Sepsis treatment strategies have been studied and discussed for many years. Some strategies remain controversial and continue to be studied, which will impact future treatment strategies. One item that remains crucial to the treatment of sepsis is the early identification of sepsis. Early identification contributes to improved outcomes. Sepsis is not only restricted to hospitals but also to the outpatient and extended-care settings. This has posed a unique opportunity for hospitals, outpatient, and extended-care settings to collaborate to improve patient outcomes. The current health care environment of value-based purchasing and reimbursement has impacted health care facilities across the nation. Sepsis has a large impact on patient quality and also the financial well-being of institutions, which has prompted the focus on this topic.

DuMont, Francis-Frank, Chong, and Balaan address some sepsis treatment controversies in their article "Sepsis and Septic Shock: Lingering Questions." They discuss a variety of topics from recent studies including: resuscitation end-points, the use of intravenous fluids and blood transfusions, administration of corticosteroids, and biomarkers for sepsis.

In the article "Back to Fundamentals: Using High- and Low-Fidelity Simulation to Provide Reinforcement of Preventative Measures for Sepsis," McDermott and Englert outline the educational technique of simulation to improve nursing interventions in the prevention of sepsis. After this work, Mihaljevic and Howard take the simulation topic outside the inpatient world with their article "Maximizing Interdisciplinary Communication for Improvements in Safety and Health Care Quality." They report their experiences in using evidenced-based sepsis simulation in the education of staff within a long-term care setting.

Chen challenges us to reconsider some clinical practices associated with fluid resuscitation used in the management of sepsis. In the article "Excessive Fluid Resuscitation in Sepsis," this author examines the theoretical benefits of fluid resuscitation and physiological responses that can negatively affect patient outcomes. He follows with "Glycocalyx in Sepsis Resuscitation," an article that unravels the mystery of the protective layer of glycoprotein within the vasculature structures that is a vital factor in physiological dynamics associated with changes in fluid volume. These contributions should alert clinicians about the potential dangers associated with aggressive fluid delivery during sepsis.

"Bathing With 2% Chlorhexidine Gluconate: Evidence and Costs Associated With Central Line-Associated Bloodstream Infections" by Shah, Schwartz, Luna, and Cullen presents meta-analysis data supporting the value of chlorhexidine as a component of evidence-based nursing practices for preventing bloodstream infections arising from central lines.

Angelelli summarizes the value propositions that health care institutions must consider when developing their antisepsis strategies and clinical protocols. In addition to discussing the financial burdens to Medicare and new systems emerging in the face of the Affordable Care Act, he asserts that interorganizational collaboration may be a vital factor in controlling escalating costs associated with sepsis. "Financial Implications of Sepsis Prevention: Early Identification and Treatment" is one article that all nurses should read.

Montanaro summarizes current evidence-based protocols in his article, "Sepsis Resuscitation: Consensus and Controversies." He stresses the vital role of ICU nurses in recognition of this life-threatening condition, and invites them to take a leading role in educating non-ICU nurses about the nuances of sepsis. Key opportunities arise when interfacing during patient transfers and exchange reports, or when working together on rapid response and code teams.

There will always be ongoing progress in the clinical issues associated with causes of sepsis, its early identification, and clinical management. ICU nurses are on the frontline and have a key role in detecting subtle signs and symptoms, which mandate prompt implementation of the bundles designed to limit morbidity and mortality linked with sepsis.

This issue concludes with a contribution from Crawford who presents "An Integrative Review of Pain Resource Nurse Programs." The author reports findings and makes recommendations for health care facilities, endeavoring to improve pain management. Four key elements are outlined as integral to design and develop effective programs including leadership commitment and active involvement in embedding a culture of effective pain management throughout the organization; addressing staff-related and organization-related challenges and barriers to pain management; a combination of strategies to overcome these barriers; and collaborative multidisciplinary teamwork and communication.

-Katrina A. Pyo, PhD, RN, CCRN

Lori Laux, MSN, RN-BC, CRNP

Issue Editors