Patient safety : evaluation of the impact of nursing hours per patient day staffing method in Western Australia

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.In March 2002 Western Australia (WA) mandated a new staffing method—nursing hours per patient day (NHPPD). This method used a “bottom up” approach to classify each hospital ward into one of seven categories using characteristics such as patient complexity, intervention levels, the presence of high dependency beds, the emergency/elective patient mix and patient turnover. Once classified, NHPPD were prescribed for each ward. The purpose of this study was two-fold focusing on data from three adult tertiary hospitals (four of seven ward categories: A, B, C and D combined), and individual ward categories A, B, C and D at one adult tertiary hospital. The first purpose was to determine the impact of implementing this staffing method (NHPPD) on nursing-sensitive outcomes (NSOs). The second was to determine the relationship between skill mix and NSOs following implementation of NHPPD. The research design was an interrupted time series and used retrospective analysis of administrative data. Patient and staffing data using the NHPPD method over a four year period were analysed. The 14 NSOs were central nervous system (CNS) complications, wound infections, pulmonary failure, urinary tract infection, pressure ulcer, pneumonia, deep vein thrombosis, ulcer, gastritis and upper gastrointestinal bleed, sepsis, physiologic/metabolic derangement, shock/cardiac arrest, mortality, failure to rescue and length of stay. The study found significant decreases in the rates of nine NSOs when examining hospital-level data following implementation of NHPPD (including mortality, sepsis and pneumonia). At the ward level, significant decreases in the rates of five NSOs (including mortality, shock/cardiac arrest and UTIs) occurred. Significant decreases in rates of eight NSOs (including failure to rescue, mortality and pneumonia) occurred with each 1% increase in RN hours across the three hospitals. At ward category level, significant decreases in the rates of five NSOs occurred with every 1% increase in RN hours (including failure to rescue, DVT and pneumonia). The findings of this study suggest a richer skill mix, even with relatively small changes (1%), continues to benefit patients by improving NSOs. This study also provides nurse leaders with evidence to support the continuation of the NHPPD staffing method. It also adds to evidence about the importance of nurse staffing to patient safety, evidence that must influence policy. Moreover, this study is one of the first to empirically review a specific nurse staffing method, based on an individual assessment of each ward to determine staffing requirements, rather than a “one-size-fits-all” approach

A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study

© 2016 John Wiley & Sons Ltd Aims: The aim of this study was to determine which tasks unregulated nursing support staff spend their work time undertaking and to determine differences between the work undertaken by licensed/regulated nurses on units which have nursing support workers and those on units which do not. Background: Acute hospital nursing teams often include nursing support staff; little is known about what kinds of tasks these unregulated support workers do and how it affects the work tasks of their licensed/regulated team members. Design: Cross-sectional analysis of nurse work sampling data. Methods: Data collection took place between March–October 2013. The proportion of time spent on 25 work activities by nursing support staff and licensed/regulated nursing staff was compared. Logistic regression models estimated whether nursing support staff or licensed/regulated nurses were more likely to conduct direct and indirect patient care tasks and whether licensed/regulated nurses on units with nursing support staff were more likely to conduct direct or indirect tasks compared with those on units without nursing support workers. Results: Nursing support staff spent the majority of their time engaged in direct care tasks, e.g. admission and assessment, hygiene and mobility. Although licensed/regulated nurses were less likely to undertake direct care tasks compared with support workers, those who worked on units with support workers undertook more direct care compared with those who worked on units without support workers. Conclusions: Nursing support workers were given tasks that required substantial amounts of patient interaction. These staff may be associated with an increase in direct care tasks for licensed/regulated nurses, who may duplicate the direct care done by nursing support workers

The Use of Unregulated Staff: Time for Regulation?

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav

Attitudes, Influences and Perceptions towards Plastic Surgery amongst Medical Students

Introduction: Plastic surgery is a dynamic and evolving field but remains poorly understood due to lack of knowledge, media misconceptions and recent changes to medical undergraduate curricula. To address issues around student interest and recruitment into the speciality, it is imperative to understand the factors influencing medical students and future clinicians. Aims: To examine influences, interest and perceptions of plastic surgery amongst Scottish medical students and explore methods to increase undergraduate engagement. Method: Cross-sectional survey distributed online via Scottish undergraduate medical school offices comprising 6 domains: demographics; career interest; perceptions, interests and influences in plastic surgery; curriculum and trainer views; understanding the role of a plastic surgeon; and undergraduate engagement. Results: A total of 193 students responded with no statistically significant relationship between year group, gender, and interest in plastic surgery. Phrases most strongly identified with plastic surgery included private practice, reconstruction and cosmetics. Placements, teaching staff and workshops/courses were found to influence perception of plastic surgery. Fortunately, only 6% of students encountered antagonism towards plastic surgery encompassing themes of negative stereotypes of surgeons and connotations surrounding cosmetic surgery. Importantly, many students were largely unaware of the range of common procedures undertaken by plastic surgeons. To overcome this lack of awareness and generate greater interest, students suggested greater plastics exposure, consultant-led teaching and workshops showcasing the specialty. Conclusion: Medical students want varied, stimulating and flexible careers – something which plastic surgery can provide. However it seems the understanding of the scope of plastic surgery is poorly understood amongs future trainees. To increase uptake and interest, negative perceptions need to be addressed and greater engagement is required from medical school upwards

The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review

To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases – CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty-one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and secondary development of tools in emergency departments. The remaining studies reported on risk assessment tools that were developed or tested in psychiatric inpatient settings. In total, 16 violence risk assessment tools were identified. Thirteen of them were developed to assess the risk of violence in psychiatric patients. Two of them were found to be accurate and reliable to predict violence in acute psychiatric facilities and have practical utility for general acute care settings. Two assessment tools were developed and administered in general acute care, and one was developed to predict patient violence in emergency departments. There is no single, user-friendly, standardized evidence-based tool available for predicting violence in general acute care hospitals. Some were found to be accurate in assessing violence in psychiatric inpatients and have potential for use in general acute care, require further testing to assess their validity and reliability

The politics of crustal faults issues and controversies around the San Ramón Fault in Chile

The seismicity of Chile is mainly controlled by large subduction zones in the Nazca and South American plates’ interface, ca. 150 km from the Chilean coast, which generated the wellknown Mw 9.5 Valdivia (1960) and Mw 8.8 Maule (2010) earthquakes. Besides large subduction events, less-studied crustal earthquakes can cause great destruction due to their shallow hypocentres. Local scientists have indeed paid increasing attention to crustal seismicity, especially after the recent Mw 7.0 Pichilemu (2010) and Mw 6.7 Pisagua (2014) shallow intraplate earthquakes. Although the San Ramón Fault (SRF) is one of the Chilean crustal faults with slower slip rate (ca. 0.3-0.4 mm/yr), it is by far the most popular in the media and amongst politicians. Running for ~30km along the foothills of Santiago, the capital of Chile, the SRF has recently been classified as active, becoming a ‘new’ hazard for nearly 2 million santiaguinos. Moreover, some researchers have estimated that the next occurrence of the up-to-Mw-7.5 earthquakes in the SRF, with an 8000-year recurrence, is geologically imminent (± 500 yr). In this article, we discuss the rise of a conflict around the SRF. The conflict stems from an official narrative about the hazard that the fault represents and the policy (re)actions to this knowledge. We focus on the tensions generated amongst stakeholders (academics, policymakers, privates, and civil society). The discussion includes the scientific disagreement amongst academics regarding the fault’s activity and seismogenic potential, and the political need for action as the SRF hazard becomes word-ofmouth and some stakeholders start demanding disaster risk mitigation. Touching upon disaster risk reduction and urban development issues, the conflict around the SRF unveils the challenges of seismic risk governance in the context of urban and crustal faults

Time, space and touch at work: Body work and labour process (re)organisation

With ‘efficiency savings’ the watchword for health and social care services, reorganisation and labour rationalisation are the order of the day. This article examines the difficulties involved in (re)organising work which takes bodies as its object, or material of production. It shows that working on bodies (‘body work’) systematically delimits possibilities for labour process rationalisation which, in turn, constrains reorganisation of the health and social care sector. It does this in three main ways. First: rigidity in the ratio of workers to bodies-worked-upon limits the potential to increase capital-labour ratios or cut labour. Secondly: the requirement for co-presence and temporal unpredictability in demand for body work diminish the spatial and temporal malleability of the labour process. Thirdly: the nature of bodies as a material of production – complex, unitary and responsive – makes it difficult to standardise, reorganise or rationalise work. A wide-ranging analysis of body work in health and social care, as well as other sectors, fleshes out these three constraints and shows that attempts to overcome them and reorganise the sector in pursuit of cost savings or ‘efficiency’, generate problems for workers and the patients, whose bodies they work upon

Sustainability of supply chains in the wake of the coronavirus (COVID-19/SARS-CoV-2) pandemic:lessons and trends

Purpose The purpose of this article is to address the prioritisation and focus of supply chain managers subsequent to coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the great lockdown of 2020. Design/methodology/approach In this article, concepts and trends on resilient and sustainable supply chains are systematized. Main trends in sustainability of supply chains in the wake of COVID-19 are presented. Findings Guidelines on building smarter and more resilient supply chains are provided and future tendencies, which includes the increase of a sustainable consumption perspective, are highlighted. Originality/value This is a conceptual article blended with a practical approach aiming to propose guidelines for managers and scholars on how to address supply chain management challenges after the coronavirus pandemic

Etnocídio indígena, depressão e suicídio nos povos originários frente a pandemia do novo Coronavírus: Indigenous ethnocide, depression and suicide in originating people related to the Coronavirus pandemic

Complexa e assustadora é a realidade em que o Brasil passa diante da pandemia do novo Corona Vírus. Diversos estudos evidenciam como o adoecimento em larga escala da população influencia diretamente na saúde mental daqueles que estão inseridos nesse meio, sendo a depressão um dos problemas mais alertados e comentados. Sendo assim, muito já se é dito sobre como a população brasileira vai passar, e como posteriormente será afetada psicologicamente pela pandemia do Covid-19, sendo então inserido dentro desse cenário tudo aquilo se vê acontecendo durante esse período, como por exemplo, mortes em grande escala, decretos de lockdown, agravamento dos problemas financeiros e uma lenta vacinação da população. Dentro desse cenário, porém longe dos holofotes, estão as comunidades indígenas, que sofrem de maneira mais devastadora os impactos que todos sofrem. Dito isso, este trabalho tem o intuito de estudar as literaturas acerca do tema e refletir sobre essa problemática localizada além de concluir que em paralelo há um processo de etnocídio gerado para esses povos originários, pois por muitos estarem isolados da sociedade, se encontram mais vulneráveis ao vírus, gerando assim a possibilidade de terem suas culturas dizimadas junto com seu povo, nos levando a refletir que impacto à saúde mental dos indivíduos esse processo pode suscitar