In an increasingly complex health care environment, the prompt recognition of critical illnesses, such as cardiogenic shock, is imperative for improving patient outcomes. Telehealth services, such as the integration of virtual intensive care units, can facilitate collaboration between clinicians to expedite treatment of complex conditions. In this case report, an intensive care nurse practitioner's use of telehealth resulted in prompt diagnosis and treatment for a patient with cardiogenic shock. The patient was initially treated for presumed septic shock. The intensive care nurse practitioner suspected cardiogenic shock and consulted with an intensivist using a virtual intensive care model of care. The patient was treated for cardiogenic shock and has returned to his baseline status, despite the morbidity and mortality typically associated with cardiogenic shock. Integration of virtual intensive care units in other health systems can offer one way to improve outcomes for critically ill patients, especially those with low-frequency, high-risk conditions.

Oncology care is rapidly evolving due to the continual emergence of new treatment. Despite the shift toward outpatient cancer care, many patients still need inpatient hospitalization for antineoplastic infusion therapies because of a variety of factors. Acute and critical care nurses may be responsible for administering complex intravenous therapies to treat cancer. This task requires careful attention to both patient and nurse safety. Nurses must be knowledgeable about hazardous drug handling, safe medication delivery, prompt recognition and management of adverse effects, and the unique challenges of infusion therapy in critically ill patients. This article outlines key nursing practice considerations and best practices for the administration of oncology infusions in critical care settings, emphasizing strategies to optimize patient outcomes and minimize risks associated with infusion therapy.

Secondary medication delivery using large-volume smart pumps offers important workflow and safety benefits. However, the widely used linear peristaltic large-volume smart pumps rely on sufficient head-height differential for accurate secondary infusion, leading to underdelivery risks. This article outlines common clinician workarounds used to mitigate these risks, including delivering secondary medications via primary mode, programming excess volume to be infused, clamping primary lines, and using short-set primary delivery. Although intended to ensure full medication delivery, these strategies introduce safety risks, increase alert burden, and heighten cognitive load. In contrast, cassette-based large-volume smart pumps use valve-controlled fluid delivery, eliminating the need for head-height differential and reducing the potential for human error. This review evaluates the risks and rewards of these workarounds and offers guidance to support informed decision-making while advocating for long-term technology solutions that improve safety, reduce clinician burden, and align with best practices in infusion therapy.

Diagnostic reasoning (DR) is a critical skill for nurse practitioners (NPs). This article provides an update of a 2022 scoping review of DR content in NP education, highlighting advances in curriculum integration. To assess the degree that scholarly literature about clinical reasoning in NP education includes DR; identify how DR is defined in NP education; and describe the teaching methodologies used to support DR-related knowledge, skills, and/or attitudes. We examined and categorized the literature from the past 2.5 years, assessing the scope, current status, and impact of DR-related content in NP education programs. Literature reviews emphasized meta-cognitive strategies and competency assessment. Case reports described innovative teaching interventions and objective measures of student competency. Primary research articles explored a variety of DR topics, including survey research, diagnostic accuracy, structured reflection, and tool validation studies. New contributions included model and tool development articles for teaching and evaluating DR. Substantial progress was seen in the integration of DR components, theory, evidence-based teaching, and evaluation approaches in NP education, demonstrating increased awareness of the importance of DR competencies for NP students. Extending these advances to faculty, preceptor, and NP research development will provide important foundations for NP education and scholarship.

T he rapidly evolving landscape of hospital-based intensive care in the United States raises difficult ethical questions about whether, and under what circumstances, clinicians and hospitals may justifiably initiate, withhold, or withdraw life-sustaining medical treatment (LSMT) over the preferences of patients or surrogates.Taking measures counter to patient and surrogate preferences regarding LSMTs that clinicians perceive to be "potentially inappropriate," "disproportionately harmful," or "nonbeneficial" may have lasting consequences not only for patients and families but also for the nurses and other clinicians who care for them.In 2015, a multisociety policy statement was published to help guide management of intractable conflicts around LSMTs between patients or surrogates and the clinicians overseeing their care.The statement defines potentially inappropriate treatments as those that have "at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them." 1(p1319) Authors of the policy recommended a 7-step dispute resolution process for managing associated conflicts.Although it offered a few illustrative case scenarios, it did not otherwise delineate which competing ethical considerations should be taken into account or how much weight each ought to carry.

Alarm bells are sounding internationally as climate change impacts planet Earth and its inhabitants. Health care organizations must consider the role they play in working toward environmental sustainability in terms of mitigation, resilience, leadership, and equity. Institutions need to address the effects of climate change on the physical health and mental well-being of patients and their families as well as employees. Awareness of the complexities of sustainability initiatives and disaster management related to inclement weather and weather-related events is critical for health care organizations to avoid precipitating the illnesses and diseases they endeavor to prevent and heal.