1. Ruppert, Susan D. PhD, RN, ANP-BC, NP-C, FCCM, FAANP

Article Content

This issue of Critical Care Nursing Quarterly features case exemplars of advanced, evidence-based practice in acute and critical care settings. These cases are the documentation of complex patient care management provided by Doctor of Nursing Practice (DNP) students at The University of Texas Health Science Center at Houston School of Nursing. The care described in each article is comprehensive and demonstrates the knowledge and skills needed to provide accountable patient care within high-acuity settings.


Understanding the why and how of delivering care from a scientific foundation is paramount to impacting positive patient outcomes. These cases illustrate the importance of using subjective and objective data in formulating differential diagnoses. The underlying in-depth pathophysiology provides a solid foundation for understanding the disease process and its manifesting signs and symptoms. In each case, the authors examine the evidence base for selecting and using elements within a formulated patient-centered plan of care. Rationales supported by the scientific literature document the evidence that supports decision making in care management for these patients.


These case narratives can also be used as important educational tools for all levels of nursing practice. The format of the articles provides clinical and academic educators with the information needed for use with groups as simulation scenarios or discussion cases. The in-depth approach provides the means for employing complex cognitive processes in planning and delivering care. Emergency and acute/critical care nurses can gain an understanding of the disease processes and rationales for management in presentation of both rare and common multisystem conditions. Advanced practice nurses in tertiary settings can examine presenting data in working through the process of formulating a differential diagnosis. Most importantly, the reader can appreciate the solid scientific basis for patient care management blending best practices in nursing and medicine.


In this issue, the reader will see the process of working through patient presentations across settings. The authors also highlight the role of the multidisciplinary team in providing high-quality, outcome-oriented care. This care goes past the confines of four walls of the hospital and must address continuity of care as the individual patient transitions across care settings and even back into the community. The involvement of family/significant others and caregivers in formulating plans of care across these settings is critical.


These authors describe case scenarios that represent the complexity of health and illness from both physical and psychosocial perspectives. The overlay of chronic illness onto acute presentations emphasizes the interplay between disease states and how each impacts the other. The article format provides the reader with a framework for understanding this continuum. These case narratives serve as examples of true practice scholarship and the translation of evidence into practice. Communication of clinical experiences and use of best practices by clinicians can be a powerful learning tool directed at improvement of future care and patient outcomes.


-Susan D. Ruppert, PhD, RN, ANP-BC, NP-C, FCCM, FAANP


Professor and Assistant Dean


The University of Texas Health Science Center at Houston


School of Nursing