This issue of Critical Care Nursing Quarterly presents articles on diverse topics, but all represent works that offer new perspectives about old problems within nursing practice.

Practice Perspectives for Universal Problems promises content that will assist critical care nurses in conquering at least a few of the nemeses that complicate their daily workload.

One of the oldest discussions in critical care staffing is whether new graduates should be placed in the critical care environment. Reddish and Kaplan offer their study of this issue in the article, "When Are New Graduate Nurses Competent in the ICU?" The authors explore the concept of competence and presents their findings gleaned by experience as preceptors for new graduates over a decade at a University Level I Regional Resource trauma facility. The distinct phases that culminate in competency can be validated by standard evaluation tools. This new approach to transitioning new graduates into the critical care setting offers a fresh perspective and dispels the long-held idea that all nurses should have medical-surgical experience before assuming a position in a critical care workforce.

"End-of-Life Nursing Education Consortium (ELNEC) Training Program: Improving Palliative Care in Critical Care" is showcased by Ferrell et al. This new curriculum is designed to assist nurses in aspects of care related to the dying patient in the critical care unit. Topics include pain and other symptom management, communication strategies, and ethics and components of palliative care aimed at both patients and their loved ones. Authors present their experiences in offering the ELNEC training and outline revisions planned for future offerings.

In the work by Parsons et al, "Team Behavioral Norms: A Shared Vision of a Healthy Patient Care Workplace," the authors report their findings from a study of 14 acute care hospitals who were participants in the healthy workplace intervention. Effective communication, positive attitudes, and accountability were among the factors identified as having a relationship with positively influencing core unit work culture. The insights provided in this article will be useful to nurses who desire to understand the dynamics of their unit and improve their practice environment.

Davidson and colleagues tackle the issue of professional boundaries between nurses and physicians in their article, "Scope Creep: When Nursing Practice Moves Beyond Traditional Boundaries." The authors explore and evaluate the practices associated with procedural sedation by using the Population Intervention Comparison Outcome (PCIO) method. Their experiences and findings will challenge your future approaches to assuming expanded nursing roles involving actions and decisions that typically have been within medicine's domain of practice.

Schouchoff's article, "Surgical Approaches for Atrial Fibrillation," explains alternatives to the typical pharmacological methods of managing atrial fibrillation. The author thoroughly reviews atrial fibrillation and common treatment options before presenting surgical treatment strategies. Patient selection, postoperative care, and follow-up management are described in detail in regard to nursing roles and responsibilities.

Deep vein thrombosis and venous thromboembolic disease are preventable but potentially fatal conditions that are often listed among comorbidities of critical illness. In their article, "Case Reviews: The Hidden Risk of Deep Vein Thrombosis-The Need for Risk Factor Assessment," Race and Collier use the case study method to demonstrate common risk factors and the need for routine, systematic assessments using a formal tool and a prescribed process.

Brady et al present "The Use of Knee-Length Versus Thigh-Length Compression Stockings and Sequential Compression Devices." For critical care nurses, this common dilemma is all-too-often solved by merely following the preferences of physicians or institutional norms. This study provides some research-based evidence that should prove useful in clinical decision making regarding deep vein thrombosis and venous thromboembolic disease prophylaxis.

Putney's work, "Bloodless Cardiac Surgery: Not Just Possible, But Preferable," challenges clinicians to embrace newer methods for operative procedures that exclude the use of blood transfusions. Benefits of reducing or eliminating blood transfusions holds the promise of curtailing the associated perils such as infections and incompatibilities that often lead to life-threatening complications for surgical patients. Blood conservation strategies and blood substitute therapies are also reviewed in the article.

Rashid's article, "Developing Scales to Evaluate Staff Perception of the Effects of the Physical Environment on Patient Comfort, Patient Safety, Patient Privacy, Family Integration With Patient Care, and Staff Working Conditions in Adult Intensive Care Units: A Pilot Study," demonstrates the value of careful architectural planning. The building and room configuration and furniture fixtures and their functional interrelationships have a significant impact on patient care and the overall hospital experience for both nurses and patients.

This collection of articles is diverse, but each represents a universal practice problem and each provides some answers to guide critical care practice. Start reading and be prepared to challenge your current thinking about these everyday issues that pervade your work.

Constance A. Hoyt, MSN, RN, Issue Editor