Patient Safety Related To Nursing Care For Patients With Emerging Diseases.
PATIENT SAFETY RELATED TO NURSING CARE FOR PATIENTS WITH
EMERGING DISEASES*
Kusman Ibrahim, S.Kp., MNS.,PhD
Faculty of Nursing, Padjadjaran University
*Presented in The International Nursing Conference on Patient Safety, 4-6 October 2010,
Bandung, Indonesia
Introduction
Many countries are witnessing signs of progress of improvement in health care
development since the last couple decades. However, there are still a number of challenges
which need to be seriously resolved in order to bring more people to have access to quality of
health care services. We observe the facts that life expectancy and good health continue to
increase in some parts of the world, yet it is fail to improve in others. The gaps of health status
between the people in developed countries and developing countries is still obvious. The global
vision of “Health for All” which firstly stated in “Alma-Ata Declaration” in 1978 and
subsequently stressed in targets of the Millennium Development Goals 2015 seems remain an
elusive goal to be brought into the reality.
The changes in life styles, climate and environmental, poverty, people mobilization as well
as urbanization have reshaped population health problems. Rising food prices coupled with
declining incomes as a result of economical crisis have increased the risk of malnutrition,
especially among children. The malnutrition constitutes as an underlying cause in about one third
of all child deaths (WHO, 2010). Maternal mortality is the health indicator that shows the widest
gaps between richer and poorer, both between and within countries. Prediction made in 2005
shows that about half a million women, most of them in developing countries die each year of
complications during pregnancy or child birth (WHO, 2007).
Emerging diseases have risen sharply and caused devastating outbreaks across the world
("Scientists make first map of emerging disease hotspots, growing threat seen in human-wildlife
conflict, drug resistance," 2008). Scientists believed that massive expansion of humans into
shrinking pockets of biodiversity and resulting contact with wildlife are the reason of new
disease originating from wildlife (e.g HIV, SARS) transmitted to humans. Meanwhile, some
nations contribute to the worse of the outbreak by posing multidrug-resistant pathogen strains
through overuse of antibiotics.
Emerging infectious diseases are estimated to continue in particular regions and groups
around the world (Commission on Social Determinants of Health [CSDH], 2008). In 2008, there
were an estimated 243 million cases of malaria causing 863 000 deaths; mostly of children under
5 years old (WHO, 2009b). Although the incidence rate of tuberculosis (TB) continued to slowly
decline, multidrug-resistant TB and HIV-associated TB still pose considerable challenges.
Globally, there were an estimated 0.5 million new cases of multidrug-resistant TB in 2007
(WHO, 2009a). In addition, more than one billion people are affected by neglected tropical
diseases such as lymphatic filariasis, dracunculiasis, cholera, and leprosy.
To date, health problems are becoming more complicated due to rapid changing of
humans’ life and environment. Caring for patients with emerging infectious diseases is daunting
task among health care professionals. For example, patients with infectious diseases are
vulnerable to expose to drug-resistant if the usage of antibiotics is not properly administrated.
This condition may threat to the safety of patients which becomes a major concern among health
care professionals in caring for patients with emerging infectious diseases. Nurses as the majority
of health care professionals who work very close to patients, can play key roles related to patient
safety in improving quality of nursing care. This paper aims to address some issues regarding
patient safety particularly in the context caring for patients with emerging diseases.
Emerging and Reemerging diseases
The WHO defined emerging disease as a disease that has appeared in a population for the
first time, or that may have existed previously but is rapidly increasing in incidence or
geographic range (WHO, 2010). Thus, the phrase ‘emerging infectious diseases’ was actually
introduced by a microbiologist and Nobel Prize winner Joshua Lederberg, refer to disease that
newly appear in a population, or have existed but are [rapidly] increasing in incidence or
geographic range (Elvinger, 2010). Emerging diseases can be attributed to either true emergence
(i.e. a newly appearing disease agent that had not been present), increased recognition (i.e. a
disease agent was present in a population but has only recently been recognized due to improved
diagnostic tests/ capabilities), increased incidence of previously recognized disease (because of
greater human and animal traffic, greater population densities, increased susceptibility of the host
population).
The basic definition of an emerging or re-emerging infectious disease is a disease whose
incidence has increased in a defined time period and location. If the disease was unknown in the
location before, the disease is considered to be emerging. However, if the disease had been
present at the location in the past and was considered eradicated or controlled, the disease is
considered to be re-emerging. Diseases considered as new emerging infectious disease such as
avian flu, Ebola, SARS, Hantavirus, and Japanese encephalitis. HIV/AIDS is an example of
emerging disease, whereas Malaria and TB are example of reemerging disease (Giriputro, 2009).
Emerging disease is commonly recognized with regard to its impact on populations: high
morbidity, mortality or case-fatality of a syndrome, and/or ‘dramatic’ clinical disease signs.
Emergence cannot be uniformly defined for all hosts and agents (Elvinger, 2010). A condition or
agent may be emerging for a population, a subpopulation, a single host or group of hosts. An
agent endemically present in one species may emerge in another species. A disease that has been
successfully controlled in a population may reemerge. In order to be able to evaluate the impact
of emerging disease (agent) in a population, and for the development and implementation of
control measures, it is essential to clearly identify all host and agent components, and their
interaction. Some questions can be addressed both qualitatively and quantitatively. Qualitatively
we may ask, “who/what is the target population?” (Host), “what is the agent and how do we
recognize it?” (Agent), and “what are the mechanisms of infection, transmission and what is the
mode of propagation?” (Interaction). Quantitatively, we should calculate the magnitude of
increase (incidence), the temporal pattern of increase and the duration of outbreak (time), and the
location or area affected (space).
Most emerging infections are caused by pathogens already present in the environment. In
particular situation, the changing conditions lead to increase the opportunity of agent to infect
new host populations. These changes include ecological changes, such as those due to human
activities or climate changes; demographic changes and behavior; travel and commerce;
technology and industry; microbial adaptation and change; and breakdown of public health
measures. Many factors precipitate emergence by placing humans or animals in contact with a
natural reservoir or host for an infection unfamiliar but already present (often a zoonotic or
arthropod-borne infection), either by increasing proximity or, often, also by changing conditions
so as to favor an increased population of the microbe or its natural host (Morse, 1996).
Nurses’ role in caring for patients with emerging diseases
Nurses are in the great position to contribute in prevention and care for patients with
emerging (infectious) diseases. It can be implemented through the development of policies with
regard to surveillance, prevention, and control, through applied research and nursing practice.
For the nurse practitioner, the degree of involvement through nursing practice will depend on the
nurse's scope of practice, expertise, and location. Nurses should incorporate an epidemiological
perspective into their practice. Nurse educator should develop nursing education programs that
provide the foundation for knowledge in the area of infectious diseases.
Cohen and Larson (1996) pointed out some ways in which nurses may act to prevent or
intervene the emerging diseases by doing the following strategies:
Educate clients about risks and personal hygiene, which can include guarding against tick
exposure; cooking meat thoroughly and eating thoroughly cooked meat; using safer sex
techniques; washing one's hands after using the toilet, changing diapers, or exposure to fecal
matter; and appropriate use of antibiotics to decrease inappropriate use of over-the-counter
drugs and inappropriate requests for antibiotics from a provider.
Use of infection control procedures; it is important that nurses have the ability to institute
appropriate controls and to educate patients, visitors, family, and personnel about infection
control and appropriate hand washing.
Maintain awareness of unusual disease clusters, outbreaks, or illnesses, and be especially
alert for unexplained deaths in young people.
Institute or participate in immunization programs for adults and children, educate patients
about the importance of immunization, and facilitate access to and availability of
immunizations for those who need it.
Use techniques to enhance client adherence to medication regimens to prevent treatment
failure and development of microbial resistance.
Participate in environmental cleanliness programs in the community and in the institution;
this can encompass such items as adequate ventilation, air pollution, and basic public health
measures such as safe water, elimination of places where birds roost and sources of standing
water, and rodent control.
Examine prescribing practices to ensure appropriate use of appropriate antibiotics.
Be an advocate for clients in regard to environment.
Obtain thorough patient histories, including an assessment of travel history, recreational
activities, and potential exposures in the workplace, home, and community; for example, the
manner in which workplace clothing in certain environments is handled can be important in
transmitting infections and toxins to the home.
Assess diet practices (for example, the use of unpasteurized milk) and teach clients about
proper nutrition and food handling.
Promote breast-feeding in countries in which there is a high risk of contamination of milk or
infant formula.
Train local people in health education and practices with use of culturally acceptable and
locally accessible material and practices.
Nurses may play significant role in the field of emerging infectious diseases through
actively participating in prevention, care, and rehabilitation of patients suffer from emerging
infectious diseases. However, it could be realized if nurses have strong commitment, awareness,
competence, and good leadership to play the role of nurses effectively in handling the problems
of emerging diseases.
Patient safety aspect in caring for patients with emerging diseases
Each year the treatment and care of hundreds of millions of patients worldwide is
complicated by infections acquired during healthcare (Pittet, Allegranzi, Storr, & Donaldson,
2006). The impact of healthcare-associated infection may imply prolonged stays in hospital,
long-term disability, massive additional financial burden, and deaths. Widespread use of
antibiotics therapy for patients with infectious disease as well as others can result in the
development of microbial resistance, leading to increased incidence and frequency of diseases
such as multi-drug-resistant tuberculosis or chloroquine-resistant malaria (Cohen & Larson,
1996; Morse, 1996). Using medical devices such as indwelling catheters and mechanical
ventilation can lead to nosocomial infections.
In the USA, Medical errors during the course of patient care are estimated to have caused
approximately 238,337 potentially preventable deaths among Medicare patients between 2004
and 2006 and up to 24,000 deaths yearly in Canada (Feng, Bobay, & Weiss, 2008). Additionally,
medication errors are the most common cause of adverse patient events in health care. These
facts imply that health care practices may also potential to impose disadvantage effects, beside
the expected positive outcomes of healing to patients. Therefore, patient safety, recently, become
an important issue in health care organizations.
Caring for patients with emerging infectious diseases should be designed comprehensively
and holistically with regard to patient safety. Patient safety is a critical indicator of healthcare
system quality (Teng, Chang, & Hsu, 2009), and indicates the degree to which care does not
have a negative impact on patient health. Nursing care has even been described as resting on a
foundation of safe practice with safety as an integral part of this care (Richardson & Storr, 2010).
This is also applied as nursing care is administered for patients with emerging diseases.
Due to limited evidences known in area patient safety related to patients with emerging
diseases, lessons learned from other area related patient safety can be taken into account in
delivering nursing care for patients with emerging diseases. Alfredsdottir and Bjornsdottir (2008)
reported that nurses in operation room expressed feeling responsible for the well-being of their
patients. Nurses often talked about their work as protecting the helpless, with prevention being of
key importance in ensuring safety. Creating an environment of warmth, respect and safety for
patients was essential to them, and they described how they try to create a quiet, relaxed and
friendly atmosphere when greeting a patient. Focusing on the patient is central, and they try to
keep conversations between themselves to a minimum while the patient is still awake. Three
factors emerged as most important in enhancing patient safety: preventive thinking,
knowledgeable and experienced workers supported by good teamwork, and mutual trust based
on many years of co-operation. Moreover, a number of issues were identified as threats to patient
safety including the fatigue that builds up over time, concentration difficulties, lack of control
over situations, insufficient staffing and unclear expectations towards staff. The study
highlighted that concerning patient safety must be an integrated part of nursing care regardless
type of diseases including emerging infectious diseases.
Research area related to patient safety in caring for patients with emerging diseases
Numerous researchers have measured patient safety using hospital records, such as patient
mortality, failure-to-rescue (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken, Clarke,
Sloane, Sochalski, & Silber, 2002), pneumonia, pressure ulcers (Cho, Ketefian, Barkauskas, &
Smith, 2003), medication errors, patient falls and infections (Blegen, Goode, & Reed, 1998).
Record-based measurement can generate a complete list of health-threatening events, and is a
useful and widely adopted approach. However, not all health-threatening events are reported
(Potylycki et al., 2006). Barriers to reporting include fear, the desire to save face, and fear of
punishment (Chiang & Pepper, 2006).
In the area of emerging diseases, researches related to patient safety are considerably
sparse. Therefore, the new research field can be difficult to navigate for researchers new to the
area. The WHO identified five research areas as framework in conducting research related to
patient safety (WHO, 2010). The five areas are arranged around the research cycle (picture 1)
which consisted of (1) measuring harm, (2) understanding causes, (3) identifying solutions, (4)
evaluating impact, and (5) translating evidence into safer care.
Measuring harm refers to measuring what goes wrong in health-care involves counting
how many patients are harmed or killed each year, and from which types of adverse events such
as medication errors, nosocomial infections, wrong-site surgery, etc. This is essential for raising
awareness and setting research priorities. Once priority areas have been identified, the next step
is to understand the underlying causes of adverse events that lead to patient harm. Due to the
complex nature of health-care, there is no single reason why things go wrong. Research is
therefore needed to identify major modifiable factors in the causal pathway. To improve patient
safety, solutions are needed that tackle the underlying causes of unsafe care. Research is needed
to determine which solutions are effective in making care safer and reducing patient harm,
compared to the standard of care. Even when solutions have been shown to work in controlled
research settings, it is important to evaluate the effectiveness of solutions in real-life settings in
terms of their impact, acceptability, and affordability. The final step in the research cycle is to
better understand how research findings can be translated into practice. This is especially
important in developing countries and transitional economies, where resources are scarce and
research infrastructures is often limited.
Picture 1. A series of research cycle in each of the key areas to stimulate new research and
debate in patient safety research
Conclusion
Despite remarkable achievements have been made in medical and health care practices
during the last decades, infectious diseases remain among the leading causes of death worldwide
for three reasons: (1) emergence of new infectious diseases, (2) re-emergence of old infectious
diseases, and (3) persistence of intractable infectious diseases. Caring for the patients with
emerging infectious diseases is a daunting task due to the complexity of the disease and the
potential side effects of the treatment that may lead to threat patients’ safety. Patient safety and
well being must be put as priority concern while caring for the patients with emerging infectious
diseases. Research is still needed to understand the phenomena of patient safety in the patients
with emerging infectious diseases, and to develop appropriate nursing care for the population.
References
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levels of hospital nurses and surgical patient mortality. Journal of the American Medical
Association, 290(12), 1617-1623.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse
staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the
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Alfredsdottir, H., & Bjornsdottir, K. (2008). Nursing and patient safety in the operating room.
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Organization.
EMERGING DISEASES*
Kusman Ibrahim, S.Kp., MNS.,PhD
Faculty of Nursing, Padjadjaran University
*Presented in The International Nursing Conference on Patient Safety, 4-6 October 2010,
Bandung, Indonesia
Introduction
Many countries are witnessing signs of progress of improvement in health care
development since the last couple decades. However, there are still a number of challenges
which need to be seriously resolved in order to bring more people to have access to quality of
health care services. We observe the facts that life expectancy and good health continue to
increase in some parts of the world, yet it is fail to improve in others. The gaps of health status
between the people in developed countries and developing countries is still obvious. The global
vision of “Health for All” which firstly stated in “Alma-Ata Declaration” in 1978 and
subsequently stressed in targets of the Millennium Development Goals 2015 seems remain an
elusive goal to be brought into the reality.
The changes in life styles, climate and environmental, poverty, people mobilization as well
as urbanization have reshaped population health problems. Rising food prices coupled with
declining incomes as a result of economical crisis have increased the risk of malnutrition,
especially among children. The malnutrition constitutes as an underlying cause in about one third
of all child deaths (WHO, 2010). Maternal mortality is the health indicator that shows the widest
gaps between richer and poorer, both between and within countries. Prediction made in 2005
shows that about half a million women, most of them in developing countries die each year of
complications during pregnancy or child birth (WHO, 2007).
Emerging diseases have risen sharply and caused devastating outbreaks across the world
("Scientists make first map of emerging disease hotspots, growing threat seen in human-wildlife
conflict, drug resistance," 2008). Scientists believed that massive expansion of humans into
shrinking pockets of biodiversity and resulting contact with wildlife are the reason of new
disease originating from wildlife (e.g HIV, SARS) transmitted to humans. Meanwhile, some
nations contribute to the worse of the outbreak by posing multidrug-resistant pathogen strains
through overuse of antibiotics.
Emerging infectious diseases are estimated to continue in particular regions and groups
around the world (Commission on Social Determinants of Health [CSDH], 2008). In 2008, there
were an estimated 243 million cases of malaria causing 863 000 deaths; mostly of children under
5 years old (WHO, 2009b). Although the incidence rate of tuberculosis (TB) continued to slowly
decline, multidrug-resistant TB and HIV-associated TB still pose considerable challenges.
Globally, there were an estimated 0.5 million new cases of multidrug-resistant TB in 2007
(WHO, 2009a). In addition, more than one billion people are affected by neglected tropical
diseases such as lymphatic filariasis, dracunculiasis, cholera, and leprosy.
To date, health problems are becoming more complicated due to rapid changing of
humans’ life and environment. Caring for patients with emerging infectious diseases is daunting
task among health care professionals. For example, patients with infectious diseases are
vulnerable to expose to drug-resistant if the usage of antibiotics is not properly administrated.
This condition may threat to the safety of patients which becomes a major concern among health
care professionals in caring for patients with emerging infectious diseases. Nurses as the majority
of health care professionals who work very close to patients, can play key roles related to patient
safety in improving quality of nursing care. This paper aims to address some issues regarding
patient safety particularly in the context caring for patients with emerging diseases.
Emerging and Reemerging diseases
The WHO defined emerging disease as a disease that has appeared in a population for the
first time, or that may have existed previously but is rapidly increasing in incidence or
geographic range (WHO, 2010). Thus, the phrase ‘emerging infectious diseases’ was actually
introduced by a microbiologist and Nobel Prize winner Joshua Lederberg, refer to disease that
newly appear in a population, or have existed but are [rapidly] increasing in incidence or
geographic range (Elvinger, 2010). Emerging diseases can be attributed to either true emergence
(i.e. a newly appearing disease agent that had not been present), increased recognition (i.e. a
disease agent was present in a population but has only recently been recognized due to improved
diagnostic tests/ capabilities), increased incidence of previously recognized disease (because of
greater human and animal traffic, greater population densities, increased susceptibility of the host
population).
The basic definition of an emerging or re-emerging infectious disease is a disease whose
incidence has increased in a defined time period and location. If the disease was unknown in the
location before, the disease is considered to be emerging. However, if the disease had been
present at the location in the past and was considered eradicated or controlled, the disease is
considered to be re-emerging. Diseases considered as new emerging infectious disease such as
avian flu, Ebola, SARS, Hantavirus, and Japanese encephalitis. HIV/AIDS is an example of
emerging disease, whereas Malaria and TB are example of reemerging disease (Giriputro, 2009).
Emerging disease is commonly recognized with regard to its impact on populations: high
morbidity, mortality or case-fatality of a syndrome, and/or ‘dramatic’ clinical disease signs.
Emergence cannot be uniformly defined for all hosts and agents (Elvinger, 2010). A condition or
agent may be emerging for a population, a subpopulation, a single host or group of hosts. An
agent endemically present in one species may emerge in another species. A disease that has been
successfully controlled in a population may reemerge. In order to be able to evaluate the impact
of emerging disease (agent) in a population, and for the development and implementation of
control measures, it is essential to clearly identify all host and agent components, and their
interaction. Some questions can be addressed both qualitatively and quantitatively. Qualitatively
we may ask, “who/what is the target population?” (Host), “what is the agent and how do we
recognize it?” (Agent), and “what are the mechanisms of infection, transmission and what is the
mode of propagation?” (Interaction). Quantitatively, we should calculate the magnitude of
increase (incidence), the temporal pattern of increase and the duration of outbreak (time), and the
location or area affected (space).
Most emerging infections are caused by pathogens already present in the environment. In
particular situation, the changing conditions lead to increase the opportunity of agent to infect
new host populations. These changes include ecological changes, such as those due to human
activities or climate changes; demographic changes and behavior; travel and commerce;
technology and industry; microbial adaptation and change; and breakdown of public health
measures. Many factors precipitate emergence by placing humans or animals in contact with a
natural reservoir or host for an infection unfamiliar but already present (often a zoonotic or
arthropod-borne infection), either by increasing proximity or, often, also by changing conditions
so as to favor an increased population of the microbe or its natural host (Morse, 1996).
Nurses’ role in caring for patients with emerging diseases
Nurses are in the great position to contribute in prevention and care for patients with
emerging (infectious) diseases. It can be implemented through the development of policies with
regard to surveillance, prevention, and control, through applied research and nursing practice.
For the nurse practitioner, the degree of involvement through nursing practice will depend on the
nurse's scope of practice, expertise, and location. Nurses should incorporate an epidemiological
perspective into their practice. Nurse educator should develop nursing education programs that
provide the foundation for knowledge in the area of infectious diseases.
Cohen and Larson (1996) pointed out some ways in which nurses may act to prevent or
intervene the emerging diseases by doing the following strategies:
Educate clients about risks and personal hygiene, which can include guarding against tick
exposure; cooking meat thoroughly and eating thoroughly cooked meat; using safer sex
techniques; washing one's hands after using the toilet, changing diapers, or exposure to fecal
matter; and appropriate use of antibiotics to decrease inappropriate use of over-the-counter
drugs and inappropriate requests for antibiotics from a provider.
Use of infection control procedures; it is important that nurses have the ability to institute
appropriate controls and to educate patients, visitors, family, and personnel about infection
control and appropriate hand washing.
Maintain awareness of unusual disease clusters, outbreaks, or illnesses, and be especially
alert for unexplained deaths in young people.
Institute or participate in immunization programs for adults and children, educate patients
about the importance of immunization, and facilitate access to and availability of
immunizations for those who need it.
Use techniques to enhance client adherence to medication regimens to prevent treatment
failure and development of microbial resistance.
Participate in environmental cleanliness programs in the community and in the institution;
this can encompass such items as adequate ventilation, air pollution, and basic public health
measures such as safe water, elimination of places where birds roost and sources of standing
water, and rodent control.
Examine prescribing practices to ensure appropriate use of appropriate antibiotics.
Be an advocate for clients in regard to environment.
Obtain thorough patient histories, including an assessment of travel history, recreational
activities, and potential exposures in the workplace, home, and community; for example, the
manner in which workplace clothing in certain environments is handled can be important in
transmitting infections and toxins to the home.
Assess diet practices (for example, the use of unpasteurized milk) and teach clients about
proper nutrition and food handling.
Promote breast-feeding in countries in which there is a high risk of contamination of milk or
infant formula.
Train local people in health education and practices with use of culturally acceptable and
locally accessible material and practices.
Nurses may play significant role in the field of emerging infectious diseases through
actively participating in prevention, care, and rehabilitation of patients suffer from emerging
infectious diseases. However, it could be realized if nurses have strong commitment, awareness,
competence, and good leadership to play the role of nurses effectively in handling the problems
of emerging diseases.
Patient safety aspect in caring for patients with emerging diseases
Each year the treatment and care of hundreds of millions of patients worldwide is
complicated by infections acquired during healthcare (Pittet, Allegranzi, Storr, & Donaldson,
2006). The impact of healthcare-associated infection may imply prolonged stays in hospital,
long-term disability, massive additional financial burden, and deaths. Widespread use of
antibiotics therapy for patients with infectious disease as well as others can result in the
development of microbial resistance, leading to increased incidence and frequency of diseases
such as multi-drug-resistant tuberculosis or chloroquine-resistant malaria (Cohen & Larson,
1996; Morse, 1996). Using medical devices such as indwelling catheters and mechanical
ventilation can lead to nosocomial infections.
In the USA, Medical errors during the course of patient care are estimated to have caused
approximately 238,337 potentially preventable deaths among Medicare patients between 2004
and 2006 and up to 24,000 deaths yearly in Canada (Feng, Bobay, & Weiss, 2008). Additionally,
medication errors are the most common cause of adverse patient events in health care. These
facts imply that health care practices may also potential to impose disadvantage effects, beside
the expected positive outcomes of healing to patients. Therefore, patient safety, recently, become
an important issue in health care organizations.
Caring for patients with emerging infectious diseases should be designed comprehensively
and holistically with regard to patient safety. Patient safety is a critical indicator of healthcare
system quality (Teng, Chang, & Hsu, 2009), and indicates the degree to which care does not
have a negative impact on patient health. Nursing care has even been described as resting on a
foundation of safe practice with safety as an integral part of this care (Richardson & Storr, 2010).
This is also applied as nursing care is administered for patients with emerging diseases.
Due to limited evidences known in area patient safety related to patients with emerging
diseases, lessons learned from other area related patient safety can be taken into account in
delivering nursing care for patients with emerging diseases. Alfredsdottir and Bjornsdottir (2008)
reported that nurses in operation room expressed feeling responsible for the well-being of their
patients. Nurses often talked about their work as protecting the helpless, with prevention being of
key importance in ensuring safety. Creating an environment of warmth, respect and safety for
patients was essential to them, and they described how they try to create a quiet, relaxed and
friendly atmosphere when greeting a patient. Focusing on the patient is central, and they try to
keep conversations between themselves to a minimum while the patient is still awake. Three
factors emerged as most important in enhancing patient safety: preventive thinking,
knowledgeable and experienced workers supported by good teamwork, and mutual trust based
on many years of co-operation. Moreover, a number of issues were identified as threats to patient
safety including the fatigue that builds up over time, concentration difficulties, lack of control
over situations, insufficient staffing and unclear expectations towards staff. The study
highlighted that concerning patient safety must be an integrated part of nursing care regardless
type of diseases including emerging infectious diseases.
Research area related to patient safety in caring for patients with emerging diseases
Numerous researchers have measured patient safety using hospital records, such as patient
mortality, failure-to-rescue (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken, Clarke,
Sloane, Sochalski, & Silber, 2002), pneumonia, pressure ulcers (Cho, Ketefian, Barkauskas, &
Smith, 2003), medication errors, patient falls and infections (Blegen, Goode, & Reed, 1998).
Record-based measurement can generate a complete list of health-threatening events, and is a
useful and widely adopted approach. However, not all health-threatening events are reported
(Potylycki et al., 2006). Barriers to reporting include fear, the desire to save face, and fear of
punishment (Chiang & Pepper, 2006).
In the area of emerging diseases, researches related to patient safety are considerably
sparse. Therefore, the new research field can be difficult to navigate for researchers new to the
area. The WHO identified five research areas as framework in conducting research related to
patient safety (WHO, 2010). The five areas are arranged around the research cycle (picture 1)
which consisted of (1) measuring harm, (2) understanding causes, (3) identifying solutions, (4)
evaluating impact, and (5) translating evidence into safer care.
Measuring harm refers to measuring what goes wrong in health-care involves counting
how many patients are harmed or killed each year, and from which types of adverse events such
as medication errors, nosocomial infections, wrong-site surgery, etc. This is essential for raising
awareness and setting research priorities. Once priority areas have been identified, the next step
is to understand the underlying causes of adverse events that lead to patient harm. Due to the
complex nature of health-care, there is no single reason why things go wrong. Research is
therefore needed to identify major modifiable factors in the causal pathway. To improve patient
safety, solutions are needed that tackle the underlying causes of unsafe care. Research is needed
to determine which solutions are effective in making care safer and reducing patient harm,
compared to the standard of care. Even when solutions have been shown to work in controlled
research settings, it is important to evaluate the effectiveness of solutions in real-life settings in
terms of their impact, acceptability, and affordability. The final step in the research cycle is to
better understand how research findings can be translated into practice. This is especially
important in developing countries and transitional economies, where resources are scarce and
research infrastructures is often limited.
Picture 1. A series of research cycle in each of the key areas to stimulate new research and
debate in patient safety research
Conclusion
Despite remarkable achievements have been made in medical and health care practices
during the last decades, infectious diseases remain among the leading causes of death worldwide
for three reasons: (1) emergence of new infectious diseases, (2) re-emergence of old infectious
diseases, and (3) persistence of intractable infectious diseases. Caring for the patients with
emerging infectious diseases is a daunting task due to the complexity of the disease and the
potential side effects of the treatment that may lead to threat patients’ safety. Patient safety and
well being must be put as priority concern while caring for the patients with emerging infectious
diseases. Research is still needed to understand the phenomena of patient safety in the patients
with emerging infectious diseases, and to develop appropriate nursing care for the population.
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