Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Effects of average speed enforcement on speed compliance and crashes : a review of the literature

Average speed enforcement is a relatively new approach gaining popularity throughout Europe and Australia. This paper reviews the evidence regarding the impact of this approach on vehicle speeds, crashes rates and a number of additional road safety and public health outcomes. The economic and practical viability of the approach as a road safety countermeasure is also explored. A literature review, with an international scope, of both published and grey literature was conducted. There is a growing body of evidence to suggest a number of road safety benefits associated with average speed enforcement, including high rates of compliance with speed limits, reductions in average and 85th percentile speeds and reduced speed variability between vehicles. Moreover, the approach has been demonstrated to be particularly effective in reducing excessive speeding behaviour. Reductions in crash rates have also been reported in association with average speed enforcement, particularly in relation to fatal and serious injury crashes. In addition, the approach has been shown to improve traffic flow, reduce vehicle emissions and has also been associated with high levels of public acceptance. Average speed enforcement offers a greater network-wide approach to managing speeds that reduces the impact of time and distance halo effects associated with other automated speed enforcement approaches. Although comparatively expensive it represents a highly reliable approach to speed enforcement that produces considerable returns on investment through reduced social and economic costs associated with crashes.

A new civics curriculum for Australian schools : is it national education?

In nation states and regions including Australia, Hong Kong, other countries of Asia, the European Economic Community and elsewhere, Civics and Citizenship education (CCE) is a contested concept. The development of The Australian Curriculum is providing a national opportunity for educators to rethink curriculum priorities and to decide on new emphases for learning in Australian schools, but policy documents have emphasized the importance of CCE for all young Australians. In this paper we discuss the notion of citizenship education as ‘national education’ in Australia. We suggest that while the development of CCE in Australia does include elements of ‘national education’, the new curriculum provides an opportunity to frame the civil, political and social components of CC for young Australians in ways that include local, national and global understandings. We argue that CCE should broaden young peoples’ world views and their passion and capacity to express their own identity, so they can be active and engaged citizens in diverse communities that include their own communities, the nation and beyond.

A comparison of Chinese and Australian early childhood mathematics

In the 21st century mathematics proficiency is synonymous with a numerate citizenry. In the past few decades young children’s ability to reason mathematically and develop mathematical proficiencies has been recognised. This paper explores the history of early childhood mathematics (ECME) that may explicate differences in Chinese and Australian contexts. Results of this review established that China and Australia are diametrically positioned in ECME. Influencing each countries philosophies and practices are their cultural beliefs. ECME in China and Australia must be culturally sustainable to achieve excellent outcomes for young children. Ongoing critique and review is necessary to ensure that ECME is meeting the needs of all teachers and children in their particular context. China and Australia with their rich contrasting philosophies can assist each other in their journeys to create exemplary ECME for the 21st century.

Sustainable infrastructure operations : a review of assessment schemes and decision support

Infrastructure forms a vital component in supporting today’s way of life and has a significant role or impact on economic, environmental and social outcomes of the region around it. The design, construction and operation of such assets are a multi-billion dollar industry in Australia alone. Another issue that will play a major role in our way life is that of climate change and the greater concept of sustainability. With limited resources and a changing natural world it is necessary for infrastructure to be developed and maintained in a manner that is sustainable. In order to achieve infrastructure sustainability in operations it is necessary for there to be: a sustainability assessment scheme that provides a scientifically sound and realistic approach to measuring an assets level of sustainability; and, systems and tools to support the making of decisions that result in sustainable outcomes by providing feedback in a timely manner. Having these in place will then help drive the consideration of sustainability during the decision making process for infrastructure operations and maintenance. In this paper we provide two main contributions; a comparison and review of sustainability assessment schemes for infrastructure and their suitability for use in the operations phase; and, a review of decision support systems/tools in the area of infrastructure sustainability in operations. For this paper, sustainability covers not just the environment, but also finance/economic and societal/community aspects as well. This is often referred to as the Triple Bottom Line and forms one of the three dimensions of corporate sustainability [Stapledon, 2004].

Embedding environmental sustainability in the undergraduate chemistry curriculum : a case study

In spite of increasing attention devoted to the importance of embedding sustainability in university curricula, few Australian universities include specific green chemistry units, and there is no mention of green or sustainable chemistry concepts in the majority of units. In this paper, an argument is posited that all universities should embed sustainable chemistry within all Chemistry courses because it is the morally correct stance to minimise the harm of climate change. Attitudes of chemistry lecturers towards integrating sustainability into their teaching have been probed and it was found, using an established model, that personal environmental perspectives are critical to their attitude. Importantly, academic staff whose research has an environmental component were more likely to incorporate sustainability into their teaching while others struggled to find ways to do so even when they believed it to be important. This paper will recommend that resources are required to assist academic staff without a green chemistry research program to incorporate sustainability into their teaching and several suggestions are provided.

Generalizing curriculum policy across boarders : crossing boundaries

"This essay is a critique of the scientific and policy rationales for transnational standardization. It analyzes two examples of policy export: early childhood standards in one of North America’s oldest Indigenous communities and the ongoing development of international standards for university teaching. It examines calls for American education to look to Finland, Canada, and Singapore for models of reform and innovation, focusing on the complex historical, cultural, and political settlements at work in these countries. The author addresses two affiliated challenges: first, the possibility of a principled understanding of evidence and policy in cultural and political-economic context, and second, the possibility of a mediative educational science that might guide policy formation." -- EDUCATIONAL RESEARCHER November 2011 vol. 40 no. 8 367-377

Nutritional support and functional capacity in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Currently there is confusion about the value of using nutritional support to treat malnutrition and improve functional outcomes in chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to clarify the effectiveness of nutritional support in improving functional outcomes in COPD. A systematic review identified 12 RCTs (n = 448) in stable COPD patients investigating the effects of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 10 RCTs), enteral tube feeding (1 RCT)] versus control on functional outcomes. Meta-analysis of the changes induced by intervention found that whilst respiratory function (FEV(1,) lung capacity, blood gases) was unresponsive to nutritional support, both inspiratory and expiratory muscle strength (PI max +3.86 SE 1.89 cm H(2) O, P = 0.041; PE max +11.85 SE 5.54 cm H(2) O, P = 0.032) and handgrip strength (+1.35 SE 0.69 kg, P = 0.05) were significantly improved, and associated with weight gains of ≥ 2 kg. Nutritional support produced significant improvements in quality of life in some trials, although meta-analysis was not possible. It also led to improved exercise performance and enhancement of exercise rehabilitation programmes. This systematic review and meta-analysis demonstrates that nutritional support in COPD results in significant improvements in a number of clinically relevant functional outcomes, complementing a previous review showing improvements in nutritional intake and weight.

Conceptualising teachers’ assessment literacies in an era of curriculum and assessment reform

Teacher assessment literacy is a phrase that is often used but rarely defined. Yet understanding teacher assessment literacy is important in an international curriculum and assessment reform context that continues to challenge teachers’ assessment practices. In this article situated examples of classroom assessment literacies are analysed using Bernstein’s (Pedagogy, symbolic control and identity: Theory, research and critique, Taylor and Francis, London, 1996; Br J Sociol Educ 20(2):157–173, 1999) theoretical tools of vertical and horizontal discourses, classification and framing. Drawing on a sociocultural view of learning, the authors define teacher assessment literacies as dynamic social practices which are context dependent and which involve teachers in articulating and negotiating classroom and cultural knowledges with one another and with learners, in the initiation, development and practice of assessment to achieve the learning goals of students. This conceptualisation of assessment literacy aims to make explicit some underpinning theoretical constructs of assessment literacy to inform dialogue and decision making for policy and practice to benefit student learning and achievement.

Visioning technology-based simulated learning environments in the social work curriculum

This report, prepared by QUT Social Work and Human Services, in collaboration with key sector stakeholders, identifies the current and potentially expanded uses of Simulated Learning Environments (SLE) as part of the Health Workforce Australia (HWA) National Project. An expert Reference Group guided the project, facilitated the data collection, and provided feedback and support on the findings and broad recommendations.

Soft power in China : public diplomacy through communication [Review]

Review of Soft Power in China: Public diplomacy through communication, edited by J IAN WANG, New York, Palgrave Macmillan, 2011, US$89 (hard), 220 pp