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.

[Book review] Rights of the Accused, Crime Control and Protection of Victims

Review of: Rights of the Accused, Crime Control and Protection of Victims. Edited by Eliahu Harnon & Alex Stein. A special volume of the Israel Law Review, Vol. 31, Nos. 1-3, Winter-Summer 1997. Published by the Faculty of Law, Hebrew University, Jerusalem.

Meaning of "residing with" and succession rights

Reviews case law on the meaning of the phrase "residing with" as used in the Housing Act 1985 s.87 to identify one of the qualifying requirements for the right to succeed to a secure tenancy. Focuses on the Court of Appeal decision in Freeman v Islington LBC on whether a daughter intended to have her settled home with her father where, in the year preceding her father's death she lived with him full time in order to care for him whilst retaining her own flat and using it as her correspondence address for everything but her credit card. Lists conclusions that can be drawn from the case law.

Performing injustice: human rights and verbatim theatre

Discusses the theatrical treatment of human rights, by reference to three British productions: Guantanamo: "Honor Bound to Defend Freedom" (2004), My Name is Rachel Corrie (2005) and Called to Account (2007), noting the use of verbatim testimony in such plays. Reviews legal scholarship highlighting the limitations of human rights laws. Considers the theatrical context of each of the plays and the ways in which they represent the status of human rights laws. Comments on the extent of theatre's practical impact on the advancement of human rights.

Healthcare: rejection of privatisation and patient fees in Central Europe

Since 2006, there have been successful campaigns against commercialisation of public health services in the four central European countries – Czech Republic, Hungary, Poland and Slovakia.

Rights for cohabitants

Reviews the guidance given by the House of Lords in Stack v Dowden on quantifying the beneficial interests of cohabiting parties in their former family home when one party seeks to rebut the presumption of joint beneficial ownership. Comments on the subsequent application of the principles by the county court in Adekunle v Ritchie and by the Privy Council in Abbott v Abbott, highlighting the approaches used to establish an equitable interest and to quantify the parties' shares in the properties. Considers whether statutory intervention is now needed to resolve the difficulties. [From Legal Journals Index]

Counter-terrorism, anti-extremism, armed conflict and human rights: using a Russian case study

This paper critically examines Russia’s compliance with human rights obligations and the rule of law in its ‘war on terror’. It seeks to draw wider parallels with respect for human rights in the framework of the fight against ‘new global terrorism’. Threats to due process, the discriminatory application of the forces of law and order specifically against perceived “non-traditional” Muslim communities, and a ratcheting up of fear of an Islamist threat can be traced following the war in Chechnya and the handling of the Dubrovka Theatre and Beslan school sieges. To what extent are there commonalities with UK complicity in the practice of extraordinary rendition, with atrocities perpetrated in Iraq and Afghanistan, and abuses in Abu Ghraib and Guantanamo? Are the impact of these reflected in domestic security policy and British minority ethnic community relations? [From the Author]

The art of auscultation: evaluating a patient's respiratory pathology

This article considers national policy drivers promoting the development of advanced assessment skills and practical procedures for the safe and effective use of the stethoscope in the clinical area. The evidence base underpinning effective use of the stethoscope in clinical practice is explored, including the preparation of the patient and the environment, applying infection control policies, and placing an emphasis on privacy and dignity. This is followed by a practical guide to auscultation technique of the respiratory system for nurses developing advanced practice skills.

Ethnic variations in the experiences of mental health service users in England: results of a national patient survey programme

Background: Minority ethnic groups in the UK are reported to have a poor experience of mental health services, but comparative information is scarce. Aims: To examine ethnic differences in patients’ experience of community mental health services. Method: Trusts providing mental health services in England conducted surveys in 2004 and 2005 of users of community mental health services. Multiple regression was used to examine ethnic differences in responses. Results: About 27 000 patients responded to each of the surveys, of whom 10% were of minority ethnic origin. In the 2004 survey, age, living alone, the 2004 survey, age, living alone, detention and hospital admissions were stronger predictors of patient experience than ethnicity. Self-reported mental health status had the strongest explanatory effect. In the 2005 survey, the main negative differences relative to the White British were for Asians. Conclusions: Ethnicity had a smaller effect on patient experience than other variables. Relative to the White British, the Black group did not report negative experiences whereas the Asian group were most likely to respond negatively. However, there is a need for improvements in services for minority ethnic groups, including access to talking therapies and better recording of ethnicity.

The impact of the nursing workforce on patient outcomes in intensive care

Introduction: Evidence from studies conducted mainly in the US and mainland Europe suggests that characteristics of the workforce, such as nurse patient ratios and workload (measured in a number of different ways) may be linked to variations in patient outcomes across health care settings (Carmel and Rowan 2001). Few studies have tested this relationship in the UK thus questions remain about whether we are justified in extrapolating evidence from studies conducted in very different health care systems. Objectives: To investigate whether characteristics of the nursing workforce affect patient mortality UK Intensive Care Units. Data: Patient data came from the case mix programme, Intensive Care National Audit and Research Centre (ICNARC), while information about the units came from a survey of all ICUs in England (Audit Comission 1998). The merged data set contained information on 43,859 patients in 69 units across England. ICNARC also supplied a risk adjustment variable to control for patient characteristics that are often the most important determinants of survival. Methods: Multivariate multilevel logistic regression. Findings: Higher numbers of direct care nurses and lower scores on measures of workload(proportion of occupied beds at the time the patient was admitted and mean daily transfers into the unit) were associated with lower mortality rates. Furthermore, the effect of the number of direct care nurses was greatest on the life chances of the patients who were most at risk of dying. Implications: This study has wide implications for workforce policy and planning because it shows that the size of the nursing workforce is associated with mortality (West et al 2006). Few studies have demonstrated this relationship in the UK. This study has a number of strengths and weaknesses and further research is required to determine whether this relationship between the nursing workforce and patient outcomes is causal.