Nurse staffing and workload drivers in small rural hospitals: An imperative for evidence

Purpose: The aim of this study was to explore staffing issues and the workload drivers influencing nursing activities in designated small rural hospitals of Western Australia. A problem for small rural hospitals is an imbalance between nurse staffing resources and work activity. Sample: A purposive sample of 17 nurse leaders employed at designated small rural hospitals in Western Australia. Method: A qualitative research design was used. Data were collected by focus group and semi-structured interviews and review of Western Australian Country Health Service records. Thematic analysis was used to interpret data. Findings: A minimum nurse staffing model is in use. Staff workload is generated from multiple activities involving 24-hour emergency services, inpatient care, and other duties associated with a lack of clinical and administrative services. These factors together impact on nursing staff resources and the skill mix required to ensure the safety and quality of patient care. Conclusion: Nurse staffing for small rural hospitals needs site-specific recording techniques for workload measurement, staff utilisation and patient outcomes. It is imperative that evidence guide nurse staffing decisions and that the workload driving nursing activity is reviewed

The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data

Objectives: The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. Design: Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/ post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury. Setting: Eleven acute care metropolitan hospitals in Western Australia. Sample: Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006–2007) and 130,540 in the post-test period (2009–2010). Results: The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia. Conclusion: The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored. ã 2016 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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

Russia in a changing climate

Climate change will shape the future of Russia, and vice versa, regardless of who rules in the Kremlin. The world\u27s largest country is warming faster than Earth as a whole, occupies more than half the Arctic Ocean coastline, and is waging a carbon-intensive war while increasingly isolated from the international community and its efforts to reduce greenhouse gas emissions. Officially, the Russian government argues that, as a major exporter of hydrocarbons, Russia benefits from maintaining global reliance on fossil fuels and from climate change itself, because warming may increase the extent and quality of its arable land, open a new year-round Arctic sea route, and make its harsh climate more livable. Drawing on the collective expertise of a large group of Russia-focused social scientists and a comprehensive literature review, we challenge this narrative. We find that Russia suffers from a variety of impacts due to climate change and is poorly prepared to adapt to these impacts. The literature review reveals that the fates of Russia\u27s hydrocarbon-dependent economy, centralized political system, and climate-impacted population are intertwined and that research is needed on this evolving interrelationship, as global temperatures rise and the international economy decarbonizes in response. This article is categorized under: Policy and Governance \u3e National Climate Change Policy Trans-disciplinary Perspectives \u3e National Reviews Trans-disciplinary Perspectives \u3e Regional Reviews. © 2023 The Authors. WIREs Climate Change published by Wiley Periodicals LLC

Mutations in multidomain protein MEGF8 identify a Carpenter syndrome subtype associated with defective lateralization

Carpenter syndrome is an autosomal-recessive multiple-congenital-malformation disorder characterized by multisuture craniosynostosis and polysyndactyly of the hands and feet; many other clinical features occur, and the most frequent include obesity, umbilical hernia, cryptorchidism, and congenital heart disease. Mutations of RAB23, encoding a small GTPase that regulates vesicular transport, are present in the majority of cases. Here, we describe a disorder caused by mutations in multiple epidermal-growth-factor-like-domains 8 (MEGF8), which exhibits substantial clinical overlap with Carpenter syndrome but is frequently associated with abnormal left-right patterning. We describe five affected individuals with similar dysmorphic facies, and three of them had either complete situs inversus, dextrocardia, or transposition of the great arteries; similar cardiac abnormalities were previously identified in a mouse mutant for the orthologous Megf8. The mutant alleles comprise one nonsense, three missense, and two splice-site mutations; we demonstrate in zebrafish that, in contrast to the wild-type protein, the proteins containing all three missense alterations provide only weak rescue of an early gastrulation phenotype induced by Megf8 knockdown. We conclude that mutations in MEGF8 cause a Carpenter syndrome subtype frequently associated with defective left-right patterning, probably through perturbation of signaling by hedgehog and nodal family members. We did not observe any subject with biallelic loss-of function mutations, suggesting that some residual MEGF8 function might be necessary for survival and might influence the phenotypes observed

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquitted events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Algorithm for nursing-sensitive outcomes used in adult populations have to be amended before application to paediatric populations. Using unlinked individual hospitalisation records to estimate rates of nursing-sensitive outcomes is likely to result in inaccurate rates

Diagnostic value of exome and whole genome sequencing in craniosynostosis

Background Craniosynostosis, the premature fusion of one or more cranial sutures, occurs in ~1 in 2250 births, either in isolation or as part of a syndrome. Mutations in at least 57 genes have been associated with craniosynostosis, but only a minority of these are included in routine laboratory genetic testing. Methods We used exome or whole genome sequencing to seek a genetic cause in a cohort of 40 subjects with craniosynostosis, selected by clinical or molecular geneticists as being high-priority cases, and in whom prior clinically driven genetic testing had been negative. Results We identified likely associated mutations in 15 patients (37.5%), involving 14 different genes. All genes were mutated in single families, except for IL11RA (two families). We classified the other positive diagnoses as follows: commonly mutated craniosynostosis genes with atypical presentation (EFNB1, TWIST1); other core craniosynostosis genes (CDC45, MSX2, ZIC1); genes for which mutations are only rarely associated with craniosynostosis (FBN1, HUWE1, KRAS, STAT3); and known disease genes for which a causal relationship with craniosynostosis is currently unknown (AHDC1, NTRK2). In two further families, likely novel disease genes are currently undergoing functional validation. In 5 of the 15 positive cases, the (previously unanticipated) molecular diagnosis had immediate, actionable consequences for either genetic or medical management (mutations in EFNB1, FBN1, KRAS, NTRK2, STAT3). Conclusions This substantial genetic heterogeneity, and the multiple actionable mutations identified, emphasises the benefits of exome/whole genome sequencing to identify causal mutations in craniosynostosis cases for which routine clinical testing has yielded negative results

Energy viability study of Microgrides in non-interconnected areas of the department of Cauca (Colombia)

Trabajo de Grado (Profundización)The feasibility of implementing a hybrid renewable energy system as a single microgrid that supplies the energy needs of a region isolated from the conventional network is studied, taking as a case the township of San Isidro in the Municipality of López de Micay located in the Department of Cauca (Colombia).1. INTRODUCTION 2. PROBLEM STATEMENT 3. OBJECTIVES 4. CONCEPTUAL FRAMEWORK 5. THEORETICAL FRAMEWORK 6. STATE OF ART 7. METHODOLOGY FOR SELECTING THE BEST ENERGY SYSTEMS FOR THE ISOLATED MICROGRID 8. APPLICATION OF THE METHODOLOGY 9. RESULTS 10. VALIDATION OF RESULTS 11. DESCRIPTION OF RESULTS 12. CONCLUSIONS AND FUTURE WORK REFERENCES ANNEXESMaestríaMagister en Ingeniería y Gestión de la Innovació

"To fly and to fight" : norms, institutions, and fighter aircraft procurement in the United States, Russia, and Japan

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Political Science, 1994.Vita.Includes bibliographical references (v. 2, 655-680).by Judyth L. Twigg.Ph.D

Western Australia facing critical losses in its midwifery workforce: A survey of midwives\u27 intentions

Objective: the ongoing attrition of the midwifery workforce frustrates future workforce planning and the provision of maternity services in Western Australia. This project determined factors contributing to the intention of the midwives to move jobs and/or leave the profession. Design: a cross-sectional survey approach was taken for this descriptive research utilising a self-administered questionnaire developed by the Nursing and Midwifery Office, Department of Health, Western Australia. Setting: public and private health sectors in Western Australia, April–May 2010. Participants: 1,600 midwives employed in the public and private health sectors throughout Western Australia were invited to participate: 712 responded (44.5%), one-fifth of the state\u27s registered midwives. Findings: most midwives worked part-time in a clinical role in public hospitals. Almost half intended moving jobs within 5 years and/or leaving midwifery. Excluding midwives of retirement age, the most common reasons for intending to move jobs were family commitments, working conditions and role dissatisfaction. Those intending to leave midwifery cited work-life balance, career change and family commitments. Midwives thought addressing the following issues would improve midwifery retention: flexible work arrangements, remuneration, staffing and caseload, workplace culture, professional development and models of care. Key conclusions: retaining the midwifery workforce requires attention to workforce practices particularly flexible work arrangements and workloads; models of care to strengthen midwives\u27 relationships with clients and colleagues; and accessible professional development. Implications for practice a review of workplace practices at unit and institution levels is urgently required in Western Australia so that midwives can achieve work-life balance and practice to the full extent of their professional role. These changes are necessary to forestall premature retirement of skilled and experienced midwives from the profession and workforce churn