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- Dall'Ora, C, et al.
(författare)
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Nurses' 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study
- 2019
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 9:1, s. e024778-
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Tidskriftsartikel (refereegranskat)abstract
- 12-hour shifts worked by nurses on acute hospital wards have been associated with increased rates of missed care reported by nurses. This study aimed to measure the association between nurses working shifts of at least 12 hours and an objective measure of missed care: vital signs observations taken on time according to an acuity-based surveillance protocol.DesignA retrospective observational study using routinely collected data from March 2012 to March 2015.Setting32 general inpatient wards at a large acute hospital in England.Participants658 628 nursing shifts nested in 24 069 ward days.Outcome measuresThe rate of daily delayed and missed vital signs observations. We focused on situations where vital signs observations were required at least every 4 hours and measured the number of instances where observations were delayed or missed, per 24-hour period. For each ward and each day, shift patterns were characterised in terms of proportion of care hours per patient day deriving from ‘long’ shifts (≥12 hours) for both registered nurses and healthcare assistants.ResultsOn 99 043 occasions (53%), observations were significantly delayed, and on 81 568 occasions (44%), observations were missed. Observations were more likely to be delayed when a higher proportion of the hours worked by healthcare assistants were part of long shifts (IRR=1.05; 95% CI 1.00 to 1.10). No significant association was found in relation to the proportion of hours registered nurses worked as long shifts.ConclusionOn days when a higher proportion of hours worked by healthcare assistants are from long shifts, the risk of delaying vital signs observations is higher, suggesting lower job performance. While longer shifts are thought to require fewer staff resources to maintain nurse-to-patient ratios, any benefits may be lost if staff become less productive.
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| 2. |
- Bowler, D. E., et al.
(författare)
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Mapping human pressures on biodiversity across the planet uncovers anthropogenic threat complexes
- 2020
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Ingår i: People and Nature. - : Wiley. - 2575-8314. ; 2:2, s. 380-394
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Tidskriftsartikel (refereegranskat)abstract
- Climate change and other anthropogenic drivers of biodiversity change are unequally distributed across the world. Overlap in the distributions of different drivers have important implications for biodiversity change attribution and the potential for interactive effects. However, the spatial relationships among different drivers and whether they differ between the terrestrial and marine realm has yet to be examined. We compiled global gridded datasets on climate change, land-use, resource exploitation, pollution, alien species potential and human population density. We used multivariate statistics to examine the spatial relationships among the drivers and to characterize the typical combinations of drivers experienced by different regions of the world. We found stronger positive correlations among drivers in the terrestrial than in the marine realm, leading to areas with high intensities of multiple drivers on land. Climate change tended to be negatively correlated with other drivers in the terrestrial realm (e.g. in the tundra and boreal forest with high climate change but low human use and pollution), whereas the opposite was true in the marine realm (e.g. in the Indo-Pacific with high climate change and high fishing). We show that different regions of the world can be defined by Anthropogenic Threat Complexes (ATCs), distinguished by different sets of drivers with varying intensities. We identify 11 ATCs that can be used to test hypotheses about patterns of biodiversity and ecosystem change, especially about the joint effects of multiple drivers. Our global analysis highlights the broad conservation priorities needed to mitigate the impacts of anthropogenic change, with different priorities emerging on land and in the ocean, and in different parts of the world. Abstrakt Der Klimawandel und andere anthropogene Faktoren, die die biologische Vielfalt verandern, betreffen nicht alle Teile der Erde in gleicher Weise. Wahrend unsere Kenntnisse zu jedem einzelnen Gefahrdungsfaktor standig wachsen, ist unser Verstandnis zu den raumlichen Beziehungen zwischen den verschiedenen Faktoren und ihr Zusammenwirken noch sehr mangelhaft. Das betrifft z.B. auch die Unterschiede zwischen terrestrischen und marinen Lebensraumen, die sehr unterschiedlichen Bedrohungen ausgesetzt sein konnen, selbst wenn sie eng benachbart sind. In der vorliegenden Studie haben wir globale Datensatze uber Klimawandel, Landnutzung, Ressourcenausbeutung, Umweltverschmutzung, biologische Invasionen und Bevolkerungsdichte zusammengestellt. Mit Hilfe multivariater Statistiken haben wir die raumlichen Beziehungen zwischen diesen Ursachen des globalen Biodiversitatswandels und deren Kombinationen untersucht, um deren Einfluss auf verschiedene Regionen der Welt zu charakterisieren. Insbesondere in den terrestrischen Regionen wirken die genannten Gefahrdungsfaktoren haufig in der gleichen Richtung, vor allem solche, die zum Teil besonders hohe Belastungen darstellen. Regionen mit starker ausgepragtem Klimawandel sind tendenziell solche Gebiete, in denen die Gefahrdung durch andere Faktoren eher geringer ist, wie z.B. in der Tundra und im borealen Nadelwald, die stark vom Klimawandel, aber weniger von hoher Nutzungsintensitat und Verschmutzung betroffen sind. Dagegen treten in den Meeresregionen gegenteilige Muster auf, wo z.B. im Indopazifik ein sehr ausgepragter Klimawandel einer hoher Ressourcenausbeutung durch Fischerei zusammenfallt. Die Regionen der Welt lassen sich in Klassen unterschiedlicher Interaktionen und Intensitaten dieser anthropogenen Gefahrungsfaktoren unterteilen. Diese insgesamt 11 verschiedene Faktorenklassen konnen nun dazu verwendet werden, Auswirkungen auf Biodiversitat zu untersuchen und die Gefahrdungs-Hotspots zu identifizieren. Diese Hotspots sind diejenigen gro ss raumigen Meeres- und Festlandsregionen, in denen prioritar Naturschutzma ss nahmen angewendet werden mussen, um den Auswirkungen des anthropogenen Biodiversitatswandels entgegenzutreten. A free Plain Language Summary can be found within the Supporting Information of this article. A free Plain Language Summary can be found within the Supporting Information of this article.
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