10 Chapter 1 Fundamental nursing care Nurses represent nearly half of the global healthcare workforce [1]. As the largest and most trusted members of this workforce, they are uniquely qualified and positioned to enhance the quality of care [2]. Through a team-based approach, nurses collaborate with other healthcare professionals, as well as patients' families and informal caregivers, across a wide range of healthcare settings. They provide holistic care addressing patients’ physical, mental, emotional, social, and spiritual needs [3]. The fundamentals of nursing care are conceptualized within three key dimensions [4, 5]. The first dimension emphasizes integrating patients’ psychosocial needs, encompassing aspects such as communication, privacy, and dignity. The second highlights the importance of nurses’ relational actions, involving behaviors such as active listening and demonstrating empathy. This thesis focusses on the third dimension: patients’ physical needs, centered on ensuring patients’ safety, which is the focus of my thesis. Given that nurses spend the most time in direct patient care, they play a critical role in the early identification and prevention of complications [5]. Nurses’ contributions to patient outcomes are often described as nurse-sensitive outcomes. Identifying these outcomes has proven to be challenging, requiring consensus on definitions, robust evidence of nurse-sensitivity, and appropriate governance to ensure their acceptance among nurses [6, 7]. This thesis addresses two key nursesensitive outcomes: in-hospital falls and pressure ulcers. In-hospital falls are among the most frequently reported adverse events in hospitals [8]. Approximately one in four falls results in injury, with about 10% leading to serious harm [9]. In-hospital fall prevention was identified as one of the eight national improvement goals by the Dutch Health Inspectorate [10]. In 1860, Florence Nightingale stated in her Notes on Nursing: “if [the patient] has a bed-sore, it is generally the fault not of the disease, but of the nursing”[11]. Bed-sores, or pressure ulcers, remain a common issue, despite major advancements in preventive measures. In 2020, Li, Lin [12] reported a pooled prevalence of pressure injuries in hospitalized patients of 12.8% (95% CI 11.8-13.9%). Pressure ulcers contribute to pain, discomfort, prolonged hospital stays, and increased workload for nurses [13, 14].
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