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Background Hospitals need to prevent, respond to, and learn from safety risks and events perceived by patients and families, who in turn rely on nurses to respond to and report their safety concerns. Objectives The aim of the study was to describe the process by which bedside nurses evaluate and determine the appropriate response to safety concerns expressed by patients or their families. Methods A qualitative design was employed. We recruited inpatient bedside nurses in an 811-bed Midwest academic medical center. Nurses provided demographic information and participated in semistructured interviews designed to elicit narratives related to evaluation and response to patient- or family-expressed safety concerns. Data analysis and interpretation were guided by grounded theory. Results We enrolled 25 nurses representing 22 units. Based on these nurses' experiences, we developed a grounded theory explaining how nurses evaluate a patient or family safety concern. Nurses make sense of the patient's or family's safety concern in order to take action. Achieving this goal requires evaluation of the meaningfulness and reasonableness of the concern, as well as the potential effect of the concern on the patient. Based on this nursing evaluation, nurses respond in ways designed to (a) manage emotions, (b) immediately resolve concerns, (c) involve other team members, and (d) address fear or uncertain grounding in reality. Nurses reported routinely handling safety concerns at the bedside without use of incident reporting. Discussion Safety requires an interpersonal and evaluative nursing process with actions responsive to patient and family concerns. Safety interventions designed to be used by nurses should be developed with the dynamic, cognitive, sensemaking nature of nurses' routine safety work in mind. Being sensitive to the vulnerability of patients, respecting patient and family input, and understanding the consequences of dismissing patient and family safety concerns are critical to making sense of the situation and taking appropriate action to maintain safety. Measuring patient safety or planning improvement based on patient or family expression of safety concerns would be a difficult undertaking using only standard approaches. A more complex approach incorporating direct patient engagement in data collection is necessary to gain a complete safety picture.

hat are you doing to prepare yourself to meet the demands of nursing in the "Genomic Age"? You may think it too soon to ask because, after all, the sequencing of the human genome was just announced last year. But this achievement is spawning dazzling new medical technologies. Genomic medicine may, in some cases, allow providers to discover a person's genetic predisposition to a given disease, to predict its onset, extent, and severity, and to pinpoint treatment. Examples of this include carrier testing, in people considering pregnancy, for conditions such as Canavan's disease; screening of neonates for metabolic disorders such as cystic fibrosis; presymptomatic testing for adult-onset conditions such as Huntington's chorea; and predisposition testing for colorectal, breast, and ovarian cancers. It's predicted that genetic testing for many more common diseases will soon be available and that approaches to risk reduction will be based on genetic profiles. Nurses are likely to be the first providers to whom patients will turn with questions about genetic risk and from whom they'll seek guidance regarding the complexities of genetic testing and interpretation. Each of the 2.2 million licensed registered nurses now employed in

Discovery of genes associated with clinical disorders increases the ability of clinicians to more accurately assess risk for their clients to develop or to be carriers of certain health problems. Estimating these risks has become more precise with the addition of genetic testing. The process of client assessment and considerations associated with genetic testing for cystic fibrosis and one form of colon cancer (familial adenomatous polyposis) are presented in a case study format. Ethical considerations in the use of genetic testing include protection of privacy, protection from coercion, and assuring client understanding of implications of test results. Practitioner responsibilities also include educating clients regarding benefits and limitations of testing, collaborating with genetic counseling resources, and monitoring the client for potential adverse outcomes of testing.