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Consideration needs to be given to the appointment of curriculum leads for patient safety who should be encouraged to work strategically across disciplines and topic areas; development of stronger links with organisational systems to promote student engagement with organisation-based patient safety practice; and role models should help students to make connections between theoretical considerations and routine clinical care.

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This paper reports on the results of a previous investigation into the ward learning environment for student nurses and its relationship to quality of nursing. The emotional aspects of caring associated with the nursing process emerged as an important component of their relationship. The nursing process, introduced during the 1970s, is described as both a philosophy and work method. As a philosophy, it promotes a people-centred rather than task-centred approach to patients and raises the profile of emotional care. Hochschild's definition and analysis of emotional labour in the workplace is used as a conceptual means to understanding the content of nurses' emotional work. It is also used to assess the extent to which the predominant ideologies of nursing, articulated through the nursing process, were applied in the selection and training of nurses to be emotional labourers. It is concluded that the nursing process is more successful as an ideology and less in providing a knowledge base with which to inform training and support for managing complex feelings.

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Primary care lags behind secondary care in the reporting of, and learning from, incidents that put patient safety at risk. In primary care, there is no universally agreed approach to classifying the severity of harm arising from such patient-safety incidents. This lack of an agreed approach limits learning that could lead to the prevention of injury to patients. In a review of research on patient safety in primary care, we identified 21 existing approaches to the classification of harm severity. Using the World Health Organization’s (WHO’s) International Classification for Patient Safety as a reference, we undertook a framework analysis of these approaches. We then developed a new system for the classification of harm severity. To assess and classify harm, most existing approaches use measures of symptom duration (11/21), symptom severity (11/21) and/or the level of intervention required to manage the harm (14/21). However, few of these approaches account for the deleterious effects of hospitalization or the psychological stress that may be experienced by patients and/or their relatives. The new classification system we developed builds on WHO’s International Classification for Patient Safety and takes account not only of hospitalization and psychological stress but also of so-called near misses and uncertain outcomes. The constructs we have outlined have the potential to be applied internationally, across primary-care settings, to improve both the detection and prevention of incidents that cause the most severe harm to patients.