Search

Background: Most studies have reported that higher levels (baccalaureate degree) of educational attainment by nurses are associated with lower levels of patient mortality. Researchers working in developed economies (e.g. North America and Europe) have almost exclusively conducted these studies. The value of baccalaureate nurse education has not been tested in countries with a developing economy. Method: A retrospective observational study conducted in seven hospitals. Patient mortality was the main outcome of interest. Anonymized data were extracted from nurses and patients from two different administrative sources and linked using the staff identification number that exists in both systems. We used bivariate logistic regression models to test the association between mortality and the educational attainment of the admitting nurse (responsible for assessment and care planning). Results: Data were extracted for 11 918 (12, 830 admissions) patients and 7415 nurses over the first 6 months of 2015. The majority of nurses were educated in South Asia and just over half were educated to at least bachelor degree level. After adjusting for confounding and clustering, nurse education was not found to be associated with mortality. Implications for nursing and health policy: Our observations may suggest that in a developing economy, the academic level of nurses’ education is not associated with a reduction in patient mortality. Findings should be interpreted with considerable caution but do challenge widely held assumptions about the value of baccalaureate‐prepared nurses. Further research focused on nursing education in developing economies is required to inform health policy and planning. [ABSTRACT FROM AUTHOR]

Aim To test the effect on patient mortality of implementing a nursing systems framework across a national health system. Background There have been five previous observational studies that have tested the effect of a nursing systems framework on clinical outcomes for patients. Implementation of a nursing systems framework in the health system of a developing country has not been evaluated. Design Quasi-experimental (before and after) study. Method A nursing systems framework consisting of six themes: (i) Professionalisation; (ii) Education; (iii) Structure; (iv) Quality of nursing care; (v) An academic health system; and (vi) Communication (Professional), was implemented across the national health system of Qatar in March 2015. Routine administrative data were extracted (March 2014-February 2016) for elective admissions. Our primary and secondary outcomes were, respectively, all cause mortality at discharge and readmission to hospital (within 28 days of discharge). We split the data into two time periods: before (March 2014-February 2015) and after (March 2015-February 2016) the implementation of the nursing systems framework. Multivariable regression modelling was used to examine the effect of the framework on patient mortality, after adjusting for key confounding variables (patient age, episode acuity, intensive care admission and length of stay). Findings Data were extracted for 318 548 patients (year 1 = 130 829; year 2 = 187 725). After adjusting for confounding, there was a significant association between the implementation of the nursing systems framework, mortality and readmission. Conclusion and implications for nursing policy and practice Our observations suggest that the implementation of a nursing systems framework may be important in improving outcomes for patients in emerging health systems. [ABSTRACT FROM AUTHOR]

An unusually thick and laterally persistent fluvial sand body crops out at the Paleocene-Eocene boundary within the northern part of the Bighorn Basin in northwest Wyoming, USA. The generation of this 'Boundary Sandstone' was previously ascribed to a period of reduced subsidence; however, a new carbon isotope record presented herein shows it to be intimately correlated to the Paleocene-Eocene Thermal Maximum ( PETM), an extreme global warming event ca. 56 Ma. This study evaluates the impacts of the PETM on fluvial deposition in the basin by integrating sedimentological data with geochemical, palaeoichnological, and palaeobotanical proxy records. Compared to pre- and post-PETM fluvial sand bodies, the Boundary Sandstone is more highly amalgamated, both vertically and laterally, but shows no changes in lithofacies associations, palaeodispersal directions, palaeoflow depths, or palaeochannel widths. At its thickest, the Boundary Sandstone resides entirely within the main body of the PETM, an ca. 113 kyr time interval when global pCO2 levels and temperatures were at their highest, and local mean annual rainfall low, floodplains well drained and vegetation comparatively sparse. The totality of data sets imply that the Boundary Sandstone is related to the preferential removal of fine-grained floodplain deposits by either: (i) rapid readjustments in river gradients related to documented short-term precipitation oscillations or (ii) reductions in the cohesiveness of overbank sediments related to decreased rooting density and water table fluctuations. Hence, short-term climate perturbations may manifest within large-scale depositional patterns in ways ostensibly like tectonics. [ABSTRACT FROM AUTHOR]