These findings highlight the role of senior staff in the establishment of a supportive, trustful ward climate, so that nurses can learn from errors, prevent their recurrence and improve patient safety.

Objective To systematically review clinical evidence gathered by direct observation of medication errors in adult patients in intensive care units. Methods Articles published between 1985 and 2008 in Englishlanguage journals indexed by the Cumulative Index for Nursing and Allied Health Literature and PUBMED were searched for studies on medication errors made by intensive care unit nurses. Studies in which errors were detected via direct observation were included. Results Six studies met the inclusion criteria, and error incidence varied considerably among them. Wrong dose, wrong administration time and rate, and dose omission were the most common errors. Antibiotics, electrolytes, and cardiovascular drugs were commonly associated with errors, but the evidence about factors contributing to errors was inconclusive. Increased monitoring was the most common consequence of medication errors, whereas life-threatening and fatal adverse events were rare. Conclusions Identification of patterns and characteristics of medication errors can guide preventive interventions. Factors contributing to errors, as well as drugs and error types associated with severe adverse events, deserve further investigation.

Patients' and their significant others' education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients-NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

Results: Referral patterns are different than for cancer patients with more respite and supportive care provided earlier in the disease trajectory, followed by terminal care. These early interventions provided respite for exhausted carers, and allow patients and carers to build a relationship with the palliative care team, whilst maintaining continuity with their heart failure nurse as key worker. Working in this way enabled nurses to accurately identify those patients who were entering the last months of life and provide appropriate supportive and palliative care. 99 patients were referred but only 80 received care due to a rapid response being unavailable, resulting in an admission to a palliative care bed, or the patient declined the service, or had a sudden death before the first shift. 74 patients (73%) from all those referred have died, 39 (53%) died within a month of referral and all apart from 3 died within a year. Patients received a mean/median of 89/36 hours of care. 55 (74%) of of those who died, did so in their place of choice. Conclusions: It is possible to provide a timely, home-based palliative care service for heart failure patients and their families. However rapid response, and better out of hours services are needed to avoid unecessary admissions.

RESUMEN -Objetivo: a) Investigar el tipo de restricción utilizada con el fin de eliminar el comportamiento violento de pacientes psiquiátricos,b) Explorar las actitudes del personal de enfermería frente al aislamiento y la contención y c) Determinar si hay alguna diferencia en las capacidades del personal de enfermería debido a su nivel educativo y a los años de experiencia. M é t o d o:La muestra estaba formada por 190 enfermeros/as de doce unidades psiquiátricas correspondientes a cinco hospitales diferentes en donde se distribuyó un cuestionario a u t o -a d m i n i s t rado y se realizó un análisis estadístico descri p t ivo junto con la ap l i c a c i ó n del test chi cuadrado.R e s u l t a d o s : Las re s t ricciones realizadas con mayor frecuencia incluían las contenciones corp o rales (42,6%), el aislamiento en la propia habitación (26%), y ambas (31,1%). El aislamiento o la contención se utilizan en la mayoría de los casos para la seguridad del paciente (70,5%),el control de su comportamiento (23,2%), y para comodidad del personal (0,5%). El ochenta por ciento de los enfermeros/as está a favor de la contención mientras que un 16,8% está en contra. No hubo diferencias estadísticamente sign i fi c at ivas en las actitudes de los enfe rm e ros/as motivadas por su nivel de fo rmación y experiencia laboral.