The organisation of nurse staffing in intensive care units: a qualitative study

© 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License. https://creativecommons.org/licenses/by/4.0/Aims: To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates. Background: Pre-pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence. Methods: Focus groups with intensive care health care professionals (n= 52 participants) and individual interviews with critical care network leads and policy leads (n= 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis. Findings: Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes. Conclusions: Whilst nurse: patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re-allocation during a shift took into account many other factors, such as patient and family nursing needs, staff wellbeing, intensive care layout and the experience, and availability, of other members of the multi-professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies. Implications for Nursing Management in order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket ‘ratio’ approach to nurse staffing, intended to apply uniformly across health services.Peer reviewe

Health professional perceptions of communicating with adolescents and young adults about bone cancer clinical trial participation

Purpose: Low recruitment of adolescents and young adults in cancer clinical trials is widely reported and may be linked to limited improvements in survival. Research to date does not adequately explain all underlying reasons for poor trial accrual. This paper reports health professional perceptions of communicating with adolescents and young adults with bone sarcoma about clinical trial participation. Methods: This study used narrative inquiry. Findings are reported from thematic analysis of in-depth interviews with eighteen multi-disciplinary health professionals working in a supra-regional bone and soft tissue sarcoma centre. Results: Participants described professional expertise, the development of specialist knowledge and skills, and strategies used to develop trusting relationships with adolescents and young adults with bone sarcoma. These factors were perceived to facilitate communication about clinical trial participation. Emergent themes were: having credibility through expertise of the team; developing specialist communication skills through reflection on practice; having inclusive approaches to education and training about clinical trials; individual communication styles used to form trusting relationships; using a patient-centred approach to connect with adolescents and young adults; creating time needed to form trusting relationships; and effective team working. Conclusions: We aligned findings of this study with characteristics of patientphysician trust and provide a basis for transferable recommendations. Our findings can be used to inform the development of age-specific, specialist communication skills and highlight health professional education needs about clinical trials. Additional research is needed to explore which elements of team working optimise improved clinical trial participation, in what contexts, and why

The extragalactic sub-mm population: predictions for the SCUBA Half-Degree Extragalactic Survey (SHADES)

We present predictions for the angular correlation function and redshift distribution for SHADES, the SCUBA HAlf-Degree Extragalactic Survey, which will yield a sample of around 300 sub-mm sources in the 850 micron waveband in two separate fields. Complete and unbiased photometric redshift information on these sub-mm sources will be derived by combining the SCUBA data with i) deep radio imaging already obtained with the VLA, ii) guaranteed-time Spitzer data at mid-infrared wavelengths, and iii) far-infrared maps to be produced by BLAST, the Balloon-borne Large-Aperture Sub-millimeter Telescope. Predictions for the redshift distribution and clustering properties of the final anticipated SHADES sample have been computed for a wide variety of models, each constrained to fit the observed number counts. Since we are dealing with around 150 sources per field, we use the sky-averaged angular correlation function to produce a more robust fit of a power-law shape w(theta)=(theta/A)^{-delta} to the model data. Comparing the predicted distributions of redshift and of the clustering amplitude A and slope delta, we find that models can be constrained from the combined SHADES data with the expected photometric redshift information.Comment: updated and improved version, accepted for publication in the MNRA

A narrative study exploring representations of identity for young adults with cancer: from diagnosis through treatment

This study aimed to explore the impact of cancer on young adults’ evolving sense of self and identity, by listening to their stories over one year from the time of diagnosis. Data were collected using a range of methods: in depth, free association narrative interviews at three time points; photographs taken by participants; and extensive reflexive field notes. Forty interviews were conducted with eighteen young adults, sixteen to thirty years of age. Eight of the participants took part in three interviews, six participants in two interviews, five participants took photographs. Eight longitudinal cases were analysed in depth, visual images were analysed from discussion in the narrative text. Through memoing, coding and comparison themes were developed across all cases and all participant’s data. Five cases have been reported as longitudinal stories to illustrate the interplay between the internal and external over the year from diagnosis. Higher order themes across all the data demonstrate the renegotiation of self over time, both developmental and in terms of ‘cancer time’, through the core components of: the inner world, (psyche, emotion and coping); self as embodied; self as relating to others, and self as relating to place. The study offers new insights into the experience of young adults with cancer and the value of basing care on individual experience beyond age but situated within biography and identity. The findings demonstrate the intensity of the juxtaposition of cancer and developmental stage and highlight the importance of visual and oral narratives and a psychosocial lens in both research and practice. The study suggests the value of narrative as a prospective intervention in health care to support sense making, identity renegotiation and revision; to give patients a voice. The study also highlights the importance professionals to be supported in ‘being with’ and in walking alongside people going through life changing illness

Diversity of toxin and non-toxin containing cyanobacterial mats of meltwater ponds on the Antarctic Peninsula: a pyrosequencing approach

Despite their pivotal role as primary producers, there is little information as to the diversity and physiology of cyanobacteria in the meltwater ecosystems of polar regions. Thirty cyanobacterial mats from Adelaide Island, Antarctica were investigated using 16S rRNA gene pyrosequencing and automated ribosomal intergenic spacer analysis, and screened for cyanobacterial toxins using molecular and chemical approaches. A total of 274 operational taxonomic units (OTUs) were detected. The richness ranged between 8 and 33 cyanobacterial OTUs per sample, reflecting a high mat diversity. Leptolyngbya and Phormidium (c. 55% and 37% of the OTUs per mat) were dominant. Cyanobacterial community composition was similar between mats, particularly those obtained from closely adjacent locations. The cyanotoxin microcystin was detected in 26 of 27 mats (10–300 ng g-1 organic mass), while cylindrospermopsin, detected for the first time in Antarctica, was present in 21 of 30 mats (2–156 ng g-1 organic mass). The latter was confirmed via liquid chromatography-mass spectrometry and by the presence of the cyrAB and cyrJ genes. This study demonstrates the usefulness of pyrosequencing for characterizing diverse cyanobacterial communities, and confirms that cyanobacteria from extreme environments produce a similar range of cyanotoxins as their temperate counterparts

'More than just money'– widening the understanding of the costs involved in cancer care

Aim. This paper examines the literature relating to the wider concept of cost in cancer care and the implications this has for the development of services particularly within the changing context of cancer care. Background. Cancer remains a major cause of morbidity and mortality in the United Kingdom (UK), treatment is often complex and expensive; both in financial and human terms. Service patterns for cancer care are shifting away from traditional inpatient, hospital settings towards short stay/day-care and home care models. This is in response to developments in health care policy, but it is also because of the availability of better tolerated treatments and demand for more patient-focused health care. Review of the literature. The databases of Cinhahl and Medline were accessed using the keywords of costs, treatment, outpatients, home care and cancer. Additional sources of literature were also accessed through hand searching key journals. The paper explores the literature in three themes. First, the cost-effectiveness of cancer treatment; second, the often invisible indirect or 'out of pocket' costs incurred by patients and their families during cancer treatment and finally, the 'human costs' of a cancer diagnosis and cancer therapy. Conclusions. In view of recent calls to improve the effectiveness of cancer care in the UK, we suggest that research is needed to address all the dimensions of cost. It is only by exploring total costs from this broad perspective that appropriate, effective and holistic services can be planned for the future

Adolescent cancer - the need to evaluate current service provision in the UK

This article suggests that service provision for adolescents with cancer requires further attention by health service researchers. Evidence of the care needs of this patient group remains scarce, particularly in terms of evaluations of the available care settings in the UK. The authors discuss the challenges facing the adolescent cancer patient population, and discuss the findings from a recent ethnographic evaluation of one of the first specialist UK units dedicated to the care of adolescents with cancer. The implications for further evaluative research, education and staff-related concerns are explored in the light of the findings