Challenges of measuring and linking patient outcomes to nursing interventions in acute care settings

Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practise, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcome measures, nursing's lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes. The present article aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care.

Flow analysis based on a pulsed flow of solution: theory, instrumentation and applications

The increased demands placed on solution propulsion by programmed flow systems, such as sequential injection analysis, lab-on-value technology, bead injection and multi-commutation, has highlighted the inability of many conventional pumps to generate a smooth, consistent flow. A number of researchers have examined ways to overcome the inadvertent, uncontrolled pulsation caused by the mechanical action of peristaltic pumps. In contrast, we have developed instruments that exploit the characteristics of a reproducible pulsed flow of solution. In this paper, we discuss our instrumental approaches and some applications that have benefited from the use of a reproducible pulsed flow rather than the traditional linear flow approach. To place our approach in the context of the continuously developing field of flow analysis, an overview of other programmed flow systems is also presented.

Measuring refugee malnutrition in the under-fives: pitfalls in practice

This article reviews the merit of using the World Health Organization (WHO) / National Center for Health Statistics (NCHS) references to evaluate the nutritional status of refugees and famine-affected populations and the implication of the findings for further development of Public Health Nutrition programs. Public health nutrition interventions, in order to change the nutritional status of refugees and famine affected-populations, need to be based on accurate and appropriate reference criteria in order to satisfy demands for cost-effectiveness and preserve the human right to adequate food. However, many are confused by the current practice of estimating malnutrition in complex emergencies and it appears that the use of WHO/NCHS references may not be appropriate for use under these conditions in particular, and in the third world in general. To verify this claim, we conducted a literature review. Factors to be reviewed were selected a priori. Computer-assisted searches for English-language publications in the MEDLINE database were conducted and references cited in related publications were reviewed. The literature was restricted to published papers from 1975 to 2000, which focused on malnutrition and its measurement. Findings from the literature review indicate that there is a need to develop more appropriate references that are reflective of the field of intervention. In the absence of more appropriate references, this paper presents the advantages and disadvantages of using these references and some policy recommendations.

Design of LabVIEW® - based software for the control of sequential injection analysis instrumentation for the determination of morphine.

LabVIEW^®-based software for the automation of a sequential injection analysis instrument for the determination of morphine is presented. Detection was based on its chemiluminescence reaction with acidic potassium permanganate in the presence of sodium polyphosphate. The calibration function approximated linearity (range 5 × 10 ^-10 to 5 × 10 ^-6M) with a line of best fit of y = 1.05 x + 8.9164 (R² = 0.9959), where y is the log₁₀ signal (mV) and x is the log₁₀ morphine concentration (M). Precision, as measured by relative standard deviation, was 0.7% for five replicate analyses of morphine standard (5 × 10^-8_M). The limit of detection (3 σ) was determined as 5 × 10^-11 M morphine.

Measuring health in a vacuum: examining the disability weight of the DALY

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

Measuring the influence of fibre-to-fabric properties on the pilling of wool fabrics

This study ranks the contribution of various fibre, yarn and fabric attributes to the pilling of wool knitwear. On the basis of an artificial neural network modelling, a combination of sensitivity analysis, forwards/backwards search and genetic algorithms was used to identify the importance of various fibre/yarn/fabric input parameters. The three different techniques show broad similarities in their assessment of which input parameters are important or are not important in affecting fabric pilling. The ranking shows that fabric cover factor has the most effect on pilling, followed by yarn count and thin places, fibre length, yarn twist, etc. It is further illustrated that the directional trend of the predicted pilling outputs for a selection of inputs was in line with the expected behaviour. To verify the findings of input feature selection, input factors deemed to have a small effect on the predicted pilling output, such as fibre length and diameter variations and curvature, were removed and the subsequent performance statistically compared to the original multi-layer perceptron. Differences between the outputs predicted by the original and pruned models are found not to be statistically significant at the 5% significance level. Results from this study may help manufacturers and knitwear designers in choosing the most appropriate materials and structures to reduce the pilling propensity of wool knitwear.

Development, reliability and validity of an instrument measuring the attitudes and knowledge of emergency department staff regarding the emergency nurse practitioner role

Introduction: The Emergency Department (ED) at The Northern Hospital is currently participating in the Victorian Department of Human Services funded Emergency Nurse Practitioner Project. This project aims to develop, implement and evaluate the Emergency Nurse Practitioner role in Victorian EDs. This led to a need to develop a specific data collection tool called The Northern Emergency Nurse Practitioner Staff Survey to examine the knowledge and attitudes of ED medical and nursing staff. This paper describes the development of The Northern Emergency Nurse Practitioner Staff Survey and presents the results of reliability and validity studies. Method: Twenty-five items were developed and piloted on a sample of 58 ED medical and nursing staff. Content and face validity were established by expert panel review. Reliability was established by tests of unidimensionality, exploratory factor analysis and internal consistency. Results: Four items were discarded because of low item to total correlation. Exploratory factor analysis of the remaining items revealed five factors with eigenvalues >1 and acceptable correlation coefficients that explained 76.7% of the variance. Cronbach’s coefficent α for these items was 0.926 indicating a high degree of internal consistency. The factors were titled to reflect the content domain of the items in each factor and the factors arranged in a logical sequence to form the final version of The Northern Emergency Nurse Practitioner Survey.

Measuring Victoria

Efforts to integrate measures of well-being and sustainability have long existed within the literature. A recent approach is the Genuine Progress Indicator (GPI). The GPI is a monetary-based index that has been designed to ascertain the impact of a growing economy on sustainable well-being. The GPI is comprised of a large number of individual items that account for these wide-ranging impacts of economic growth, including social and environmental benefits and costs as well as those of the standard economic variety. Within this paper, the methodology of the GPI is presented. The impact of economic growth on sustainable well-being is also briefly reviewed for Victoria. This analysis is conducted by estimating a GPI for Victoria over the period 1986-2003.

Measuring Australia's well-being using hierarchical needs

A new approach to well-being measurement is presented in this paper based on multidimensional hierarchical human needs and motivation. This paper empirically applies this new measure of well-being to Australia for the period 1985–2000. This hierarchical approach is underpinned by a rigorous psychological theory of human motivation. Hierarchical human needs are classified into five categories. Eight indicators have been chosen to reflect these categories. A composite indicator of these eight indicators is calculated. This paper concludes that it is necessary to consider multidimensional human needs and motivation when analysing and seeking to improve well-being through economic and social development activities.

Measuring social welfare: application of social choice theory

This paper questions conventional approaches to measuring social welfare through gross domestic product (GDP). This paper is divided into two parts. The first part adopts a systems approach to development and incorporates this into the theory of social choice. The second part operationalises this approach through the development of a cost-benefit adjusted gross domestic product (CBAGDP) social welfare function, which overcomes certain limitations of this traditional measure of development. The CBAGDP is then used to estimate welfare in Thailand. This approach is justified because of its normative values and its plausible results.

Measuring human well-being in Thailand : a normative social choice approach

Numerous methods exist within the literature to measure human well-being. A limitation of some approaches however is that they fail to explicitly consider society's views, choices and preferences on how human well-being should be defined. It is possible though to explicitly incorporate society's value judgements in defining and measuring human well-being through normative social choice theory. Normative social choice theory reflects the views, opinions and perspectives of societies of differing economic and social circumstances so that measures of human well-being retain their relevance for public policy makers in those countries. This paper reviews two indicators based on this theory for Thailand over the 25 year period, 1975-1999. The first indicator focuses on certain hierarchical needs and the second is a measure of adjusted national income. It is concluded that both measures provide important insights.

Measuring consumer involvement : a test of the automobile involvement scale

This study empirically investigated consumer involvement with a product class. Data was collected from 178 vehicle buyers. Reliability and factor analyses investigated the structure of the Bloch (1981) instrument and the dimensions underlying involvement. In terms of replication, the results suggest the reduced-item version of the instrument previously proposed by Shimp and Sharma (1983) is reliable and is a less excessive measurement instrument. Similar dimensions underlying involvement with the product class are reported here. The study extends previous work by obtaining similar results in a different cultural setting, producing findings from a more relevant sample, applying an additional method of data collection, and suggesting that the underlying dimensions may be temporally stable.

Measuring marketing performance: a critique of empirical literature

This paper reviews 46 empirical studies which have assessed performance measurement in marketing. The paper reports on two highly relevant topics in regard to performance measurement: (1) subjective and objective measurement; and (2) financial and non-financial performance measures. Furthermore, the paper provides a tabulated summary of a comprehensive literature review of the types of performance measures utilised in recent literature. Firstly, it was found that there seems to be agreement about the use of a subjective measurement perspective as an acceptable means of measuring performance, and that this is the preferred means of measuring performance by researchers. Secondly, the literature review identified that businesses are no longer defining performance only in terms of the traditional financial measures – they are adopting new frameworks and methodologies. However, this change is not as prominent as might be thought, as financial measures still predominate in research results. Furthermore, this review of performance measures also identified that current measurement selection by researchers is somewhat arbitrary rather than scientific, which is not assisting in the development of a “general performance measure”.