6Cs + principles = care.

Every nurse needs to be mindful of their personal contribution to the quality of care delivery. Crucially, this involves the everyday nursing interacations and activities that make up a patient's direct experience of care.

Reflecting on the true value of care.

The RCN's (2012) Principles of Nursing Practice are a set of statements about the characteristics of high quality nursing care. This article gives an overview of the principles and demonstrates through a personal reflection that emergency nurses can refer to them when planning and delivering compassionate and evidence-based care in complex settings.

Measuring the safety climate in NHS organisations.

This article discusses the differences between organisational culture and organisational climate, and provides an overview of the relationship between safety culture and safety climate within these wider concepts. The article concludes with a brief description of an initiative to test a safety climate measurement tool for use in NHS organisations.

Investigating the role and impact of expert nurses.

This literature review was conducted to identify the attributes of an expert nurse and the direct and indirect impact they have on patient care, health-care organisations and nursing. Given the loss of expert nursing posts as a result of NHS deficits, there is an urgent need to differentiate between a range of expert nursing roles and how these contribute to positive patient and health outcomes and organisational efficiency. The focus of the literature search was on developments in the UK and the results indicated that ambiguity and confusion exist around the terminology and definitions associated with expert nurses. Research shows that expert nurses have a positive impact on patient care and organisational efficiency. However, a lack of clarity leads to a dilution of expert nursing roles and nurse expertise. There is a need for national guidance on the skills required of expert nurses and the necessity of considering the formal protection of nursing titles.

Challenges in delivering safe patient care: a commentary on a quality improvement initiative.

The specific aim of this commentary is to identify the challenges identified by nurses in the delivery of safe patient care. In reporting, some of the messages emanating from the research and policy literature, the paper highlights the importance of taking a system approach to the investigation of patient safety failures, the conflicting evidence relating to patient deaths as a result of failures in safety, and the underlying importance of culture. The paper outlines the reasons why patient safety has become so prominent, and provides a brief description of some of the definitions and terminology in current use. The commentary articulates a number of challenges in the delivery of safe care as identified by nurses during a recent quality improvement initiative, and these are organized under the themes of organizational context, working environment, and the organization and management of care. In conclusion, the paper describes the implications arising from the quality improvement initiative and the need for further research exploring the nature of safety culture in health-care organizations.

At the centre of practice.

IN THE CURRENT climate of change, nurses need to respond quickly and appropriately to emerging challenges and to acquire rapid information about issues that affect quality of care.

Principles of aseptic technique in urinary catheterisation.

Most nurses are aware of the importance of aseptic technique but some may be unsure about applying the technique during urinary catheterisation. This article explains the principles of aseptic techniquue and their application to the procedure of urinary catheterisation.

Sharp thinking.

Nurses are the healthcare professionals most at risk from neeldestick and sharps injuries, according to the latest figures from the RCN's EPINet project. During 2004, 1,990 injuries were reported from the 20 self-selecting participating sites. Nurses sustained 43 per cent of these injuries. Disposable syringes and needles were the most common equipment to cause injury. Although discouraged, 4 per cent of injuries occurred during recapping of needles. Just under a third of injuries were sustained by staff other than the original user of the sharp.

Using indicator development to revise infection control activities in an acute NHS trust.

AIM: This paper describes a 2-year project to facilitate improved infection control within an acute National Health Service trust. BACKGROUND: Organizational support, broad ownership of issues and adequate resources are needed to enable good infection control to underpin improvements in care. METHOD: Development of indicators, agreed at a stakeholder workshop, was used as a focus. The Infection Control Team was expanded. RESULTS: The team has a wider skills base and can deliver proactive and reactive services in closer collaboration with clinicians, especially modern matrons. The infection control committee has been reconstituted and become more effective. There have been demonstrable health and financial gains over 2 years, and improved performance against national standards. CONCLUSION: Focusing on indicator development enabled key stakeholders to gain a collective appreciation of the issues that the trust faced, increased ownership of agreed actions and rooted infection control activity in trust mechanisms for monitoring and business planning.

Monitoring sharps injuries: EPINet surveillance results.

Sharps injuries are one of the main types of accident sustained by NHS staff. The RCN's Be Sharp Be Safe campaign was launched in 2001 with the aim of reducing sharps injuries and includes a surveillance project to describe the current pattern of sharps injuries being experienced in participating trusts. This article gives an overview of the results from the second year of the surveillance project and indicates how the data can be used to help improve practice. Nurses emerge as the staff group reporting the highest proportion of injuries recorded in the study period. The most common sharps injury scenario involves nurses giving injections in the patient's room or ward area. Aspects of poor disposal practice and incidents involving the recapping of needles continue to result in injuries and are worthy of further investigation. Analysis of the data by location can highlight specific tasks which could be reviewed to identify safer working practices.