ObjectiveTo investigate whether the daily workload per nurse (Oulu Patient Classification (OPCq)/nurse) as measured by the RAFAELA system correlates with different types of patient safety incidents and with patient mortality, and to compare the results with regressions based on the standard patients/nurse measure.SettingWe obtained data from 36 units from four Finnish hospitals. One was a tertiary acute care hospital, and the three others were secondary acute care hospitals.ParticipantsPatients’ nursing intensity (249 123 classifications), nursing resources, patient safety incidents and patient mortality were collected on a daily basis during 1 year, corresponding to 12 475 data points. Associations between OPC/nurse and patient safety incidents or mortality were estimated using unadjusted logistic regression models, and models that adjusted for ward-specific effects, and effects of day of the week, holiday and season.Primary and secondary outcome measuresMain outcome measures were patient safety incidents and death of a patient.ResultsWhen OPC/nurse was above the assumed optimal level, the adjusted odds for a patient safety incident were 1.24 (95% CI 1.08 to 1.42) that of the assumed optimal level, and 0.79 (95% CI 0.67 to 0.93) if it was below the assumed optimal level. Corresponding estimates for patient mortality were 1.43 (95% CI 1.18 to 1.73) and 0.78 (95% CI 0.60 to 1.00), respectively. As compared with the patients/nurse classification, models estimated on basis of the RAFAELA classification system generally provided larger effect sizes, greater statistical power and better model fit, although the difference was not very large. Net benefits as calculated on the basis of decision analysis did not provide any clear evidence on which measure to prefer.ConclusionsWe have demonstrated an association between daily workload per nurse and patient safety incidents and mortality. Current findings need to be replicated by future studies.

The checklist increased OR teams' awareness of patient-related issues, the procedure and expected risks. It also enhanced team communication and prevented communication failures. Our findings support use of the WHO checklist in various surgical fields.

We will get through this together– rhetoric as a sensemaking practice in managing a pandemic In a poorly managed crisis situations, inconsistent management produces cacophony, ambiguity and anxiety that disrupts optimal thinking and action. At best, consistently used rhetorics can help the handling and management of the pandemic. This study approaches pandemic management from a rhetorical perspective, looking at the role of rhetoric as part of the sensemaking process. We use a single case data to understand the rhetoric used in the case of Wellbeing Services County of Ostrobothnia. We identify three primary rhetoric: persuasion, encouragement, and obligation. We describe how these rhetoric were used to manage the sensemaking processes within the region.