4 research outputs found
Evaluation of a COVID â19 fundamental nursing care guideline versus usual care: The COVIDâNURSE cluster randomized controlled trial
Aim: To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVIDâ19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient healthârelated quality of life and costâeffectiveness. Design: Parallel twoâarm, clusterâlevel randomized controlled trial. Methods: Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVIDâ19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patientâreported coâprimary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intentionâtoâtreat analyses. Results: We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570â572 (98.1%â98.5%) patient participants in 14 clusters. We found no evidence of betweenâgroup differences on any patient, nurse or economic outcomes. We found betweenâgroup differences over time, in favour of the intervention, for three of our five coâprimary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the âotherâ ethnicity subgroup. Conclusion: We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on nonâwhite British patients' experience of care. Implications for the Profession and/or Patient Care: We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. Impact: Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on nonâwhite British patients' experience of care. Reporting Method: CONSORT and CONSERVE. Patient or Public Contribution: Patients with experience of hospitalization with COVIDâ19 were involved in guideline development and writing, trial management and interpretation of findings
Democracyâs Effect on Economic Growth: A Pooled Time-Series Analysis, 1951â1980
The relationship between democracy and economic growth has concerned social scientists since the 17th century, but recent democracy movements make this question especially important today. Do poor countries face a cruel trade-off between democracy and growth? Do democracy and growth go together as a win-win proposition? Or is democracy irrelevant to growth? Using pooled annual time-series data from 1951-1980 for 106 countries, including 88 non-core countries, we explore long-term and short-term direct and indirect effects of democracy on growth. Little or no direct effect emerges, but positive indirect effects appear via two mechanisms: a marginally significant effect via investment and a robust effect via government expenditure. Democracy also has a robust non-linear effect on economic growth via social unrest, inhibiting growth under non-democratic regimes and furthering it in highly democratic ones. Combining these findings, we conclude that democracy does not significantly hamper economic growth, and under many circumstances slightly boosts it