Nursing resources and patient outcomes in intensive care: a systematic review of the literature

Objectives: To evaluate the empirical evidence linking nursing resources to patient outcomes in intensive care settings as a framework for future research in this area. Background: Concerns about patient safely and the quality of care are driving research on the clinical and cost-effectiveness of health care interventions, including the deployment of human resources. This is particularly important in intensive care where a large proportion of the health care budget is consumed and where nursing staff is the main item of expenditure. Recommendations about staffing levels have been trade but may not be evidence based and may not always be achieved in practice. Methods: We searched systematically for studies of the impact of nursing resources (e.g. nurse-patient ratios, nurses' level of education, training and experience) on patient Outcomes, including mortality and adverse events, in adult intensive care. Abstracts of articles were reviewed and retrieved if they investigated the relationship between nursing resources and patient Outcomes. Characteristics of the studies were tabulated and the quality of the Studies assessed. Results: Of the 15 studies included in this review, two reported it statistical relationship between nursing resources and both mortality and adverse events, one reported ail association to mortality only, seven studies reported that they Could not reject the null hypothesis of no relationship to mortality and 10 studies (out of 10 that tested the hypothesis) reported a relationship to adverse events. The main explanatory mechanisms were the lack of time for nurses to perform preventative measures, or for patient surveillance. The nurses' role in pain control was noted by One author. Studies were mainly observational and retrospective and varied in scope from 1 to 52 units. Recommendations for future research include developing the mechanisms linking nursing resources to patient Outcomes, and designing large multi-centre prospective Studies that link patient's exposure to nursing care oil a shift-by-shift basis over time. (C) 2007 Elsevier Ltd. All rights reserved.

Trust, leadership and economic necessity in post-compulsory education

Trust is a complex concept that has increasingly been debated in academic research (Kramer and Tyler, 1996). Research on 'trust and leadership' (Caldwell and Hayes, 2007) has suggested, unsurprisingly, that leadership behaviours influence 'follower' perceptions of leaders' trustworthiness. The development of 'ethical stewardship' amongst leaders may foster high trust situations (Caldwell, Hayes, Karri and Bernal, 2008), yet studies on the erosion of teacher professionalism in UK post-compulsory education have highlighted the distrust that arguably accompanies 'new managerialism', performativity and surveillance within a climate of economic rationalisation established by recent deterministic skills-focused government agendas for education (Avis, 2003; Codd, 1999, Deem, 2004, DFES, 2006). Given the shift from community to commercialism identified by Collinson and Collinson (2005) in a global economic environment characterised by uncertainty and rapid change, trust is, simultaneously, increasingly important and progressively both more fragile and limited in a post compulsory education sector dominated by skills-based targets and inspection demands. Building on such prior studies, this conference paper reports on the analysis of findings from a 2007-8 funded research study on 'trust and leadership' carried out in post-compulsory education. The research project collected and analysed case study interview and survey data from the lifelong learning sector, including selected tertiary, further and higher education (FE and HE) institutions. We interviewed 18 UK respondents from HE and FE, including principals, middle managers, first line managers, lecturers and researchers, supplementing and cross-checking this with a small number of survey responses (11) on 'trust and leadership' and a larger number (241) of survey responses on more generalised leadership issues in post-compulsory education. A range of facilitators and enablers of trust and their relationship to leadership were identified and investigated. The research analysed the ways in which interviewees defined the concept of 'trust' and the extent to which they identified that trust was a mediating factor affecting leadership and organisational performance. Prior literature indicates that trust involves a psychological state in which, despite dependency, risk and vulnerability, trustors have some degree of confident expectation that trustees will behave in benevolent rather than detrimental ways. The project confirmed the views of prior researchers (Mayer, Davis and Schoorman, 1995) that, since trust inevitably involves potential betrayal, estimations of leadership 'trustworthiness' are based on followers' cognitive and affective perceptions of the reliability, competence, benevolence and reputation of leaders. During the course of the interviews it also became clear that some interviewees were being managed in more or less transaction-focused, performative, audit-dominated cultures in which trust was not regarded as particularly important: while 'cautious trust' existed, collegiality flourished only marginally in small teams. Economic necessity and survival were key factors influencing leadership and employee behaviours, while an increasing distance was reported between senior managers and their staff. The paper reflects on the nature of the public sector leadership and management environment in post-compulsory education reported by interviewees and survey respondents. Leadership behaviours to build trust are recommended, including effective communication, honesty, integrity, authenticity, reliability and openness. It was generally felt that building trust was difficult in an educational environment largely determined by economic necessity and performativity. Yet, despite this, the researchers did identify a number of examples of high trust leadership situations that are worthy of emulation.

(Un)veiling desire: re-defining relationships between gendered adult education subjects and adult education programmes

My underlying argument, in this paper, is that conceptualisations of power as a commodity, through which the 'disempowered-as-illiterate' subject moves towards becoming an 'empowered-as-literate' subject, forces constructs of identities into a powerful/powerless dichotomy which does not always do justice to diverse experiences. The claimed 'empowering' intentions of adult education programme and policy practice may, in reality, contribute to the dominance of restrictive disciplining and regulatory discursive practices. Moving away from emancipatory trajectories of adult education programmes that allege only liberation from domination, through 'literacy', can promise freedom points to another position of hope. Drawing on Foucauldian analysis, I explore sites of resistance as possibilities of transforming 'structures of understanding' at different levels. Officially validated and recognised transformations, in adult education programme as well as policy understandings, of the 'illiterate' subject may also hope to include choices in postures of autonomy (see Spivak 1996) made by programme participants in other 'fields' of socio-cultural practice linked to their material realities. Subsequently, 'empowerment' of the 'illiterate Indian village woman' cannot solely be imagined as a product of laws, policies and institutional discursive practices (see, for example, Gouws 2005; Rai 2003 on gender mainstreaming and Mosse 2005 on aid policy and practice). The 'illiterate Indian village woman' represented as a site of resistance, throughout this paper, displaces homogeneous representations of the 'illiterate' which situate her in the role of 'dependent' or 'victim', as failed attempts to rob her of her historical and political agency (Mohanty 1996). Through narrating other 'images' of refusal in my ethnographic vignettes, I hope to recognise different individuals' sense of agency, at all levels, as embedded in and evolving through forms of collective action that activate differences in order to develop possibilities and sustain hope for transforming historically rooted discursive practices of inequality. I provide ethnographic accounts of resisting 'literacy' programme participants, based in different villages in Bihar (Northern India), as accounts of resistance impacted on by notions of norms, translating and interpreting Others, networks and empowerment.

But no one in my family has been to university - aiming higher: school students attitudes to higher education

In this paper, we present findings from the second stage of a three year longitudinal study involving 3,570 students aged 13-18 in a London Borough looking at the impact of Widening Participation (WP) on the attitudes of students. We outline findings from a previous stage and then focus specifically on two cohorts of Year 10 students (aged 14-15) in two consecutive years. The students completed the specially designed Attitudes to Higher Education Questionnaire (AHEQ) and provided information on WP activities in which they had participated. Data on the students' academic attainment and social backgrounds were also included. There were significant sex and cohort differences and interactions which were found to be related to WP activities specifically aimed at increasing the participation of socially disadvantaged students in higher education. The implications of findings are discussed in relation to theories of social identity and self concept and the implementation of strategies to increase participation in Higher Education

Continuing Professional Development: rhetoric and practice in the NHS

This article explores the experience of Continuing Professional Development (CPD) by supervisory-level clinical staff in the National Health Service. Four main themes are highlighted in the literature, namely the nature and experience of CPD, its relationship with human resource management practices and in particular in career development and planning. These themes are examined utilising sources of (triangulated) empirical data based on a 2500 sample survey conducted across five NHS Trusts. A key finding was that responsibility for learning and development was perceived as belonging to the individual rather than the organisation. Other findings concern a lack of resource-based commitment by the organisation to CPD for clinical staff undertaking supervisory-level roles and evidence of 'credentialism' with its emphasis on seeking certificated qualifications. The findings raise concerns about the potential for clinical staff to become disillusioned and to perceive a potential breach in their psychological contract because of problems in reconciling their own interests with those of their professional body, and that of their employer in relation to CPD.

‘Nothing will prevent me from doing a good job’. The professionalisation of part-time teaching staff in further and adult education

Approximately 85,000 part-time teaching staff working in further education (FE) and adult and community learning (ACL) are often seen as ‘a problem’. The intrinsic ‘part-timeness’ of these staff tends to marginalise them: they remain under-recognised and largely unsupported. Yet this picture is over-simplified. This article examines how part-time staff make creative use of professional autonomy and agency to mitigate problematic ‘casual employment’ conditions, reporting on results from Learning and Skills Development Agency-sponsored research (2002–2006) with 700 part-time staff in the learning and skills sector. The question of agency was reported as a key factor in part-time employment. Change is necessary for the professional agency of part-timers to be harnessed as the sector responds to ambitious sectoral ‘improvement’ agendas following the Foster Report and FE White Paper. Enhanced professionalisation for part-time staff needs greater recognition and inclusion in change agendas.