Public interests in water concession disputes

The flux of foreign investment into the water industry led to the internationalisation of contracts and of the method of settlement of possible disputes. When disputes over the performance of a water concession give origin to investor-state arbitrations, public authorities are put in a challenging position. The state need to combine two different roles – its role in the provision of services of public interest and the fulfilment of its international legal obligations arising from international investment agreements. The complexity of this relationship is patent in a variety of procedural and substantive issues that have been surfacing in arbitration proceedings conducted before the International Centre for Settlement of Investment Disputes. The purpose of this dissertation is to discuss the impact of investment arbitration on the protection of public interests associated with water services. In deciding these cases arbitrators are contributing significantly in shaping the contours and substance of an emerging international economic water services regime. Through the looking glass of arbitration awards one can realise the substantial consequences that the international investment regime has been producing on water markets and how significantly it has been impacting the public interests associated with water services. Due consideration of the public interests in water concession disputes requires concerted action in two different domains: changing the investment arbitration mechanism, by promoting the transparency of proceedings and the participation of non-parties; and changing the regulatory framework that underpins investments in water services. Combined, these improvements are likely to infuse public interests into water concession arbitrations.

Pressure ulcer management in Oman: nurses’ knowledge and views

Background: Pressure ulcers (PrUs) have a significant impact on health system expenditure and patient’s quality of life. It is a global problem. Many studies were undertaken in regard to PrU prevention and management. In Oman, no studies have been conducted to investigate nurses’ knowledge on prevention and management of PrUs. The purpose of this descriptive sequential explanatory mixed-method study was to explore the nurses’ level of knowledge in relation to prevention and management of PrUs in Oman. Methods: A mixed method design was used and the study was conducted over two Phases. In Phase I, a questionnaire was developed to explore nurses’ knowledge on PrU, policy, and resources. The main section of the questionnaire was the Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) which tests the knowledge on PrU. Another two sections were developed including questions about wound policy and resources available for PrU prevention and management in Oman. The questionnaire was distributed to nurses who were working in surgical, medical, orthopaedic, CCU, and ICU wards/units in seven hospitals. In Phase II study, semi-structured qualitative interviews were conducted with 16 of the questionnaire respondents. Interviews took approximately 30 minutes, were recorded and transcribed verbatim. Qualitative data were analysed using the Knowledge, Attitudes and Practice (KAP) model as the a priori framework. Results: In Phase I, 478 questionnaires were analysed. The knowledge test results showed the overall mean percent score for correctly answered questions was 51% suggesting a low level of knowledge. There was a significant relationship between nurses’ knowledge and age (P=0.001) and between knowledge and years of experience (P=0.001) with knowledge increasing with age and years of experience. In Phase II, four themes were identified from the interviews: knowledge, attitude, and practice (framework themes) and perception of role. Findings indicated positive and negative attitudes towards the care of PrUs. Some nurses stated feeling rewarded when they see wounds improving while others said they could not work with patients independently because they lacked the knowledge and the skills needed. There was variation in the management of PrU between hospitals. Both studies indicated that the wound management policy did not include enough information to guide nurses. Conclusion: Overall the nurses’ level of knowledge on PrU was relatively low. Most nurses were not familiar with wound management policy or different PrU prevention and management strategies. Nurses are aware of the risk of PrUs and try their best to manage them with the available resources however more training is required.