European Academy of Nursing Science 2016 Summer Conference

Abstract

BMC Nursing 2016, 15(Suppl 1):K1 Background Nurses have a twofold role in healthcare. On one hand, they provide care to patients who are not able to take care of themselves. On the other hand nurses play a vital role as guardians of patient safety. It is mainly on the second role of nurses that the EU funded RN4CAST project is focusing. Materials and methods Data from more than 33,000 nurses and 11,000 patients in 500 hospitals from 12 European countries were collected from 2009 until 2011. It is one of the largest databases in the world on nurses staffing and its impact on patient safety. Results One of the main results [1] is that an increase in a nurses' workload by one patient increases the likelihood of an inpatient dying within 30 days of admission by 7%. And every 10% increase in bachelor's degree nurses is associated with a decrease in this likelihood by 7%. Relating this finding to the human error theory of James Reason, there seem to be a knowledge problem in early detecting of risks and adverse events. Secondly there are some slips and lapses in execution because of a too high workload. As an example, one out of four nurses say that they didn't have the time to perform proper patient surveillance [2]. Again, this is explained by nurse staffing, education , working environment and non-nursing tasks to be performed. Discussion and conclusions In the follow-up of the report of the Institute of Medicine on "to err is human" [3], the crucial role of nurses in patient safety is highly underestimated [4]. This is mainly because the evidence is recent and mainly based on observational data. But the evidence is growing and consistent and strong evaluated against the Bradford-Hill criteria of causation (1965), showing that mechanisms are well understood, can be replicated across populations and settings and are time and dose-response related. Based on the available evidence, we see that some countries are adapting already their legislation to provide safe nurse staffing ratios to create a safe environment for their patients. Nursing 2016, 15(Suppl 1):K2 Complex wounds affect approximately 1.5 people per 1000, impair quality of life and are costly to health services. In the UK community nurses lead the care of people with complex wounds, from assessment to treatment selection. Some of the earliest randomised controlled trials (RCTs) of wound treatments were of oral zinc. Published in the 1970s these trials used different doses of zinc, measured different outcomes, had different eligibility criteria and very small sample sizes. Each new trial failed to build on the evidence that already existed or learned from mistakes. When a systematic review of the evidence for oral zinc was finally conducted, it concluded that we have no idea whether it makes a difference and the evidence is very low quality [1]. Systematic reviews should be the starting point for all new research. Cochrane reviews provide a lens for scrutiny of the quality of wounds trials and the evolution of the evidence. All Cochrane reviews appraise the included studies in a standardised way. The 199 RCTs included in the five largest Cochrane Wounds reviews have a median sample size of only 115, and most are at high risk of bias (due to BMC Nursing 2016, 15(Suppl 1):67