This issue of Critical Care Nursing Quarterly is a collection of clinical studies and research that impact nursing practice. The authors represent perspectives of the bedside nurse, the emerging nurse researcher, and industry experts, who are developing solutions for today's health care environment.

Pattillo presents 3 student papers, which illustrate the potential value of using evidence-based bundles to improve care. Topics addressed include awakening and the effects of sleep cycle interruption, choice of sedation regimens, and the importance of early mobility and exercise in the ICU.

Van der Kooi et al share an intriguing research report, "Sleep Monitoring by Actigraphy in Short-Stay ICU Patients." Using a small, but homogeneous sample, these nurses from the Netherlands demonstrated that actigraphy underestimates wake time and overestimates sleep cycles, making it of little value for use in short-stay patients. Their article emphasizes the importance of having a better understanding of sleep as a factor in ICU outcomes and indicates need for further research to identify appropriate tools to quantify sleep/wake cycles.

LiveData is a leader in networked computer applications to improve throughput as well as patient outcomes in the perioperative setting. In the Robbins' article, "Improving the Quality of Patient Care and Lowering Costs in the Perioperative Suite," the author demonstrates positive results of a systems approach to managing patient safety and throughput of surgical patients. LiveData's close planning with hospital management and its partnering with other key players in the surgical arena are highlighted as vital elements in cost containment as well as the successful implementation of an overall safety net for patients.

Bonuel is a nurse leader and advocates for acuity-adaptable environments for patients. Her doctoral research has produced exciting results in her own workplace and has influenced concept adoption by other hospitals. Two articles, "Acuity Adaptable Patient Rooms Improve Renal Transplant Patient's Length of Stay" and "Experiences of Nurses Caring for Renal Transplant Patients in an Acuity Adaptable Patient Room" chronicle her research and its clinical impacts. In the final article of this issue, she shares her comprehensive literature review on acuity-adaptable rooms.

A rare, life-threatening disorder, Malignant Hyperthermia, is considered by Twine. Although usually seen in the operating room or postanesthesia care environment, this author describes a case of malignant hyperthermia, which presented in the ICU and outlines the management of this devastating condition based on established best practices.

There is an ongoing controversy regarding the presence of family members during resuscitation scenarios. Hayajneh reports his research data in his article, "Jordanian Professional Nurses' Attitudes and Experiences of Having Family Members Present During CPR of Adult Patients."

Greenberg presents preliminary genetic research findings related to Polycythemia Vera, a hematopoietic stem cell disorder, which initiates unregulated increases in erythrocytes, leukocytes, or platelets. The results of this aberration include an accelerated red blood cell production leading to thrombosis and related hemorrhagic crises. It is vital that critical care nurses understand this rare, but life-threatening hematological emergency, to establish appropriate guidelines for clinical interventions and patient education.

Infection control programs continue to compile best practices involving the use of antibiotics and other antimicrobial agents for patient care. A recent controversy involves the use of chlorhexidine as well as other antiseptic antibacterials in routine skin care. Ravin considers this dilemma in her article "Chlorhexidine: To Bathe or Not to Bathe?"

"Five Alive: Using Mock Code Simulation to Improve Responder Performance in the First Five Minutes of a Code" is one hospital's attempt to find a best practice model for this emergency. Delac and Blazier, both nurse educators, offer an approach to quality improvements associated with resuscitation scenarios. Findings from their clinical investigations involving 103 nurse subjects are reported in this article and reveal dramatic improvements in time to CPR initiation, defibrillation, and other interventions.

"Evidenced-Based Pharmacotherapy for Rate Control in Atrial Fibrillation" by Greenberg compares traditional and emerging regimens for managing this commonplace cardiac problem. She stresses that the goal of treatment, whether controlling heart rate or rhythm, is to reduce hemodynamic symptoms and prevent the devastating development of thrombi.

Every critical care nurse should find several of their own questions and concerns addressed within this issue. The writers hope that their articles will stimulate new interest among ICU nurses to consider modest clinical investigations and research aimed at improving practices and patient outcomes.

-Catherine M. Dougherty, MA, RN, FAAFS

Issue Editor