a war of no negotiations with the enemy, no summit meetings, no compromise, and surely no need to modify policies to accommodate the feelings and the policies of the enemy, or examine any just accusations that the enemy might possibly have. The enemy’s soldiers will not be given prisoner of war status and will be tried in special military courts (New York Times, May 26, 2003). Similar to the enemies of the Cold War, the enemy in the new war is depicted as sinister, cunning and underhanded. This time—and it is no irrelevant difference—the enemy actually struck mainland west on September 11 and before, and is expected to strike again. The fear is that the enemy will develop and use weapons of mass destruction against us—nuclear weapons, or more probable, radiological dispersion devices, also called â€Å"dirty bombs† (conventional bombs to which radioactive material has been added). The result would be the spread of radioactivity over a large area. But we are advised that we must not panic. Just be careful and vigilant. This war too, America advises us openly and in advance, is a war of global proportions. It is an open-ended war with the world as its arena. The enemy assumes two general forms. One part is visible, above ground, represented by evil governments and reminiscent of the old Soviet bloc. So far only four of the enemy governments in the new war have been identified—the former governments in Afghanistan and Iraq, and two remain â€Å"axis of evil† governments in Iran and North Korea. The other enemy component is invisible, consisting, we are told, of cells in some 50 or 60 typically unnamed countries. These are not the cells of the communist party, but the underground organizations of what Washington chooses to call â€Å"terrorists† (New York Times, October 24, 2002). Whatever its form, whether bearing the legality of government or existing underground, the enemy should be destroyed. To do this, we must sometimes act alone, unilaterally. Other times we can act with our allies. America attacked the Afghan government only three weeks after the 9/11 tragedy. It therefore demonstrated that it was determined to protect the nation against terrorism, â€Å"to fight the war against terrorism,† not only by police measures—interpreting the determination to protect the nation as actions taken on to constrain and apprehend criminals but also by actually waging war against governments (Douglas Kellner, 2003). This, despite the fact that former approach is recognized as the most promising way a government can use to guard its citizens against terrorism if that government is interested in peace. Such an approach entails the kind of police measures actually adopted by Washington and other governments such as anti-terrorist measures affecting airplanes and airports, as well as foreign policy measures such as pulling troops out of Saudi Arabia, and threatening to lessen aid to Israel. The use of war, however, increases the damage to the victim country and the innocent parties therein. This increases the moral quandary posed by just war theory, as well as increasing the hatred that can consequence against the perceived aggressor, as has been demonstrated in the recent war against Iraq (Frederick H. Gareau; 2004). Thus like the war on terrorism, non-proliferation leadership desires global cooperation and coalitions. The two might combine such as while states both proliferate and sponsor terrorism-but their intimidation, and the techniques for dealing with them, are varied. Proliferation is provoked by customary state interest’s geography and security and maybe not terror, and consequently might require a varied set of policy responses. The approaches to proliferation will diverge in Iraq, North Korea, and South Asia. The â€Å"war on terrorism† rubric offers neither explanation nor path concerning our non-proliferation policy options. That said, if a propagating state sponsors terrorism, or has relations with terrorists disparate to the United States, then these two areas of center converge. And our tools to agreement with both threats must be directly focused on those states (New York Times, December 10, 2002). It is unsure that we face a feasible intimidation of a large-scale nuclear harass from another main nuclear power. The further real threat is now the development and deliverability of nuclear, chemical and biological weapons by terrorist associations and the states which support them. The Bush Administration has mapped a new path in association with Russia by moving to lessen nuclear munitions to usually low numbers and engaging former opponent on controlling the expand of nuclear technology. Nunn-Lugar non-proliferation programs have institutionalized a vital helpful association unswerving to the reduction and power of nuclear or double use materials. But we should be careful not to be lulled into a counterfeit sense of security with this new Russian-American agreement. The truth is that this new agreement – which represents progress – does not comprise the mainly dangerous nuclear threat that we still must deal with, and that is strategic nuclear weapons. Short-range nuclear missiles and bombs are left out of this agreement. Thus, The basic challenges for western countries foreign policy today are much as they have been in the past: to safe our interests and support our ideals in an deficient and precarious world. And to do it through leading coalitions of common interest. Reference: Akira Iriye, The Globalizlng Of America, 1913-1945, At 34-35 (1993) Andrà ©ani, G. (1999–2000), ‘The Disarray of US Non-proliferation Policy’, Survival 41(4): 42–61. Douglas Kellner, From 9/11 to Terror War: the Dangers of the Bush Legacy. Lanham. Rowman and Littlefield, 2003, p. 263. Duclos, D. (1998), The Werewolf Complex: America’s Fascination with Violence. Oxford: Berg. Erald A. Combs, American Diplomatic History: Two Centuries Of Changing Interpretations 56-61 (1983) Frederick H. Gareau; State Terrorism and the United States: From Counterinsurgency to the War on Terrorism, Clarity Press, 2004 Frederickson, Kari (2001), The Dixiecrat Revolt and the End of the Solid South, 19321968. Chapel Hill, NC: University of North Carolina Press. Friedman, T.L. (2000), The Lexus and the Olive Tree: Understanding Globalization. New York: Anchor Books, 2nd edn. Gruber, L. (2000), Ruling the World: Power Politics and the Rise of Supranational Institutions. Princeton, NJ: Princeton University Press. Guyatt, N. (2000), Another American Century? The United States and the World After 2000. London: Zed Books. Hallinan, J.T. (2001), Going Up the River: Travels in a Prison Nation. New York: Random House. Huntington, S.P. (1999), ‘The Lonely Superpower’, Foreign Affairs 78(2): 35–49. Kaul, I., I. Grunberg and M.A. Stern (eds) (1999), Global Public Goods: International Cooperation in the 21st Century. New York: Oxford University Press. Keohane, R.O., and H.V. Milner (eds) (1996), International and Domestic Politics. Cambridge: Cambridge University Press. Kirkendall, R.S. (1980), A Global Power: America since the Age of Roosevelt. New York: Knopf, 2nd edn. New York Times, May 26, 2003, p. A18 New York Times, October 24, 2002, p. A1 Walter Lafeber, The American Age: U.S. Foreign Policy At Home And Abroad, 1750 To The Present 614-18 (1994). Walter Lafeber, The American Search For Opportunity, 1865-1913, At 180 (1993) William G. Howell, Power Without Persuasion: The Politics Of Direct Presidential Action 24-54 (2003) William Stueck, Rethinking The Korean War: A New Diplomatic

Assessment and Care Planning: Holistic Assessment

Introduction This essay deals with the holistic assessment of a patient who was admitted onto the medical ward where I undertook my placement. Firstly, the relevant life history of the patient will be briefly explained. Secondly, the Roper, Logan and Tierney model of nursing that was used to assess the care needs of the patient will be discussed, and then the assessment process will be analysed critically. Identified areas of need will be discussed in relation to the care given and with reference to psychological, social, and biological factors as well as patho-physiology. Furthermore, the role of inter-professional skills in relation to care planning and delivery will be analysed, and finally the care given to the patient will be evaluated. Throughout this assignment, confidentiality will be maintained to a high standard by following the Nursing and Midwifery Council (NMC) Code of Conduct (2008). No information regarding the hospital or ward will be mentioned, in accordance with the Data Protection Act 1998. The pseudonym Kate will be used to maintain the confidentiality of the patient.The PatientKate, a lady aged 84, was admitted to a medical ward through the Accident and Emergency department. She was admitted with asthma and a chest infection. She presented with severe dyspnoea, wheezing, chest tightness and immobility. Kate is a patient known to suffer from chronic chest infections and asthma, with which she was diagnosed when she was young. She takes regular bronchodilators and corticosteroids in the form of inhalers and tablets. Kate lives on her own in a one bedroom flat. She has a daughter who lives one street away and visits her frequently. Her daughter stated that Kate has a very active social life; she enjoys going out for shopping using a shopping trolley.Assessment of the PatientAssessment TheoryIn this ward, the Roper, Logan and Tierney model of nursing, which reflects on the twelve activities of living, is used as a base for assessing patients (Alabaster 2011). These activities are â€Å"maintaining safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, controlling body temperature, mobility, working and playing, sexuality, sleeping, and dying† Holland (2008, p.9). Elkin, Perry and Potter (2007) outlined nursing process as a systematic way to plan and deliver care to the patient. It involves four stages: assessment, planning, implementation and evaluation. Assessment is the first and most critical step of the nursing process, in which the nurse carries out a holistic assessment by collecting all the data about a patient (Alfaro-Lefevre 2010). The nurse uses physical assessment skills to obtain baseline data to manage patients’ problems and to help nurses in the evaluation of care. Data can be collected through observation, physical assessment and by interviewing the patient (Rennie 2009). A complete assessment produces both subjective and objective findings (Wilkinson 2006). Holland (2008) defines subjective data as information given by the patient. It is obtained from the health history and relates to sensations or symptoms, for example pain. Subjective data also includes biographical data such as the name of the patient, address, next of kin, religion etc. Holland defines objective data as observable data, and relates it to signs of the disease. Objective data is obtained from physical examination, for example of blood pressure or urine. Before assessment takes place, the nurse should explain when and why it will be carried out; allow adequate time; attend to the needs of the patient; consider confidentiality; ensure the environment is conducive; and consider the coping patterns of the patient (Jenkins 2008). The nurse should also introduce herself to help reduce anxiety and gain the patient’s confidence. During assessment, the nurse needs to use both verbal and non-verbal communication. Using non-verbal communication means that she should observe the patient, looking at the colour of the skin, the eyes, and taking note of odour and breathing. An accurate assessment enables nursing staff to prioritise a patient’s needs and to deal with the problem immediately it has been identified (Gordon 2008). Documentation is also very important in this process; all information collected has to be recorded either in the patient’s file or electronically (NMC, 2009b).Carrying out the AssessmentKate was allocate d a bed within a four-bed female bay. Her daughter was with her at the bedside. Gordon (2008) stated that understanding that any admission to hospital can be frightening for patients and allowing them some time to get used to the environment is important for nursing staff. Kate’s daughter was asked if she could be present while the assessment was carried out, so that she could help with some information, and she agreed. Alfaro-Lefevre (2008) recommended that nursing assessments take place in a separate room, which respects confidentiality, and that the patient be free to participate in the assessment. Although there was a room available, Kate’s daughter said it was fine for the assessment to take place at the bedside because her mother was so restless and just wanted to be next to her. The curtains were pulled around the bed, though William and Wilkins argued that it ensures visual privacy only and not a barrier to sound. NMC (2009a) acknowledges this, along with the n eed to speak at an appropriate volume when asking for personal details to maintain confidentiality. The assessment form that was used during Kate’s assessment addressed personal details and the twelve activities of living. A moving and handling assessment form was also completed because of her immobility. First, personal details such as name, age, address, nickname, religion, and housing status were recorded. Information was also recorded about any agency involved, along with next of kin and contact details, and details of the general practitioner. Holland (2008) stated that these details should be accurate and legible so that, in case of any concerns about the patient, the next of kin can be contacted easily. The name and age are also vital in order to correctly identify the patient to avoid mistakes. Knowing what type of a job the patient does or the type of the house she lives in helps to indicate how the patient is going to cope after discharge. Holland also insisted that religion should be known in case the patient would like to have some privacy during prayers, and thi s should be included in the care plan. The second assessment to be done focused on physical assessment and the activities of living. Barrett, Wilson and Woollands (2009) suggested that when enquiring about the activities of living, two elements should be addressed: usual and current routines. Additionally, identifying a patient’s habits will help in care planning and setting goals. During physical assessment, when objective data was collected, Kate demonstrated laboured and audible breath sounds (wheezing) and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: blood pressure 110/70; pulse 102 beats /min; respirations 26/min; temperature 37.4 degrees Celsius; oxygen saturation 88%; peak flow 100 litres; weight 60kg; and body mass index 21. Taking and recording observations is very important and is the first procedure that student nurses learn to do. These observations are made in order to detect any signs of deterioration or progress in the p atient’s condition (Field and Smith 2008). Carpenito-Moyet (2006) stated that it is important to take the first observations before any medical intervention, in order to assist in the diagnosis and to help assess the effects of treatment. Kate’s initial assessment was carried out in a professional way, taking account of the patient’s particular circumstances, anxieties and wishes. After the baseline observations were taken, the twelve activities of living were analysed and Kate’s needs were identified. Among the needs identified, breathing and personal hygiene (cleansing) will be explored.Identified Care NeedsBreathingWilkinson (2006) states that a nursing diagnosis is an account about the patient’s current health situation. The normal breathing rate in a fit adult is 16-20 respirations/minute, but can go up to 30 due to pain, anxiety, pyrexia, sepsis, sleep and old age (Jenkins 2008). In old people, muscles become less efficient, resulting in increasing efforts to breathe, causing a high respiratory rate. On assessment, Kate’s problem was breathing that resulted in insufficient intake of air, due to asthma. She was wheezing, cyanosed, anxious and had shortness of breath. Wilkinson (2006) explained that a goal statement is a quantifiable and noticeable criterion that can be used for evaluation. The goal statement in this case would be for Kate to maintain normal breathing and to increase air intake. The prescription of care for Kate depended on the assessment, which was achieved by monitoring her breathing rate, rhythm, pattern, and saturation levels. These were documented hourly, comparing the readings with initial readings to determine changes and to report any concerns. The other part of the plan was to give psychological care to Kate by involving her in her care and informing her about the progress, in order to reduce anxiety. Barrett, Wilson and Woollands (2012) stated that it is very important to give psychological care to patients who are dyspnoeic because they panic and become anxious. Checking and recording of breathing rate and pattern is very important because it is the only good way to assess whether this patient is improving or deteriorating, and it can be a very helpful method for nurses to evaluate whether or not the patient is responding to treatment (Jamieson 2007). Mallon (2010) stated that, if the breathing rate is more than 20, it indicates the need for oxygen. Blows (2001), however, argued that this can happen even after doing exercise, not only in people with respiratory problems. Griffin and Potter (2006) stated that, respirations are normally quiet, and therefore if they are audible it indicates respiratory disease. Nurses needs to be aware of these sounds and what they mean, for example a wheezing sound indicates bronchiole constriction. Kate’s breathing was audible and the rate was also above normal and that is why breathing was prioritised as the first need. Oxygen saturation level was also monitored with the use of a pulse oximeter. The normal saturation level is 95-99% (British National Formulary ((BNF)) 2011a). Nevertheless the doctor said that 90-95% was fine for Kate, considering her condition and her age. Kate was started on two litres of oxygen and she maintained her oxygen saturation between 90 and 94%. The peak expiratory flow was monitored and recorded to identify the obstructive pattern of breathing that takes place in asthma (Hilton, 2005). This is another method that is used to assess the effectiveness of the medication (inhalers) the asthmatic patient is taking, and this test should be carried out 20 minutes after medication is administered. It is the Trust’s policy to do hourly observations on patients who have had one, two or three abnormal readings, until readings return to normal. Kate was observed for any blueness in the lips and tongue and for oral mucosa as this could be a sign of cyanosis. All the prescribed nebulisers, inhalers, bronchodilators, corticosteroids, antibiotics and oxygen therapy were administered according to the doctor’s instructions. Bronchodilators are given to dilate the bronchioles constricted due to asthma, and corticosteroids reduce inflammation in the airway (BNF 2011b). Kate was also started on antibiotics to combat the infection because, on auscultation, the doctor found that the chest was not clear. Kate was nursed in an upright position using pillows and a profiling bed in order to increase chest capacity and facilitate easy respiratory function by use of gravity (Brooker and Nicol, 2011). In this position, Kate was comfortable and calm while other vital signs were being checked. Pulse rate and blood pressure were also being checked and recorded because raised pulse can indicate an infection in the blood.CleansingDue to breathlessness and loss of mobility it was difficulty for Kate to maintain her personal hygiene. Hygiene is the practice of cleanliness that is needed to maintain health, for example bathing, mouth washing and hair washing. The skin is the first line of defence, so it is vital to maintain personal cleansing to protect the inner organs against injuries and infection (Hemming 2010). Field and Smith (2008) stated that personal cleansing also stimulates the body, produces a sense of well-being, and enables nurses to assess the patient holistically. Personal hygiene is particularly important for the elderly because their skin becomes fragile and more prone to breaking down (Holloway and Jones 2005). Therefore this need was very important for Kate; she needed to maintain her hygiene as she used to, before she was ill. The goal for meeting this need was to maintain personal hygiene and comfort. The care plan prescribed involved first gaining consent from Kate, explaining what was going to be done. Hemming (2010) recommended that identifying the patient’s usual habit is very important because each individual has different ideas about hygiene due to age, culture or religion. Identifying usual habits helps individuals to maintain their social life if things are done according to their wishes. Though Hemming said all human beings need personal hygiene, Holland (2008) argued that it is important to ask patients how they feel about being cleaned, especially in private areas. Kate indicated that she didn’t mind being assisted with washing and dressing. She preferred washing daily, shower and a hair wash once a week, and a mouth wash every morning and before going to bed. Kate was assisted with personal care 5-10 minutes after having her medication, especially the nebuliser. Individuals with asthma experience shortness of breath whenever they are physically active (Ritz, Rosenfield and Steptoe 2010). After having medication Kate was able to participate during personal hygiene. According to NMC guidelines on confidentiality (2009a), privacy and dignity should be maintained when giving care to patients. Therefore, whenever Kate was being assisted with personal care, it was ensured that the screens were closed and she was properly covered. Field and Smith (2008) suggested that assisting a patient with personal hygiene is the time that nurses can assess the patient holistically. Since Kate was immobile, it was very important to check her pressure areas for any redness. She was also checked for any pallor, jaundice, cyanosis or dry skin that needed attention. The care was always carried out according to her wishes.The Role of Inter-Professional SkillsConsi dering Kate’s age and condition, she needed multi-professional teamwork. NMC (2008) encourages teamwork to maintain good quality care. Kate was referred to the respiratory nurse who is specialised in helping people with breathing problems. Since Kate was on oxygen since admission, the respiratory nurse taught her the importance of healthy breathing and taught her some breathing exercises to help wean her from oxygen. Kate was also referred to the physiotherapist who did breathing exercises with her. Kate was not able to walk without aid so she was also referred to the occupational therapy department to assess how she was going to manage at home, or if she required aids to help her manage the activities of living. Upon meeting together, all the multi-disciplinary team agreed that Kate needed a care package, as she could no longer live without care. She was referred to social services so that they could assess this aspect of Kate’s future. After one week Kate was medically fit but could not go home because she was waiting for the care package to be ready. Her nurse shared information with the multi-disciplinary team in order to establish continuity of care for Kate. The team prepared for her discharge: the occupational therapy staff went to visit her home to check if there was enough space for her walking frame; social services arranged for a care package; and her nurses referred her to the district nurse to help her with her medication and make sure it did not run out.OutcomeKate responded well to the medication she was prescribed; normal breathing was maintained, her respirations became normal, ranging from 18 to 20 respirations per minute, and her oxygen saturation ranged from 95% to 99%. Kate was able to wash and dress herself with minimal assistance. She was discharged on a continuous care package comprising care three times a day, and the district nurse helped her with the medication to control her asthma.Evaluat ionThe model of the twelve activities of living was followed successfully on the whole. The nurse collected subjective and objective data, allowing a nursing diagnosis to be formulated, goals to be identified and a care plan to be constructed and implemented. Privacy is very important in carrying out assessments, and this was not achieved fully in Kate’s assessment. However, this lower level of privacy has to be balanced against causing anxiety to the patient. Kate’s daughter thought that the bedside assessment would be more comfortable for her mother, and therefore cause least anxiety. This was very important because of the effects of potential panic on breathing; therefore, this was the correct balance to strike. A multi-disciplinary team was involved in meeting Kate’s care goals. This is a good example of the use of inter-professional skills, as a number of different departments were involved in creating and implementing the care plan. However, the system was not as efficient as it should have been: Kate spent unnecessary time in hospital after recovery because the care plan was not yet in place. Assessment can also take a long time, especially with the elderly who are usually slow to respond. Therefore, more time is needed to be sure that the necessary progress has been achieved before taking further steps. However, poor staffing also affects performance in this area, an observation supported by the Royal College of Nursing (2012). In conclusion, the assessment of this patient was completed successfully, and the deviation from best practice recommendations (the lower level of privacy) was justified by the clinical circumstances. Progress from assessment to care goals was good, and at this point an inter-disciplinary team was used successfully. However, the one flaw in this process was delays, caused partly by the difficulties of working across different departments, and partly, it seems, by staff shortages. Reference List Alabaster, C.S (2011) ‘Care and rehabilitation of people with long term conditions’ in Brooker, C. and Nicol, M. (eds) (2011) Alexander’s Nursing Practice (4th ed). London: Churchill Livingstone.. Chapter 32 Alfaro–LeFevre, R. (2008) Critical thinking and clinical judgment: A practical approach to outcome-focused thinking (3rd ed.). St. Louis, MO: Saunders. Barrett, D., Wilson, B. and Woollands, A. (2009) Care Planning: A Guide for Nurses (2nd ed). Harlow: Pearson Education. Chapter 2. Blows, W. T. (2001) The Biological Basis of Nursing: Clinical Observations. London: Routledge. British National Formulary (2011a) Oxygen. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain. British National Formulary (2011b) Corticosteroids. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain. Brooker, C. and Nicol, M. (eds) (2011) Alexander’s Nursing Practice (4th ed). London: Churchill Livingstone. Carpenito-Moyet, L. J. (2006) Handbook of Nursing Diagnosis (11th ed). Philadelphia: Lippincott. Doughty, L. and Lister, S. (eds) (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures (student edition) (7th ed). Oxford: Wiley Blackwell. Elkin, M. K., Perry, A. G. and Potter, P. A. (2007). Nursing Interventions and Clinical Skills. Philadelphia: Mosby. Field, L. and Smith, B. (2008). Nursing Care (2nd ed). Harlow: Pearson Education. Gordon, M., (2008). Nursing Assessment and Diagnostic Reasoning. Philadelphia: F.A. Davis company. Griffin, A., Potter, P. (2006) Clinical Nursing Skills and Techniques (6th ed). Philadelphia: Mosby Hemming, L. (2010). ‘Personal Cleansing and Dressing’ in I. Peate (ed) Nursing Care and the Activities of Living. (2nd ed). Oxford: Wiley Blackwell. Chapter 9. Hilton, A. (2003) Fundamental Nursing Skills. London: John Wiley & Sons Holland, K., (2008) ‘An introduction to the Roper-Logan-Tierney model for nursing, based on Activities of Living’ in Holland, K., Jenkins, J., Solomon, J. and Whittam, S. (eds). Applying the Roper, Logan and Tierney Model in Practice. London: Churchill Livingstone. Chapter 1, pp.9-10. Holloway, S. and Jones, V. (2005). ‘The importance of skin care and assessment’ in the British Journal of Nursing Dec 2005-Jan 2006 14(22): 1172-6. Jamieson, E. Whyte, L. A. and McCall, J. A. (2002) Clinical Nursing Practices. London: Churchill Livingstone. Jenkins, J., (2008) ‘Breathing’ in Holland, K., Jenkins, J., Solomon, J and Whittan, S. (eds) Applying the Roper, Logan and Tierney Model in Practice. London: Churchill Livingstone. Chapter. 5. Mallon, S. (2010) ‘Breathing’ in I. Peate (ed) Nursing Care and the Activities of Living (2nd ed). Oxford: Wiley Blackwell. Chapter 8. Nursing and Midwifery Council (2008) The Code of Conduct. London: NMC. Available at: http://www.nmc-uk.org/Publications/Standards/The-code/Introduction/ Accessed 24/05/2012 Nursing and Midwifery Council (2009a) The Code of Conduct: Confidentiality. London: NMC. Available at: (http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Confidentiality/) Accessed 24/05/2012 Nursing and Midwifery Council (2009b) Record Keeping: Guidance for Nurses and Midwives. London: NMC. Available at: http://www.nmc-uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidanceforNursesandMidwives.pdf Accessed 24/5/2012 Rennie, I. (2009). ‘Exploring approaches to clinical skills development in nursing education’ in Nursing Times 105: 3, 20-22. Available at: http://www.nursingtimes.net/exploring-approaches-to-clinical-skills-development-in-nursing-education/1973990.article Accessed 14/05/2012 Ritz, T., Rosenfield, D. and Steptoe, A. (2010) ‘Physical activity, lung function, and shortness of breath in daily life of asthma patients’ in Chest 138(4), 913-918. Royal College of Nursing (2012) Safe staffing for older people’s wards. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0010/439399/Safe_staffing_for_older_people_V3.pdf Accessed: 24/05/2012 Wilkinson, J. M. (2006) Nursing Process and Critical Thinking. (4th ed). New Jersey: Pearson Prentice Hall.

Time-Filler Games for Every Classroom