A systematic review of the association between nursing staff and nursing-sensitive outcomes in long-term institutional care

Aims To examine the association between type of nursing staff and nursing-sensitive outcomes in long-term institutional care. Design This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020. Data sources The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included. Review methods The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to critically appraise the reporting of the studies. Results Fifteen articles were included. Of 33 quality of care outcomes, 21 were identified as nursing-sensitive outcomes of which 13 showed a significant association with nursing staff, specifically: Activities of daily living, aggressive behavior, bladder/bowel incontinence, contractures, expressive language skills, falls, infection (including vaccination), range of motion, pain, pressure ulcers, and weight loss. However, studies reported inconsistent results regarding the association among RNs, LPNs, CNAs, and HCAs and these nursing-sensitive outcomes, evidence shows that more RNs have a positive impact on nursing-sensitive outcomes. As to the evidence regarding the other type of nursing staff, especially HCA, findings regularly showed a negative association. Conclusion Future research should be expanded with structure and process variables of which the mediating and moderating effect on nursing-sensitive outcomes is known. These may explain variances in quality of care and guide quality improvement initiatives. Researchers should consider fully applying Donabedian's structure-process-outcomes framework as it is a coherent entirety for quality assessment. Impact This review provides an overview of quality of care outcomes that are responsive to nursing interventions in long-term institutional care. As the effects can be monitored and documented, quality assessment should focus on these nursing-sensitive outcomes. The inconclusive results make it difficult to provide recommendations on who should best perform which care

Sustainable Agricultural Productivity Growth and Bridging the Gap for Small-Family Farms: Interagency Report to the Mexican G20 Presidency

In 2011, G20 leaders committed to sustainably increase agricultural (production and) productivity (paragraph 43 of the Cannes Declaration). They "agree(d) to further invest in agriculture, in particular in the poorest countries, and bearing in mind the importance of smallholders, through responsible public and private investment," they "decide(d) to invest in research and development of agricultural productivity. Early in 2012 Mexico, as G20 President, invited international organisations to examine practical actions that could be undertaken to sustainably improve agricultural productivity growth, in particular on small family farms. The preparation of this report, co-ordinated by the FAO and the OECD, responds to this request. It is a collaborative undertaking by Bioversity, CGIAR Consortium, FAO, IFAD, IFPRI, IICA, OECD, UNCTAD, Coordination team of UN High Level Task Force on the Food Security Crisis, WFP, World Bank, and WTO. We, the international organisations, are pleased to provide you with this joint report and look forward to continuing collaboration within the G20 framework to further elaborate and, as appropriate, implement the recommendations that it contains

What determines women's participation in collective action? Evidence from a western Ugandan coffee cooperative

Women smallholders face greater constraints than men in accessing capital and commodity markets in Sub-Saharan Africa. Collective action has been promoted to remedy those disadvantages. Using survey data of 421 women members and 210 nonmembers of a coffee producer cooperative in Western Uganda, this study investigates the determinants of women's participation in cooperatives and women's intensity of participation. The results highlight the importance of access to and control over land for women to join the cooperative in the first place. Participation intensity is measured through women's participation in collective coffee marketing and share capital contributions. It is found that duration of membership, access to extension services, more equal intrahousehold power relations, and joint land ownership positively influence women's ability to commit to collective action. These findings demonstrate the embeddedness of collective action in gender relations and the positive value of women's active participation for agricultural-marketing cooperatives

Natural capital accounting perspectives: a pragmatic way forward

Introduction: Recent debates surrounding the application of natural capital accounting (NCA) have produced several approaches to further develop this system, as well as highlighted a number of conceptual and methodological issues that need to be resolved before mainstreaming NCA into policy and decision making. We argue that prolonged debate over the value concepts (i.e., exchange versus other values) underpinning different modifications to NCA has slowed progress in experimentation and uptake by policymakers.Outcomes: Consequently we propose three broad approaches which can be progressed in parallel to reinvigorate experimentation with the NCA principles and practice, while at the same time generating policy relevant tools and evidence bases for decision support. The three approaches are; extended SNA accounting anchored to the use of exchange values; a complementary accounts network (CAN) that utilizes plural values as supplementary accounts to the SNA system; and wealth accounting that focuses on measures of welfare and wellbeing. The three approaches are complementary and data developed in any one can inform the other two.Conclusions: We contend that CAN offers the most flexibility and opportunities to progress short term support for decision making on environmental issues which are now becoming urgent

Securing effective and equitable coverage of marine protected areas : the UK's progress towards achieving Convention on Biological Diversity commitments and lessons learned for the way forward

Current international agreements call for protecting 10% of marine and coastal waters by 2020, with the intention of increasing that target to 30% by 2030. With 24% of its territorial waters protected, the UK falls short of the new expected target. As well as quantitative targets, qualitative criteria have been internationally agreed for protected area designation, including minimum coverage values and characteristics that encompass effectively and equitably managed, ecologically representative and well-connected systems of protected areas and other effective area-based conservation measures, and integrated into the wider landscape and seascape. The legal framework supporting protected area designations at sea is summarized and explained for UK territorial waters. Efforts to date to achieve current marine protected area (MPA) targets are reviewed, with emphasis on how well the existing protected area portfolio captures the qualitative criteria. Examples are given of other effective conservation measures complementary to formalized MPAs, especially with regard to achieving and promoting qualitative criteria for biodiversity conservation, including appropriate recognition of and support for areas conserved by indigenous people, local communities and private entities. A precis on the governance of MPAs and other effective conservation measures in the UK and its overseas territories is presented. Whilst the UK has made exceptional progress with quantitative MPA coverage, it is still not clear whether designated areas offer effective protection. A UK-level strategy is in place to address this; and at site level, Lyme Bay MPA illustrates the benefits of addressing qualitative criteria. Illustrated by the UK example, an urgent call is made for ongoing and future marine in situ area-based conservation efforts to substantiate quantitative and qualitative considerations, and to ensure that MPA networks are ultimately fit for purpose