The living standards of families with children reporting low incomes

The Government has high-profile child poverty targets which are assessed using a measure of income, as recorded in the Household Below Average Income series (HBAI). However, income is an imperfect measure of living standards. Previous analysis suggests that some children in households with low income do not have commensurately low living standards. This report aims to document the extent to which this is true, focusing on whether children in low-income households have different living standards depending on whether their parents are employed, self-employed, or workless

Examining the content validity of the Birthing Unit Design Spatial Evaluation Tool (BUDSET) within a woman-centred framework.

Introduction: The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audit tool, the Birth Unit Design Spatial Evaluation Tool (BUDSET), was developed to assess the optimality of birthing environments. The BUDSET is based on 4 domains (fear cascade, facility, aesthetics, support), each comprising design principles that are further differentiated into specific assessable design items. In the process of developing measurement tools, content validity must be established. The aim of this study was to establish the content validity of the BUDSET from the perspective of women and midwives. Methods: This was a mixed-methods study with a survey assessing agreement with BUDSET items and in-depth interviews. Survey results were analyzed using an item-level content validity index and a survey-level validity index. Interview data were analyzed using a directed content analysis approach. The study was conducted in 2 locations¿a major maternity hospital and a midwifery research center, both in Australia. Study participants were 10 women and 2 midwifery academics. Results: The survey revealed that content-related validity varied according to the BUDSET domain, with the domains of facility and support established as content valid by most participants. The domains of the fear cascade and aesthetic were less strong, particularly among pregnant women. Interview data analysis provided content validity evidence of both the fear cascade and aesthetic domains. A further 4 subthemes of fear cascade also were identified: foreign space, medical-hospital-emergency, being sterile/clinical, and protecting the woman from the environment. Content validity evidence for facility and support domains also was established. Discussion: This study has established that the BUDSET is content valid for assessing the optima ity of birthing environments. Some further refinement of the tool is now possible

Violence toward nurses, the work environment, and patient outcomes

Purpose: To relate nurses' self-rated perceptions of violence (emotional abuse, threat, or actual violence) on medical-surgical units to the nursing working environment and to patient outcomes.Design: Cross-sectional collection of data by surveys and primary data collection for 1-week periods on 94 nursing wards in 21 hospitals in two states of Australia.Methods: Nursing Work Index-Revised (NWI-R); Environmental Complexity Scale (ECS) PRN-80 (a measure of patient acuity); and a nursing survey with three questions on workplace violence; combined with primary data collection for staffing, skill mix, and patient outcomes (falls, medication errors).Findings: About one third of nurses participating (N=2,487, 80.3% response rate) perceived emotional abuse during the last five shifts worked. Reports of threats (14%) or actual violence (20%) were lower, but there was great variation among nursing units with some unit rates as high as 65%. Reported violence was associated with increased ward instability (lack of leadership; difficult MD and RN relationships). Violence was associated with unit operations: unanticipated changes in patient mix; proportion of patients awaiting placement; the discrepancy between nursing resources required from acuity measurement and those supplied; more tasks delayed; and increases in medication errors. Higher skill mix (percentage of registered nurses) and percentage of nurses with a bachelor of science in nursing degrees were associated with fewer reported perceptions of violence at the ward level. Intent to leave the present position was associated with perceptions of emotional violence but not with threat or actual assault.Conclusions: Violence is a fact of working life for nurses. Perceptions of violence were related to adverse patient outcomes through unstable or negative qualities of the working environment. Perceptions of violence affect job satisfaction.Clinical Relevance: In order to manage effectively the delivery of nursing care in hospitals, it is essential to understand the complexity of the nursing work environment, including the relationship of violence to patient outcomes. © 2009 Sigma Theta Tau International

Staff satisfaction and retention and the role of the Nursing Unit Manager

Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated. Crown Copyright © 2009

The implications of staff 'churn' for nurse managers, staff, and patients

▶ In this article, the term "churn" is used not only because of the degree of change to staffing, but also because some of the reasons for staff movement are not classified as voluntary turnover. ▶ The difficulties for the nurse managing a unit with the degree of "churn" should not be under-estimated. ▶ Changes to skill mix and the proportions of full-time, agency, and temporary staff present challenges in providing clinical leadership, scheduling staff, performance management, and supervision. ▶ Perhaps more importantly, it is likely that there is an impact on the continuity of care provided in the absence of continuity of staffing. ▶ A greater understanding of the human and financial costs and consequences, and a willingness to change established practices at the institutional and ward level, are needed

Submarine landslides in the Santa Barbara Channel as potential tsunami sources

International audienceRecent investigations using the Monterey Bay Aquarium Research Institutes (MBARI) Remotely Operated Vehicles (ROVs) "Ventana" and "Tiburon" and interpretation of MBARI's EM 300 30 kHz multibeam bathymetric data show that the northern flank of the Santa Barbara Basin has experienced massive slope failures. Of particular concern is the large (130 km2) Goleta landslide complex located off Coal Oil Point near the town of Goleta, that measures 14.6-km long extending from a depth of 90 m to nearly 574 m deep and is 10.5 km wide. We estimate that approximately 1.75 km3 has been displaced by this slide during the Holocene. This feature is a complex compound submarine landslide that contains both surfical slump blocks and mud flows in three distinct segments. Each segment is composed of a distinct head scarp, down-dropped head block and a slide debris lobe. The debris lobes exhibit hummocky topography in the central areas that appear to result from compression during down slope movement. The toes of the western and eastern lobes are well defined in the multibeam image, whereas the toe of the central lobe is less distinct. Continuous seismic reflection profiles show that many buried slide debris lobes exist and comparison of the deformed reflectors with ODP Drill Site 149, Hole 893 suggest that at least 200 000 years of failure have occurred in the area (Fisher et al., 2005a). Based on our interpretation of the multibeam bathymetry and seismic reflection profiles we modeled the potential tsunami that may have been produced from one of the three surfical lobes of the Goleta slide. This model shows that a 10 m high wave could have run ashore along the cliffs of the Goleta shoreline. Several other smaller (2 km2 and 4 km2) slides are located on the northern flank of the Santa Barbara Basin, both to the west and east of Goleta slide and on the Conception fan along the western flank of the basin. One slide, named the Gaviota slide, is 3.8 km2, 2.6 km long and 1.7 km wide. A distinct narrow scar extends from near the eastern head wall of this slide for over 2km eastward toward the Goleta slide and may represent either an incipient failure or a remnant of a previous failure. Push cores collected within the main head scar of this slide consisted of hydrogen sulfide bearing mud, possibly suggesting active fluid seepage and a vibra-core penetrated ~50 cm of recent sediment overlying colluvium or landslide debris confirming the age of ~300 years as proposed by Lee et al. (2004). However, no seeps or indications of recent movement were observed during our ROV investigation within this narrow head scar indicating that seafloor in the scar is draped with mud