Using Discrete Event Simulation (DES) to manage theatre operations in healthcare: An audit-based case study

This paper discusses the application of Discrete Event Simulation (DES) in modelling the complex relationship between patient types, case-mix and operating theatre allocation in a large National Health Service (NHS) Trust in London. The simulation model that was constructed described the main features of nine theatres, focusing on operational processes and patient throughput times. The model was used to test three scenarios of case-mix and to demonstrate the potential of using simulation modelling as a cost effective method for understanding the issues of healthcare operations management and the role of simulation techniques in problem solving. The results indicated that removing all day cases will reduce patient throughput by 23.3% and the utilization of the orthopaedic theatre in particular by 6.5%. This represents a case example of how DES can be used by healthcare managers to inform decision making. © 2008 IEEE.

Effects of control of C/N ratio by low-cost carbohydrate addition on water quality and pond ecology in freshwater prawn Macrobrachium rosenbergii post-larvae nursing system

An experiment was conducted to evaluate the effects of control of carbon/nitrogen ratio (C/N ratio) by addition of low cost carbohydrate to the water column on water quality and pond ecology in freshwater prawn Macrobrachium rosenbergii post-larvae nursing system. In this experiment, two level of dietary protein 20% and 35% without carbohydrate addition (‘P20' and ‘P35') and with carbohydrate addition (‘P20+CH' and ‘P35+CH') were compared in small ponds of 40 m² area stocked with 20 post-larvae (0.021 ± 0.001g) per m² . Maize flour was used as low cost carbohydrate and applied to the water column followed by the first feeding during the day. The addition of carbohydrate significantly reduced (p< 0.05) ammonia-nitrogen (NH sub(3)-N) and nitrite-nitrogen (NO sub(2) - N) of water in P20 + CH and P35 + CH treatments. It significantly increased (p< 0.05) the total heterotrophic bacteria (THB) population both in water and sediment. Fifty nine genera of plankton were identified belonging to the Bacillariophyceae (11), Chlorophyceae (21), Cyanophyceae (7), Dinophyceae (1), Rotifera (7) and Crustacea (9) without any significant difference (p>0.05) of total phytoplankton and zooplankton among the treatments. Survival rate of prawn was significantly lowest (p<0.05) in P20 and no significant difference (p>0.05) was observed between P20+CH and P35 treatments. Control of C/N ratio by the addition of low-cost carbohydrate to the pond water column benefited the freshwater prawn nursing practices in three ways (1) increased heterotrophic bacterial growth supplying bacterial protein augment the prawn post-larvae growth performances, (2) reduced demand for supplemental feed protein and subsequent reduction in feed cost and (3) reduced toxic NH sub(3)-N and NO sub(2)-N levels in pond nursing system.

The use of podcasts to enhance research-teaching linkages in undergraduate nursing students.

An understanding of research is important to enable nurses to provide evidencebasedcare. However, undergraduate nursing students often find research a challenging subject. The purpose of this paper is to present an evaluation of the introduction of podcasts in an undergraduate research module to enhance research teaching linkages between the theoretical content and research in practice and improve the level of student support offered in a blended learning environment. Two cohorts of students (n=228 and n=233) were given access to a series of 5 “guest speaker” podcasts made up of presentations and interviews with research experts within Edinburgh Napier. These staff would not normally have contact with students on this module, but through the podcasts were able to share their research expertise and methods with our learners. The main positive results of the podcasts suggest the increased understanding achieved by students due to the multi-modal delivery approach, a more personal student/tutor relationship leading to greater engagement, and the effective use of materials for revision and consolidation purposes. Negative effects of the podcasts centred around problems with the technology, most often difficulty in downloading and accessing the material. This paper contributes to the emerging knowledge base of podcasting in nurse education by demonstrating how podcasts can be used to enhance research-teaching linkages and raises the question of why students do not exploit the opportunities for mobile learning.

Reviewing the evidence on nursing record systems

Urquhart, C. & Currell, R. (2005). Reviewing the evidence on nursing record systems. Health Informatics Journal, 11(1), 33-44. First appeared as a paper in iSHIMR2004, Proceedings of the Ninth International Symposium on Health Information Management Research, 15-17 June 2004, Sheffield, UK.

Re-focusing risk assessment in forensic mental health nursing.

Editorial in the Journal of Psychiatric and Mental Health Nursing, 2015, 22(7)

Hypertension - a contemporary approach to nursing care

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors such as obesity can be controlled, others for example genetics are more difficult to treat because often there is more than one factor involved. This paper explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. It is more cost-effective, staff is more productive and clients are more compliant with treatment.

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.

US imperialism in action: An audit-based appraisal of the Coalition Provisional Authority in Iraq

This paper drawing from audit reports reflects upon the post-Iraq war administration the Coalition Provisional Authority (CPA). It argues that the CPA’s compliance with basic levels of decent public administration were akin to Guantanamo’s compliance with basic levels of natural justice. The audit reports demonstrate that the CPA was a chaotic administration which spent billions without proper controls or procedures and left precious Iraqi oil revenues open to fraudulent acts. The CPA failed to comply with its obligations under UN resolutions. It identifies the geopolitical/economic implications of the US government which was partly motivated by economic concerns but it was also motivated by political concerns—the imposition of US hegemony. It then turns to the broader economic imperatives of the falling rate of profit and the imposition of neoliberalism (market fundamentalism).

Why do nursing students who consider leaving stay on their courses?

A global shortage of nurses means there is an increasing interest in attrition rates among nursing students. This UK research by Julie Bowden looked at attrition from the perspective of those who almost left, but ultimately stayed. It highlights the importance of the support provided by personal tutors.

Violence and aggression in the emergency department: factors impinging on nursing research

This paper examines issues involved in the debate regarding the role of research in nursing. The authors take the example of violence and aggression in the emergency field to discuss methodological, philosophical, professional, logistical, power differentials and leadership theory that influence and explain the process of conducting research surrounding violence and aggression experienced by nurses working in emergency departments. The paper examines the importance of research and discusses practical issues that impinge or frustrate clinical nursing staff who wish to conduct original research.

Meeting the health needs of people with learning disabilities: guidance for nursing staff

This guide has been produced to support registered nurses and nursing students in primary and secondary care, who are trained in branches other than learning disabilities, to deliver high quality health care to people with learning disabilities.