Background Early detection of pupillary changes in patients with head injuries can alert the care team to increasing intracranial pressure. Previous research has shown inconsistencies in pupil measurement that are most likely due to the subjective nature of measuring pupils without the assistance of technology. Objectives To evaluate nurses’ abilities to assess pupil diameter accurately and detect unequal pupils. Methods In a 3-part study, the accuracy of critical care and neurosurgical nurses’ assessments of pupils was determined. The study included assessment of drawings of eyes with an iris and pupil, examination of photographs of human eyes, and bedside examination of patients with a head injury. Results Subjective assessments of pupil diameter and symmetry were not accurate. Across all phases of the study, pupil diameters were underestimated and the rate of error increased as pupil size increased. Nurses also failed to detect anisocoria and misidentified pupil reactivity. In addition, nearly all nurses relied on subjective estimation, even when tools were available. Conclusions Critical care and neurosurgical nurses underestimated pupil size, were unable to detect anisocoria, and incorrectly assessed pupil reactivity. Standardized use of pupil assessment tools such as a pupillometer is necessary to increase accuracy and consistency in pupil measurement and to potentially contribute to earlier detection of subtle changes in pupils. If pupillary changes are identified early, diagnostic and treatment intervention can be delivered in a more timely and effective manner.

Purpose – This paper aims to examine how “wilderness tourism” is being successfully used to promote tourism development in the economically depressed community of Bangor Ridge in Jamaica. Through this promotion, its sponsor, Sun Venture Tours, has been able to create employment for local residents and in so doing, contribute to community development and poverty alleviation. The company has also been able to demonstrate that local entrepreneurs have the capacity to address issues in their communities with little or no reliance on government. Design/methodology/approach – The paper employs a qualitative research methodology using both primary and secondary data. The study focuses specifically on Bangor Ridge in Jamaica with Costa Rica and Belize used as comparators. Findings – This paper concludes that the exclusion of heritage assets from the government's development strategies for tourism in Jamaica has resulted in economic and social stagnation and a decline in economic opportunities for rural communities on the island where unemployment and poverty are rife. It argues that there is a strong case for consultation among all stakeholders as to the value of the country's natural assets and the future of tourism in Jamaica. The paper observes that tourism cannot be sustained unless Jamaica's natural assets are preserved and carefully utilized. Originality/value – This paper explores topical issues and provides a case study that clearly illustrates how government could redirect its interest in terms of support to local communities whose assets form the basis for tourism products on the island.