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.

Risikowahrnehmung und psychologische Reaktionen in öffentlichen Krisensituationen am Beispiel von Terrorattentaten / Risk perception and psychological reactions in public crisis situations using the example of terror attacks

The reactions to the 9/11 terror attacks were immense in the western population. In the current review, the impact of terror attacks is presented with surveys, clinical interviews, and scientific polls, which were identified in a comprehensive literature search. Results show that the fear of further terror attacks is comparatively overestimated in the population and is associated with numerous psychological consequences and reactions. The overestimation of the probability of further terror attacks is related among other reasons to its unique features and its strong representation in the media. Several independent studies proved that the number of stress symptoms and psychiatric diagnoses is associated with a high risk perception in relation to terror attacks. This was not only the case for victims of terror attacks, but also for people indirectly exposed to the terror attacks. In addition, there is evidence that the number of the stress symptoms correlate with the duration of TV consumption of new findings about terror attempts. Methodologically, there is a critical lack of more in-depth analyses to explain the development of risk perceptions and its influence on mental and physical health. Because of the international importance and cross-cultural differences, an international standardization of research is desirable. [In German] Die Reaktionen auf die Terrorattentate vom 9. September 2001 in New York waren in der westlichen Bevölkerung immens. In der vorliegenden Übersichtsarbeit werden die Auswirkungen von Terrorattentaten durch Einbeziehung bevölkerungsrepräsentativer Untersuchungen, Surveys, klinischer Interviews und Einstellungsbefragungen dargestellt, die über eine deskriptive Literaturrecherche ermittelt wurden. Als Ergebnis des Reviews zeigt sich, dass die Angst vor weiteren Terrorattentaten in der Bevölkerung vergleichsweise hoch und mit zahlreichen psychologischen Folgen und Reaktionen assoziiert ist. Die Einschätzung der Auftretenswahrscheinlichkeit eines Terrorattentats hängt unter anderem mit den besonderen Charakteristika und der hohen medialen Präsenz des Themas zusammen. Die Anzahl der Stresssymptome bis hin zu psychiatrischen Diagnosen erwies sich in mehreren unabhängigen Untersuchungen mit einer hohen Risikowahrnehmung assoziiert. Dies ließ sich nicht nur bei den Opfern von Terrorattentaten, sondern auch bei indirekt Betroffenen zeigen. Darüber hinaus gibt es mehrfache Belege dafür, dass die Anzahl der Stresssymptome mit der Dauer des TV-Konsums über Neuigkeiten zu Terrorattentaten zusammenhing. Als methodische Kritik ist an den gegenwärtigen Untersuchungsszenarien einzuwenden, dass es derzeit keine tiefer gehenden Analysen zur Entwicklung der Risikowahrnehmung und zu ihrem Einfluss auf die Gesundheit gibt. Aufgrund der internationalen Bedeutung des Themas und der interkulturellen Unterschiede im Umgang mit Krisensituationen ist eine internationale Standardisierung von Untersuchungszugängen wünschenswert.

A grey literature review of the Cultural Olympiad

This article considers the development of the UK Cultural Olympiad supporting London's successful bid to stage the Olympic Games in 2012. It suggests that the Cultural Olympiad is a complex event itself and needs to be better understood if any impacts are to be felt in a meaningful sense. The event is thus considered through review of over 50 documents relating to its management, in the context of a number of identified themes: cultural development, developing institutional frameworks, social benefit, educational benefit and promotional benefit.

Jung’s cultural writing: spiral essays and performing symbols (in literature)

Performance is a key ingredient of Jung’s writings on culture and of the function of the Jungian symbol in literature. This paper will compare and contrast Jung’s performance of cultural analysis and healing in his essays with the way his notion of the symbol works in literature to knit the individual psyche into the collective. It will explore Jung’s unique essay form of the spiral as a literary innovation, and look at the way a Jungian reading of literary reveals a significant contribution to cultural studies. [From the Author]

Psyche and the arts: Jungian approaches to music, architecture, literature, painting and film

Does art connect the individual psyche to history and culture? Psyche and the Arts challenges existing ideas about the relationship between Jung and art, and offers exciting new dimensions to key issues such as the role of image in popular culture, and the division of psyche and matter in art form. Divided into three sections - Getting into Art, Challenging the Critical Space and Interpreting Art in the World - the text shows how Jungian ideas can work with the arts to illuminate both psychological theory and aesthetic response. Psyche and the Arts offers new critical visions of literature, film, music, architecture and painting, as something alive in the experience of creators and audiences challenging previous Jungian criticism. This approach demonstrates Jung’s own belief that art is a healing response to collective cultural norms. This diverse yet focused collection from international contributors invites the reader to seek personal and cultural value in the arts, and will be essential reading for Jungian analysts, trainees and those more generally interested in the arts. [From the Publisher]

Literature and the shaman: Jung, trauma stories and new origin stories in The Lion, the witch and the wardrobe by C.S. Lewis

The paper first considers the role of Jungian ideas in relation to academic disciplines and to literary studies in particular. Jung is a significant resource in negotiating developments in literary theory because of his characteristic treatment of the ‘other’. The paper then looks at The Lion, the Witch and the Wardrobe (1950) by C.S. Lewis whose own construction of archetypes is very close to Jung’s. By drawing upon new post-Jungian work from Jerome Bernstein’s Living in the Borderland (2005), the novel is revealed to be intimately concerned with narratives of trauma and of origin. Indeed, a Jungian and post-Jungian approach is able to situate the text both within nature and in the historical traumas of war as well as the personal traumas of subjectivity. Where Bernstein connects his work to the postcolonial ethos of the modern Navajo shaman, this new weaving of literary and cultural theory points to the residue of shamanism within the arts of the West. [From the Publisher]

Discourse and soul: Jung, literature, science and tragedy as mythical writing

This paper will propose that literature and science, far from being discrete spheres of cultural activity, are, in fact, the cultural expressions of interlocking myths. They therefore overlap and even take each other’s places, as examination of the ‘science’ of C.G. Jung and the ‘art’ of a writer such as John Cowper Powys, will show. ‘Dis-course’, I argue, is the material aspect of the mythical structuring of psychic experience. In the work of Jung and Powys, discourse is the articulation of the soul in the world that spans personal, social, natural and cosmic space. [From the Author]

Postcolonial futures: postcolonial literature and the Obama moment

Since the late 1970s the western academy has encouraged the development of postcolonial literary theory and the formulation of a postcolonial literary canon existing outside the prescriptive narratives of the ‘mother’ country and empire. Having lost faith in the binary oppositions underpinning such narratives, we turned to alternative fictions that contested the construction of the ‘other’, the world divided between the ‘West and the Rest’. The publication of Edward Said’s Orientalism in 1978 marked the beginning of the discipline now known as postcolonial studies with its new ways of understanding ‘the west’s’ relationship with ‘the east’ and, by extension, all the former colonies of empire. Despite these radical origins, however, postcolonialism’s more recent emphasis on the psychological and its affirmation of the hybrid text and self has, for many, served to obscure real economic social realities that have very little to do with the magical or wondrous textual expression of a postcolonial identity. This paper considers problems associated with defining the postcolonial and proposes that, in a literary context, we broaden its meaning to include texts traditionally outside the category of postcolonial literature. To extend the meaning of postcolonial is timely as we are now witnessing its relocation from ‘margin’ to ‘centre’ with the election of Barack Obama. This moment may be seen as a disruption of conventional understandings of what constitutes postcolonial literature, essentially as oppositional discourse that could only define itself as peripheral to, or ‘post’, metropolitan and economic concerns. [From the Author]

An overview of the literature concerning the oceanography of the eastern North Atlantic region

An overview of the main oceanographic features of the eastern North Atlantic boundary, with emphasis toward the upper layers, is presented. The principal features discussed are: water mass boundaries; forcing by wind, density and tides; topographic features and effects; fronts; upwelling and downwelling; poleward flows; coastal currents; eddies. The occurrence and spatial and seasonal variability of these features is described in five regional sections: Celtic Sea and western English Channel; Bay of Biscay; western Iberia; Gulf of Cadiz; northwest Africa. This paper is intended to provide a base of physical oceanographic knowledge in support of research in fisheries, biological and chemical oceanography, and marine biology.