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.

A new 14+: vocational diplomas and the future of schools, colleges and universities. An educational and campaigning pamphlet

Written in an accessible and campaigning style, this pamphlet affords a valuable context to the introduction of the first group of specialist diplomas for 14 year olds in September 2008. The diplomas are the latest in a line of failed initiatives that have sought to provide vocational ‘alternatives’ for those young people staying in full-time education and not considered ‘academic’. Rather than developing any useful employment skills, Allen and Ainley argue that their introduction reflects the changing significance of education in the division and social control of learners that now extends from school to college and on to university. Those who are opposed to the current post-14 agenda, must not only put forward radical alternatives to the current curriculum offer but also, the authors argue, address issues of democracy and accountability. To do this, teacher trade unionists must make new types of alliances with local communities and also with their students.