Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.

Modern healthcare environments are becoming increasingly complex. Delivering high-quality fundamental care in these environments is challenging for nurses and has been the focus of recent media, policy, academic and public scrutiny. Much of this attention arises from evidence that fundamental care is being neglected or delivered inadequately. There are an increasing number of standards and approaches to the delivery of fundamental care, which may result in confusion and additional documentation for nurses to complete. This article provides nurses with an approach to reframe their thinking about fundamental care, to ensure they meet patients’ care needs and deliver holistic, person-centred care.

Modern healthcare environments are becoming increasingly complex. Delivering high-quality fundamental care in these environments is increasingly challenging for nurses and has been the focus of recent media, policy, academic and public scrutiny. Much of this attention arises from evidence that fundamental care is being neglected or delivered inadequately. There are an increasing number of standards and approaches to the delivery of fundamental care, which may result in confusion and additional documentation for nurses to complete. This article provides nurses with an approach to reframe their thinking about fundamental care, to ensure they meet patients' care needs and deliver holistic and person-centred care.

Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care. There are various challenges in clinical practice that make it increasingly difficult to deliver effective care centred on such relationships. Understanding and addressing these challenges is crucial to ensure a positive experience of care for patients, families, carers and nurses. This article outlines how nurses can use a framework to develop therapeutic relationships with patients and use the best available evidence to deliver effective care. It also explores the challenges in developing effective therapeutic relationships with patients at the healthcare system level, and considers how these challenges can be addressed.

Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care. There are various challenges in clinical practice that make it increasingly difficult to deliver effective care centred on such relationships. Understanding and addressing these challenges is crucial to ensure a positive experience of care for patients, families, carers and nurses. This article outlines how nurses can use a framework to develop therapeutic relationships with patients and use the best available evidence to deliver effective care. It also explores the challenges in developing effective therapeutic relationships with patients at the healthcare system level, and considers how these challenges can be addressed.

Mounting pressure is being exerted to ensure that the delivery of care is evidence-based and clinically effective. However, the challenge this presents to practitioners is complex. The authors propose that successful implementation of evidence into practice is a function of three elements: the nature of the evidence; the context in which the change is to take place; and the way the process is managed. A framework has been developed to represent these factors. For those about to embark on implementation work, this article closes by highlighting a number of key questions for consideration, stimulated by the framework.

Aim The RCN Clinical Leadership Development Programme was set up in 1995 and sought to identify how clinical nurses in recognised leadership positions could improve the quality of patient care.

Method The programme was tested on four senior nurses and 24 ward sisters in four acute hospital trusts in England over an 18-month period. The primary research question was whether the intervention improved the clinical leadership skills of participants. A pre-test/post-test design incorporating action research was deployed.

Results On a number of leadership dimensions, ward sisters’ and senior nurses’ performance had significantly improved. Five key themes emerged from the process data documenting the journey towards more effective clinical leadership: managing self; managing the team; patient-centred care; networking; and becoming more politically aware. There was evidence to show that patient care had also improved as measured by the way nursing care was organised; by patients’ accounts of care they received and by documented improvements nurses carried out as a result of direct observation of care.

Conclusion From the results of the study, it appears that there is a need for more effective clinical leadership development programmes for nurses to achieve better patient-centred care.

In the first of two articles, Alison Kitson outlines the fundamental elements of nursing, and how they should be protected and communicated. She argues that having the ability to care for the patient as a whole person is the essence of good nursing practice, in which a range of environmental and organisational conditions prevail, and over which the nurse must be in control. Similarly, basic observation and practical skills in traditional nursing must be evident before nurses can be assured they have met basic needs. She considers the effect of health care and other changes on nursing, along with strategies for ensuring that the essence of nursing is protected. The second article will appear next week.