1,721,054 research outputs found
Safe staffing for nursing in emergency departments: evidence review
No full textOBJECTIVE: Getting staffing levels wrong in hospitals is linked to excess mortality and poor patient experiences but establishing the safe nurse staffing levels in the emergency department (ED) is challenging because patient demand is so variable. This paper reports a review conducted for the National Institute for Health and Care Excellence (NICE) which sought to identify the research evidence to inform UK nursing workforce planning.DESIGN: We searched 10 electronic databases and relevant websites for English language studies published from 1994. Studies included reported a direct measure of nurse staffing relative to an activity measure (eg, attendances, patient throughput) or an estimate of nurse staffing requirements. Randomised or non-randomised trials, prospective or retrospective observational, cross-sectional or correlational studies, interrupted time-series, and controlled before and after studies were considered.RESULTS: We identified 16,132 items via databases and 2193 items through manual and other searching. After title/abstract screening (by one reviewer, checked by a second) 55 studies underwent full assessment by the review team. 18 studies met the inclusion criteria for the NICE review, however 3 simulation studies that reported simulated rather than measured outcomes are not reported here.CONCLUSIONS: The evidence is weak but indicates that levels of nurse staffing in the ED are associated with patients leaving without being seen, ED care time and patient satisfaction. Lower staffing is associated with worse outcomes. There remain significant gaps and in particular a lack of evidence on the impact of staffing on direct patient outcomes and adequate economic analyses to inform decisions about nurse staffing. Given that an association between nurse staffing levels and patient outcomes on inpatient wards has been demonstrated, this gap in the evidence about nurse staffing in EDs needs to be addressed
An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland
No full textAimTo evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice.BackgroundThe number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain.DesignA multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients' records and 208 medications prescribed by 25 Registered Nurse Prescribers.MethodsData were extracted from patient and prescription records between March–May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen's kappa statistic (inter-rater reliability).ResultsNurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95–96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug–drugs or disease–condition interaction, and duplication of therapy were judged appropriate in 87–92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)?80% (reviewer 1) of prescribing decisions met all eight criteria.ConclusionThe majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing
Effectiveness of management approaches and organisational factors on nurse sensitive outcomes
No full textThis review is the second of two reviews to inform the safe staffing guideline. The first review investigated three broad questions 1) which patient safety outcomes are associated with nurse and healthcare assistant staffing levels and skill mix 2) how the ward environment, including physical layout and diversity of clinical disciplines, affect safe staffing requirements and 3) what patient factors affect nurse and healthcare assistant staffing requirements at different times during the day.The second review aims to explore evidence to inform guidance related to the following twosets of questions, as set out in the scope (NICE, 2013).1. What management approaches affect nurse and healthcare assistant staffing requirements? a. What nursing staff supervisory approaches and/or team management approaches are required? As supervisory approaches the following are considered:i. Supervisory ward staffii. Leadership approachesiii. Systems of organising nursing workb. What approaches for identifying required nurse staffing levels and skills mix are effective, and how frequently should they be used?2. What organisational factors influence staffing at a ward level? This includes: a. Management structures and approachesb. Organisational cultur
The experience of social and emotional loneliness of older people in Ireland
No full textThis paper reports a study of the risk factors for social and emotional loneliness among older people in Ireland. Using the ‘Social and Emotional Scale for Adults’, the social and emotional dimensions of loneliness were measured. Emotional loneliness was conceptualised as having elements of both family loneliness and romantic loneliness. The data were collected through a national telephone survey of loneliness in older people conducted in 2004 that completed interviews with 683 people aged 65 or more years. It was found that levels of social and family loneliness were low, but that romantic loneliness was relatively high. Predictors for social loneliness were identified as greater age, poorer health, living in a rural area, and lack of contact with friends. Living in a rural setting, gender (male), having a lower income, being widowed, no access to transport, infrequent contact with children and relatives and caring for a spouse or relative at home were significant predictors of family loneliness. Romantic loneliness was predicted by marital status, in particular being widowed. Never having married or being divorced or separated were also significant predictors for romantic loneliness. The findings indicate that loneliness for older people is variable, multi-dimensional and experienced differently according to life events, with, for example, the death of a partner being followed by the experience of emotional loneliness, or the loss of friends or declining health leading to social loneliness
The association between patient safety outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements
No full textIntroductionIdentifying safe approaches to nurse staffing in hospital wards is a key challenge for healthservice providers. The National Institute for Health and Care Excellence (NICE) has beenasked by the Department of Health and NHS England to develop an evidence-basedguideline on safe and efficient staffing in acute adult inpatient wards.This review is the first of two reviews to inform the safe staffing guideline. It aims to exploreevidence to inform guidance related to the following three sets of questions, set out in thescope.1. What patient safety outcomes are associated with nurse and healthcareassistant staffing levels and skill mix?a. What outcomes are associated with tasks undertaken by registerednurses, healthcare assistants (HCA), and other staff?b. Which outcomes should be used as indicators of safe staffing?2. What patient factors affect nurse and healthcare assistant staffingrequirements at different times during the day? These include:a. Patient dependency and acuity assessment and gradingb. Patient turnover.3. How does the ward environment, including physical layout and diversity ofclinical disciplines, affect safe staffing requirements
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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