Climate Change: Time for Hospitals to Respond.

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.

Nursing leadership from the bedside to the boardroom.

Experienced acute and critical care nurses are poised to be high-impact leaders in the current, ever-changing health care landscape. These professionals need new skills to carry them to the next level, as they are called on to lead in a new age filled with increasing complexities. This article provides strategies for nurses to consider and reflect on throughout their leadership journey.

Providing adult and pediatric care in the same unit: multiple considerations.

As always in acute and critical care, preparation is fundamental to positive patient and family outcomes. Although integration of diverse age populations may occur rarely in a unit, strategic planning should be in place for such occurrences,with relevant competencies considered, addressed, and evaluated on a continuing basis.

Maintaining professional boundaries in the pediatric intensive care unit.

Team members in the PICU need to have an understanding of the potential for professional boundary violations. These lines are dynamic and easily blurred and may be crossed during well-intentioned interactions. We hope that knowledge of the warning signs will help health care providers and patients and families remain in the zone of helpfulness.

Inability to alkalinize urine in a patient at risk for tumor lysis syndrome: a case report.

This report provides a description and discussion of a 19-year-old, 65-kg male, with a large mediastinal mass, right pleural effusion, and pericardial effusion, requiring urine alkalinization during a propofol infusion. The patient required NaHCO3 boluses, urine pH, electrolyte, arterial blood gas and lactate monitoring, and discontinuation of the propofol. The authors suggest that caution be used when prescribing a propofol infusion for patients who are at risk of tumor lysis syndrome and the need for urine alkalinization.

Questions unanswered: propofol use in the pediatric intensive care unit.

As professionals who care for the sickest children, we want to provide the best evidence-based care available. While there are questions still to be answered, it is clear that when propofol is administered to children, it should be done in a manner that is intentional, well planned, and consistent with national guidelines and regulatory groups. Haphazard administration of propofol will place children at risk.