THE NURSING EDGE

Clinical Routines Overview

The clinical routines pillar is the foundation of the THE NURSING EDGE framework. It encompasses the repetitive tasks and procedures that nurses perform daily, such as vital sign collection, medication administration, and wound care. By mastering these routines, nurses can develop a sense of confidence and competence in their practice. As noted by Dr. Thompson, a seasoned nursing educator, "Clinical routines are the building blocks of nursing practice. When nurses are proficient in these routines, they can focus on more complex aspects of care, such as critical thinking and decision-making."

Importance Of Clinical Routines

Clinical routines are essential for several reasons. Firstly, they ensure consistency and standardization of care, which is critical for patient safety. Secondly, they help nurses develop a sense of familiarity and comfort with the tasks they perform, reducing anxiety and stress. Finally, clinical routines provide a framework for nurses to assess their skills and identify areas for improvement. The following table highlights the key benefits of clinical routines:

Developing Clinical Routines

Developing effective clinical routines requires a structured approach. Nurses should start by identifying the tasks and procedures they perform most frequently and then break them down into smaller, manageable steps. As Nurse Manager, Ms. Johnson, explained, "By breaking down complex tasks into smaller steps, nurses can develop a sense of mastery and control over their practice. This, in turn, can lead to improved patient outcomes and increased job satisfaction." The following are key steps to develop clinical routines:

• Identify frequently performed tasks and procedures
• Break down complex tasks into smaller, manageable steps
• Develop checklists and protocols to ensure consistency and standardization
• Practice and reinforce new skills through repetition and feedback

Cognitive Checks Overview

Cognitive checks are a critical component of the THE NURSING EDGE framework, enabling nurses to think critically and make sound decisions in complex clinical situations. As Dr. Thompson noted, "Cognitive checks are the mental processes that nurses use to evaluate patient data, identify potential problems, and develop effective care plans." By incorporating cognitive checks into their practice, nurses can reduce errors, improve patient outcomes, and enhance their overall confidence and competence.

Importance Of Cognitive Checks

Cognitive checks are essential for several reasons. Firstly, they help nurses to identify potential problems and develop effective care plans. Secondly, they enable nurses to evaluate patient data critically, reducing the risk of errors and adverse events. Finally, cognitive checks provide a framework for nurses to reflect on their practice, identifying areas for improvement and developing strategies for professional growth. The following table highlights the key benefits of cognitive checks:

Decision Making Process

The decision-making process is a critical aspect of cognitive checks, involving the evaluation of patient data, identification of potential problems, and development of effective care plans. As Ms. Johnson explained, "The decision-making process is a complex and dynamic process, requiring nurses to think critically and make sound judgments in rapidly changing clinical situations." The following are key steps in the decision-making process:

1. Data Collection: Gather relevant patient data, including vital signs, medical history, and laboratory results.
2. Data Analysis: Evaluate patient data critically, identifying potential problems and developing hypotheses.
3. Care Plan Development: Develop effective care plans, based on the analysis of patient data and the identification of potential problems.
4. Care Plan Implementation: Implement the care plan, monitoring patient outcomes and adjusting the plan as necessary.

Strategies For Effective Decision Making

Several strategies can be used to enhance decision making, including the use of decision-making frameworks, such as the Nursing Process, and the development of critical thinking skills, such as analysis and evaluation. Additionally, nurses can use checklists and protocols to ensure consistency and standardization in their practice, reducing the risk of errors and adverse events. The following table highlights key strategies for effective decision making:

Effective Communication Strategies

Effective communication is the backbone of the THE NURSING EDGE framework, allowing nurses to convey complex medical information in a clear and concise manner to patients, families, and healthcare teams. As noted by Dr. Lee, "Clear communication is essential for building trust with patients and ensuring they receive high-quality care." By mastering effective communication strategies, nurses can significantly enhance patient outcomes, improve patient satisfaction, and reduce the risk of medical errors.

Importance Of Effective Communication

The importance of effective communication in nursing practice cannot be overstated. It not only facilitates the exchange of critical information but also helps in building strong, trusting relationships between nurses, patients, and their families. Effective communication is key to preventing misunderstandings, ensuring patient safety, and promoting collaborative care among healthcare teams. The following table outlines the primary benefits of effective communication in nursing:

Communication Barriers

Despite its importance, effective communication in healthcare settings is often challenged by various barriers, including language barriers, cultural differences, and environmental factors. For instance, language barriers can significantly impede the communication process, necessitating the use of interpreters or translation services to ensure that patients receive accurate and understandable information. The following are common barriers to effective communication in nursing:

1. Language Barriers: Differences in language between nurses and patients can lead to misunderstandings and miscommunications.
2. Cultural Differences: Variations in cultural backgrounds and values can affect how information is perceived and interpreted.
3. Environmental Factors: Noise, lack of privacy, and other environmental factors can distract from or disrupt the communication process.

Strategies For Effective Communication

To overcome these barriers and communicate effectively, nurses can employ several strategies. Using simple and clear language helps ensure that messages are understood by patients and families, regardless of their educational background or language proficiency. Active listening is another crucial strategy, as it involves not just hearing the words but also understanding the underlying concerns and emotions of the patient. Additionally, non-verbal communication techniques, such as maintaining eye contact and using open body language, can convey empathy and build trust. The use of visual aids and communication tools can also facilitate the communication of complex medical information in an engaging and understandable way. The following table summarizes these strategies:

Prioritization And Time Management

Prioritization and time management are essential skills for nurses to master, enabling them to manage their workload effectively and provide high-quality patient care. As Dr. Thompson noted, "Prioritization and time management are critical components of the THE NURSING EDGE framework, helping nurses to stay focused and organized in a fast-paced healthcare environment." By developing effective prioritization and time management strategies, nurses can reduce stress, improve patient outcomes, and enhance their overall job satisfaction.

Importance Of Prioritization

Prioritization is essential for several reasons. Firstly, it helps nurses to identify the most critical tasks and manage their workload effectively, reducing the risk of errors and adverse events. Secondly, it enables nurses to allocate their time and resources efficiently, ensuring that patients receive the care they need in a timely manner. Finally, prioritization provides a framework for nurses to delegate tasks and collaborate with healthcare teams, developing effective care plans and improving patient outcomes. The following table highlights the key benefits of prioritization:

Strategies For Effective Prioritization

Several strategies can be used to enhance prioritization, including the use of task lists, prioritization frameworks, and time management tools. Additionally, nurses can use critical thinking skills to evaluate patient needs and develop effective care plans. The following table highlights key strategies for effective prioritization:

Common Challenges

Despite the importance of prioritization and time management, several challenges can hinder the process, including heavy workloads, limited resources, and lack of support. As Ms. Johnson explained, "Heavy workloads can be a significant challenge in healthcare, requiring nurses to prioritize their tasks effectively and manage their time efficiently." The following are common challenges:

1. Heavy Workloads: Excessive workload can hinder the prioritization process, requiring nurses to manage their time and resources efficiently.
2. Limited Resources: Limited resources, such as staffing and equipment, can affect the prioritization process, requiring nurses to be creative and flexible.
3. Lack Of Support: Lack of support from healthcare teams and management can hinder the prioritization process, requiring nurses to advocate for themselves and their patients.

Takeaways

In conclusion, prioritization and time management are essential skills for nurses to master, enabling them to manage their workload effectively and provide high-quality patient care. By developing effective prioritization and time management strategies, nurses can reduce stress, improve patient outcomes, and enhance their overall job satisfaction. Key takeaways include:

• Prioritization is essential for reducing errors and adverse events
• Effective time management is critical for allocating resources efficiently
• Critical thinking skills are necessary for evaluating patient needs and developing effective care plans
• Nurses should use task lists, prioritization frameworks, and time management tools to enhance their prioritization and time management skills.

Introduction To Clinical Habits

The concept of small, incremental changes in clinical habits and practice was a crucial aspect of THE NURSING EDGE framework. By mastering small clinical habits, nurses could become safer, sharper, and more confident practitioners. This approach emphasized the importance of subtle adjustments to daily routines and thought processes in improving patient outcomes and nurse well-being. As clinical routines expert, Dr. Thompson, noted, "Small changes can add up to make a significant difference in patient care. It's not about overhaulting the entire system, but about making intentional, incremental changes that can have a profound impact."

The Impact Of Small Changes

Research had shown that small changes in clinical habits could lead to significant improvements in patient outcomes. For example, a study found that implementing a simple cognitive check before medication administration reduced errors by 30%. Another study found that using a communication checklist during patient handoffs improved patient satisfaction ratings by 25%. These findings highlighted the potential of small changes to have a lasting impact on patient care. The following table summarizes some of the key findings:

Overcoming Barriers To Change

Despite the potential benefits of small changes, nurses often faced barriers to implementing them in practice. Common challenges included heavy workloads, limited resources, and lack of support from colleagues or management. To overcome these barriers, nurses needed to develop strategies for prioritizing and managing their time effectively. As nurse educator, Ms. Johnson, advised, "It's essential to identify the small changes that can have the greatest impact and focus on implementing those first. This can help build momentum and create a sense of accomplishment, which can be a powerful motivator for further change."

Strategies For Implementing Small Changes

Nurses could use several strategies to implement small changes in their practice. These included:

• Identifying areas for improvement through self-reflection and peer feedback
• Developing action plans for implementing small changes
• Using checklists and protocols to standardize care
• Seeking support from colleagues and management

By using these strategies, nurses could overcome the barriers to change and start making small, incremental improvements in their practice. As Dr. Thompson noted, "The key is to start small and be consistent. With time and practice, these small changes can become ingrained habits that improve patient care and nurse well-being."

Clinical Habits And Patient Safety

The relationship between clinical habits and patient safety was a critical aspect of THE NURSING EDGE framework. By mastering small clinical habits, nurses could reduce errors, improve patient outcomes, and enhance patient safety. As Dr. Thompson noted, "Clinical habits are the foundation of safe and effective patient care. By developing good habits, nurses can reduce the risk of errors and improve patient outcomes." For example, a study found that implementing a simple cognitive check before medication administration reduced errors by 30%. Another study found that using a communication checklist during patient handoffs improved patient satisfaction ratings by 25%.

The Role Of Cognitive Checks

Cognitive checks played a crucial role in ensuring patient safety. These checks helped nurses identify potential problems, develop effective care plans, and reduce errors. As Ms. Johnson advised, "Cognitive checks are essential for ensuring patient safety. They help nurses think critically and make sound decisions, which can reduce the risk of errors and improve patient outcomes." The following table summarizes some of the key cognitive checks that nurses can use to improve patient safety:

Strategies For Improving Patient Safety

Nurses could use several strategies to improve patient safety, including:

• Developing standardized protocols for high-risk procedures
• Using checklists and protocols to standardize care
• Implementing cognitive checks to reduce errors
• Seeking support from colleagues and management
• Engaging in continuous learning and professional development

By using these strategies, nurses could reduce the risk of errors, improve patient outcomes, and enhance patient safety. As Dr. Thompson noted, "Patient safety is a top priority for nurses. By developing good clinical habits and using cognitive checks, nurses can reduce the risk of errors and improve patient outcomes."

Overcoming Barriers To Patient Safety

Despite the importance of patient safety, nurses often faced barriers to implementing safety protocols in practice. Common challenges included heavy workloads, limited resources, and lack of support from colleagues or management. To overcome these barriers, nurses needed to develop strategies for prioritizing and managing their time effectively. As Ms. Johnson advised, "It's essential to identify the small changes that can have the greatest impact on patient safety and focus on implementing those first. This can help build momentum and create a sense of accomplishment, which can be a powerful motivator for further change."

The Impact Of Clinical Habits On Patient Outcomes

The impact of clinical habits on patient outcomes was a critical aspect of THE NURSING EDGE framework. By mastering small clinical habits, nurses could improve patient outcomes, reduce errors, and enhance patient safety. As Dr. Thompson noted, "Clinical habits are the key to improving patient outcomes. By developing good habits, nurses can reduce the risk of errors, improve patient satisfaction, and enhance patient safety." The following table summarizes some of the key findings on the impact of clinical habits on patient outcomes:

Developing Targeted Strategies

The process of developing targeted strategies for improving patient safety and outcomes involved several key steps. First, nurses needed to identify areas for improvement in their clinical habits and practices. This could involve conducting a self-assessment, seeking feedback from colleagues, or reviewing patient outcomes data. As Dr. Thompson noted, "Identifying areas for improvement is the first step in developing targeted strategies for change. By understanding where we need to improve, we can focus our efforts on making meaningful changes."

Identifying Areas For Improvement

Nurses could use several tools and techniques to identify areas for improvement in their clinical habits and practices. These included:

• Self-assessment: Reflecting on their own practices and identifying areas for improvement
• Peer review: Seeking feedback from colleagues on their practices and performance
• Patient outcomes data: Reviewing data on patient outcomes to identify areas for improvement
• Quality improvement initiatives: Participating in quality improvement initiatives to identify and address areas for improvement

Prioritizing And Managing Time

Once areas for improvement had been identified, nurses needed to prioritize and manage their time effectively to implement changes. This could involve:

• Setting goals: Setting specific, measurable goals for improvement
• Developing action plans: Developing action plans to achieve goals
• Allocating time and resources: Allocating time and resources to support implementation of changes
• Monitoring progress: Monitoring progress and making adjustments as needed

Implementing Changes

Implementing changes involved putting targeted strategies into practice. This could involve:

• Developing standardized protocols: Developing standardized protocols for high-risk procedures
• Using checklists and protocols: Using checklists and protocols to standardize care
• Implementing cognitive checks: Implementing cognitive checks to reduce errors
• Seeking support: Seeking support from colleagues and management

As Ms. Johnson advised, "Implementing changes can be challenging, but it's essential to stay focused on the goals and outcomes we want to achieve. By working together and supporting each other, we can make meaningful changes that improve patient safety and outcomes."

Overcoming Barriers To Change

Despite the importance of implementing changes, nurses often faced barriers to change. Common challenges included heavy workloads, limited resources, and lack of support from colleagues or management. To overcome these barriers, nurses needed to develop strategies for prioritizing and managing their time effectively, seeking support from colleagues and management, and staying focused on the goals and outcomes they wanted to achieve.

Strategies For Success

To ensure success in implementing targeted strategies, nurses could use the following strategies:

• Break down large goals into smaller ones: Breaking down large goals into smaller, manageable tasks
• Celebrate small wins: Celebrating small wins to build momentum and motivation
• Seek support from colleagues and management: Seeking support from colleagues and management to overcome barriers to change
• Stay focused on the goals and outcomes: Staying focused on the goals and outcomes they wanted to achieve

Overcoming Barriers To Change

Nurses often faced barriers to change, including heavy workloads, limited resources, and lack of support from colleagues or management. To overcome these barriers, nurses needed to develop strategies for prioritizing and managing their time effectively, seeking support from colleagues and management, and staying focused on the goals and outcomes they wanted to achieve. As Dr. Thompson noted, "Overcoming barriers to change requires a combination of effective time management, strategic planning, and collaboration with colleagues and management."

Strategies For Overcoming Barriers

Nurses could use several strategies to overcome barriers to change, including:

• Prioritizing tasks: Prioritizing tasks based on importance and urgency
• Seeking support: Seeking support from colleagues and management to overcome barriers to change
• Developing contingency plans: Developing contingency plans to address potential obstacles
• Staying flexible: Staying flexible and adapting to changing circumstances

Role Of Colleagues And Management

Colleagues and management played a crucial role in supporting nurses in implementing changes. They could provide emotional support, technical assistance, and resources to help nurses overcome barriers to change. As Ms. Johnson advised, "Colleagues and management can provide valuable support and guidance to help nurses implement changes and overcome barriers to change. By working together, we can create a supportive environment that fosters innovation and improvement."

Staying Motivated And Focused

To stay motivated and focused, nurses needed to celebrate their successes, no matter how small, and remind themselves of the importance of their work. They could also seek support from colleagues and management, and engage in self-care activities to reduce stress and increase motivation. As Dr. Thompson noted, "Staying motivated and focused requires a combination of celebrating successes, seeking support, and engaging in self-care activities. By taking care of ourselves and staying focused on our goals, we can overcome barriers to change and achieve our desired outcomes."

Assessing Current Skills

The first step in professional development and growth is assessing current skills. This involves taking a thorough inventory of one's strengths, weaknesses, and areas for improvement. As registered nurse Emily Chen noted, "Assessing my current skills helped me identify areas where I needed more training and education, which ultimately improved my patient care." Nurses can use various tools and frameworks to assess their skills, including self-reflection, peer feedback, and performance evaluations.

Identifying Strengths And Weaknesses

To assess current skills, nurses should start by identifying their strengths and weaknesses. This can be done by reflecting on past experiences, seeking feedback from colleagues and supervisors, and evaluating performance data. The following table outlines some key areas to consider when assessing current skills:

Creating A Personal Development Plan

Once nurses have assessed their current skills, they can create a personal development plan to address areas for improvement. This plan should include specific goals, objectives, and strategies for achieving them. As nurse educator Dr. Rachel Lee advised, "A personal development plan helps nurses stay focused on their goals and motivated to learn and grow." The plan should also include a timeline for achieving goals and a system for tracking progress.

Overcoming Barriers To Development

Nurses may face various barriers to development, including lack of time, limited resources, and insufficient support. To overcome these barriers, nurses can use strategies such as prioritizing tasks, seeking out mentors and role models, and leveraging technology and online resources. The following list outlines some additional strategies for overcoming barriers to development:

• Seeking out opportunities for continuing education and professional development
• Joining professional organizations and networking with other nurses
• Using self-reflection and self-care to manage stress and stay motivated
• Identifying and addressing knowledge gaps and areas for improvement
• Developing a growth mindset and being open to new challenges and experiences

Developing A Professional Portfolio

Developing a professional portfolio is an essential step in professional development and growth. A professional portfolio is a collection of documents and artifacts that showcase a nurse's skills, knowledge, and experience. It can include items such as certificates, transcripts, and letters of recommendation, as well as examples of work products, such as care plans and patient education materials. As Emily Chen noted, "My professional portfolio has been invaluable in helping me to demonstrate my skills and experience to potential employers and to track my progress over time."

Components Of A Professional Portfolio

A professional portfolio should include a variety of components that showcase a nurse's skills and experience. The following table outlines some key components to include:

Using A Professional Portfolio

A professional portfolio can be used in a variety of ways, including to apply for jobs, to seek promotions, and to demonstrate competence to employers and patients. It can also be used to track progress over time and to identify areas for improvement. As Dr. Rachel Lee advised, "A professional portfolio is a powerful tool for nurses to demonstrate their skills and experience and to advance their careers." The following list outlines some additional ways to use a professional portfolio:

• To apply for graduate school or other advanced education programs
• To seek certification or specialization in a particular area of nursing
• To demonstrate competence to employers and patients
• To track progress over time and to identify areas for improvement
• To showcase skills and experience to potential employers

Maintaining A Professional Portfolio

Maintaining a professional portfolio requires ongoing effort and attention. Nurses should regularly update their portfolios to reflect new skills and experience, and should also regularly review and revise their portfolios to ensure that they are accurate and effective. The following table outlines some strategies for maintaining a professional portfolio:

Benefits Of A Professional Portfolio

A professional portfolio can have a number of benefits for nurses, including helping to demonstrate skills and experience, tracking progress over time, and identifying areas for improvement. It can also help nurses to advance their careers and to increase their confidence and competence. As Emily Chen noted, "My professional portfolio has been invaluable in helping me to demonstrate my skills and experience and to advance my career." The following list outlines some additional benefits of a professional portfolio:

• Helps to demonstrate skills and experience to potential employers
• Tracks progress over time and identifies areas for improvement
• Helps to advance careers and increase confidence and competence
• Provides a sense of accomplishment and pride in work
• Helps to identify areas for further education and development
• Enhances credibility and reputation as a professional nurse

Mentorship And Coaching

Mentorship and coaching are essential components of professional development and growth in nursing practice. A mentor is an experienced nurse who can provide guidance, support, and feedback to a less experienced nurse. As Dr. Rachel Lee advised, "A good mentor can help you to navigate the challenges of nursing practice, to develop your skills and confidence, and to achieve your career goals." Coaching, on the other hand, is a more structured process that involves working with a coach to identify and achieve specific goals.

Benefits Of Mentorship

Mentorship can have a number of benefits for nurses, including helping to develop skills and confidence, providing guidance and support, and enhancing career advancement opportunities. The following table outlines some of the benefits of mentorship:

Finding A Mentor

Finding a mentor can be a challenging but rewarding experience. Nurses can find mentors through their workplace, professional organizations, or networking events. As Emily Chen noted, "I found my mentor through a professional organization, and she has been invaluable in helping me to develop my skills and confidence." The following list outlines some strategies for finding a mentor:

• Ask colleagues or supervisors for recommendations
• Attend professional organization meetings and events
• Participate in online forums and discussion groups
• Volunteer for committees or task forces
• Seek out mentors who are experienced and knowledgeable in areas of interest

Coaching Models

There are a number of coaching models that can be used in nursing practice, including the GROW model and the OSKAR model. The GROW model involves setting Goals, Reality-checking, Option-generating, and Way-forward planning. The OSKAR model involves identifying the Outcome, Scale, Know-how, Action, and Response. As Dr. Rachel Lee advised, "Coaching models can be helpful in providing a structured approach to achieving goals and developing skills."

Overcoming Barriers To Mentorship

There are a number of barriers that can prevent nurses from finding mentors or participating in coaching programs, including lack of time, lack of access to mentors, and lack of support from employers. The following table outlines some strategies for overcoming these barriers:

Maintaining A Mentorship Relationship

Maintaining a mentorship relationship requires ongoing effort and commitment. Nurses should regularly communicate with their mentors, seek feedback and guidance, and be open to learning and growth. As Emily Chen noted, "My mentor has been invaluable in helping me to develop my skills and confidence, and I make sure to regularly communicate with her and seek her feedback and guidance." The following list outlines some strategies for maintaining a mentorship relationship:

• Regularly schedule meetings with the mentor
• Be open and honest about goals and challenges
• Seek feedback and guidance on a regular basis
• Be willing to learn and grow
• Show appreciation and gratitude for the mentor's time and expertise

Effective Communication In Mentorship

Effective communication is critical in a mentorship relationship. Nurses should be able to clearly articulate their goals and challenges, and be open to feedback and guidance. As Dr. Rachel Lee advised, "Effective communication is essential in a mentorship relationship, as it helps to build trust and understanding between the mentor and mentee." The following table outlines some strategies for effective communication in mentorship:

Staying Current With Best Practices

Nurses must stay current with best practices in order to provide high-quality patient care. As Dr. Rachel Lee advised, "Staying current with best practices is essential in nursing practice, as it helps to ensure that patients receive the best possible care." This can be achieved through ongoing education and training, attending conferences and workshops, and participating in online forums and discussion groups.

Strategies For Staying Current

The following table outlines some strategies for staying current with best practices:

Benefits Of Staying Current

Staying current with best practices has a number of benefits, including improved patient outcomes, increased job satisfaction, and enhanced career advancement opportunities. As Emily Chen noted, "Staying current with best practices has helped me to improve my skills and confidence, and has enhanced my career advancement opportunities." The following list outlines some of the benefits of staying current with best practices:

• Improved patient outcomes
• Increased job satisfaction
• Enhanced career advancement opportunities
• Increased confidence and competence
• Improved ability to adapt to changing healthcare environment

Overcoming Barriers To Staying Current

There are a number of barriers that can prevent nurses from staying current with best practices, including lack of time, lack of access to education and training programs, and lack of support from employers. The following table outlines some strategies for overcoming these barriers:

Using Technology To Stay Current

Technology can be a useful tool for staying current with best practices. Nurses can use online resources, such as journal articles and research studies, to stay current with the latest research and findings. As Dr. Rachel Lee advised, "Technology can be a powerful tool for staying current with best practices, but it is essential to use it effectively and efficiently." The following list outlines some strategies for using technology to stay current:

• Use online resources, such as journal articles and research studies
• Participate in online forums and discussion groups
• Use social media to stay current with best practices and network with other nurses
• Use mobile apps to access education and training programs
• Use electronic health records to stay current with patient information and best practices

Measuring The Effectiveness Of Staying Current

Measuring the effectiveness of staying current with best practices is essential to ensure that nurses are providing high-quality patient care. The following table outlines some strategies for measuring the effectiveness of staying current:

Maintaining A Culture Of Excellence

Maintaining a culture of excellence is essential for staying current with best practices. This can be achieved by promoting a culture of ongoing learning and professional development, recognizing and rewarding excellence, and providing opportunities for feedback and evaluation. As Dr. Rachel Lee advised, "Maintaining a culture of excellence is essential for providing high-quality patient care and staying current with best practices." The following list outlines some strategies for maintaining a culture of excellence:

• Promote a culture of ongoing learning and professional development
• Recognize and reward excellence
• Provide opportunities for feedback and evaluation
• Encourage collaboration and teamwork
• Foster a culture of safety and quality