New Guidance to Build a Resilient Chain for Sepsis Care
Inspired by AHA’s Chain of Survival for cardiac arrest, this sepsis strategy has six crucial steps.
“The Sepsis Chain of Survival: A Comprehensive Framework for Improving Sepsis Outcomes,” in Critical Care Medicine, aims to complement the care of patients with advanced sepsis by organizing and simplifying best practices. It represents a global call to action for a unified and locally adaptable sepsis strategy for patients of all ages.
Inspired by the American Heart Association’s (AHA’s) Chain of Survival concept for cardiac arrest, the sepsis strategy has six crucial steps:
- Awareness and prevention – Educate communities and healthcare professionals to recognize early signs of infection and sepsis, enabling timely intervention to prevent progression to severe illness.
- Early recognition and call for help – Promote awareness of sepsis danger signs, including fever, rapid breathing, elevated heart rate and altered mental status. Equip community responders and healthcare teams to detect symptoms, and use available tools to guide timely intervention.
- Continuous source control – Quickly identify and then eliminate the source of infection through interventions such as surgical drainage, debridement or removal of infected devices.
- Appropriate fluids, oxygen and antibiotics – Initiate timely antimicrobials, oxygen and fluid resuscitation guided by clinical assessment, local epidemiology and resource availability. li> Appropriate fluids, oxygen and antibiotics – Initiate timely antimicrobials, oxygen and fluid resuscitation guided by clinical assessment, local epidemiology and resource availability.
- Critical care without walls – Ensure timely sepsis care through coordinated efforts across hospitals, EMS, clinics and community health workers, enabling early monitoring, intervention and escalation using available resources.
- Post-sepsis care and return to community – Support survivors through rehabilitation, sepsis education and psychosocial resources to address physical, cognitive and emotional challenges.
For nurses, knowing the signs of suspected sepsis and speaking up can be critical to a patient’s survival. Explore AACN’s sepsis resources to access evidence-based guidelines, clinical tools and bedside strategies that support early recognition and effective response.
For nurses, knowing the signs of suspected sepsis and speaking up can be critical to a patient’s survival. Explore AACN’s sepsis resources to access evidence-based guidelines, clinical tools and bedside strategies that support early recognition and effective response.
Results of National Survey of Nurse Managers and CNOs
Nurse managers and CNOs report moderate progress on workload strategies.
A national survey of nurse managers and chief nursing officers (CNOs) highlights shared efforts to strengthen the nurse manager role, while revealing key differences in how each group perceives progress on strategies to improve workload and well-being.
“Priorities for Nurse Managers: Guidance From a National Survey,” in Nurse Leader, provides a road map for nurse managers by prioritizing issues they perceive as most impactful. A total of 177 nurse managers and 54 CNOs completed the survey with six questions in multiple choice and ranking formats.
Regarding well-being strategies, CNOs report greater implementation progress than nurse managers, especially in leadership development and workplace violence support. Both groups note limited adoption of flexible work options, such as remote work and alternative schedules, even though nurse managers view them as essential to well-being.
The survey identifies three key priorities:
- Review collaborative strategies — CNOs and nurse managers should regularly discuss advocacy, perceived value and shared implementation of high-impact strategies.
- Sustain workplace violence progress — CNOs should review and celebrate progress with nurse managers to close perception gaps and reinforce momentum.
- Broaden implementation across teams — CNOs should extend strategies across the interprofessional team, including 24/7 departments such as respiratory therapy, environmental services and radiology. They should advocate for changes at the highest levels.
AACN offers resources to help nurse managers develop leadership skills and build professional networks. Resources include “Fundamental Skills for Nurse Managers,” an interactive, self-paced course offering CE hours, and AACN’s free online communities, where nurses connect, collaborate and access tools to support practice, leadership, professional development and more.
“Advancing the nurse manager role is a worthwhile investment to enhance organizational and patient outcomes and invest in future nursing and health care executive leaders,” adds the article in Nurse Leader.
Nurse-Led Family Support Interventions
The trial was conducted in Switzerland with 885 family members (412 in the intervention group).
Nurse-led support interventions were associated with a slight improvement in family satisfaction and a strong increase in the quality of communication and emotional support for the families of ICU patients, according to multiple surveys.
“Nurse-Led Family Support Intervention for Families of Critically Ill Patients,” in JAMA Internal Medicine, notes that the interprofessional interventions produced higher mean scores on satisfaction surveys, communication assessments and cognitive and emotional support than usual care.
The results suggest that “nurse-led family care pathways combining interprofessional family communication structures with regular nurse check-ins with families may be a promising approach to increase quality of family care in the ICU,” adds the randomized trial.
Conducted at 16 ICUs in Switzerland with 885 family members (412 in the intervention group) of patients who spent at least 48 hours in critical care, the trial sought to measure the impact of a novel program led by nurses that “offered relationship-focused, psychoeducational support, and ensured interprofessional communication along the ICU trajectory.”
Participants completed multiple surveys, including “family satisfaction with ICU” on a scale of 0-100. Family members in the intervention group had an average score of 81.78, compared with 79.39 for those in the control group. On the family-clinician questionnaire with a 1-5 scale, the average score in the intervention group was 0.37 points higher; on the cognitive and nurse emotional support questionnaire with a 14-70 scale, the average score in the intervention group was 8.71 points higher.
Although the family nurses in the intervention group were supposed to engage in at least five actions across the three components, only 23% of family members received all of them within the specified time frame.
Related AACN resources include a practice alert, “Facilitating Family Presence During Resuscitation and Invasive Procedures Throughout the Life Span,” on how nurses can help family members be present during key times in critical care patients’ hospitalizations.
Pericarditis Guidelines Updated With New Scoring System
The proposed diagnostic framework requires pleuritic chest pain and at least one of five supporting criteria.
New guidelines from the American College of Cardiology (ACC) outline diagnostic and therapeutic advances in acute and recurrent pericarditis, introducing refined imaging-based strategies and novel criteria to help cardiovascular care teams improve evaluation, treatment and long-term outcomes.
“2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis,” in JACC, proposes a scoring system based on six clinical and imaging criteria. It highlights the evolving role of biologic therapies and multimodality imaging in guiding care beyond traditional anti-inflammatory approaches.
The proposed diagnostic framework requires pleuritic chest pain and one or more of five supporting criteria, yielding a score of 0 (unlikely), 1 (possible) or 2+ (definite) for pericarditis. These criteria include “clinical findings of pericardial rub, ECG changes, new or worsening pericardial effusions, serologic findings of elevated inflammatory markers and imaging findings of pericardial inflammation,” the report notes.
Management begins with dual anti-inflammatory therapy — colchicine and high-dose NSAIDs or aspirin, followed by tapering as symptoms and inflammatory markers resolve. Exercise restriction, gastric protection and hospitalization for high-risk cases such as tamponade, refractory pain or constrictive pericarditis are also emphasized.
The guidelines recommend referral to pericardial disease centers (PDCs) for patients with recurrent, refractory or high-risk pericarditis requiring advanced therapies or coordinated follow-up. PDCs streamline care through structured protocols, multidisciplinary collaboration and timely access to imaging, education and specialty services — reducing hospitalizations while supporting clinical trials, medication management and long-term disease control.
“As patient volumes increase, PDCs can evolve from being part of broader cardiovascular services to standalone units, optimizing specialized care delivery.”
The guidelines also address pericardial disease in oncology patients, noting that pericarditis may result from the malignancy itself, oncologic therapies or infection in immunosuppressed patients. Diagnosis relies heavily on imaging, while treatment is tailored to etiology and goals of care, often leading to symptom relief, hemodynamic stabilization or procedural intervention in advanced cases.
Preceptors: Requirements for Their Specialized Role
Preceptors need specific competencies as well as leadership and organizational support.
Preceptors – who play a critical role in the development of new nurses, students and new graduates – require specialized education, sufficient dedicated time and a specific competency program to teach effectively.
“Preceptors: Essential to Nurse Retention,” in American Nurse, supports an ongoing structured education program to prepare preceptors by building the competencies to succeed in their role. “The support of a good preceptor serves as one of the most meaningful tools available to prevent the loss of nurses due to turnover or failure to transition,” the article notes. They also have a positive effect on recruitment, onboarding and new graduates just beginning their careers.
Preceptors teach preceptees about the culture as well as clinical requirements. “As leaders, preceptors’ authentic use of this skill [cultural instruction] has a positive effect on a nurse’s ability to develop self-efficacy, job satisfaction and clinical performance.”
The article cites a lack of support from organizational leaders as well as strategies to ensure well-trained preceptors as nurse retirements increase. “Organizations should offer preceptor preparation courses as early as possible, and educators should work toward meeting the needs of both early career and experienced nurses.”
Although there are 40 defined competencies for preceptors, there is no standardized program to ensure they meet them. “Preceptor development also should align with improvements in new graduate orientation programs (transition to practice, nurse residencies), which must become standard practice to support new nurses, ease their professional adjustment, reduce transition shock and improve retention.”
AACN resources include an online course with realistic scenarios: “Fundamental Skills for Preceptors” provides preceptors with the essential skills they need to succeed in their vital roles. In addition, AACN offers six evidence-based standards to create and sustain a healthy work environment to support nursing practice that leads to quality outcomes for patients, families and nurses.
Outcomes of Fasting or Feeding Before Extubation
Fasting before extubation, which is a widely used clinical practice, could now be reevaluated.
Maintaining enteral nutrition in the hours before respiratory extubation produced similar outcomes to fasting, providing potential opportunities for clinicians to keep ICU patients’ calorie intake at sufficient levels.
“Continued Enteral Nutrition Until Extubation Compared With Fasting Before Extubation in Patients in the Intensive Care Unit: An Open-Label, Cluster-Randomised, Parallel-Group, Non-inferiority Trial,” in The Lancet Respiratory Medicine, notes that extubation failure rates for mechanically ventilated patients were nearly identical in groups who fasted for six hours beforehand with gastric suctioning compared with those who stayed on enteral nutrition. The finding “represents a potential alternative in this population,” the trial notes.
Conducted at 22 ICUs in France and involving 2,138 ICU patients (1,130 in the intention-to-treat group and 1,008 in the per-protocol group), the trial found extubation failure in 17.2% of patients assigned to ongoing nutrition and 17.5% of patients assigned to fasting in one set of patients and 17.0% and 17.9%, respectively, in a second set. A secondary outcome of pneumonia within 14 days occurred in 1.6% of patients with nutrition and 2.5% of those who fasted.
According to a related article in MedPage Today, surveys indicate that fasting, which is a widely used clinical practice, can now be reevaluated. A principal concern for ventilated patients is failure to receive their recommended calorie intake, and the trial finds that patients in the fasting group received only 20% of normal intake on the day of extubation.
AACN resources include “Initial and Ongoing Verification of Feeding Tube Placement in Adults,” which is a practice alert on preventing dangerous misplacements of tubes, and “Nutrition Considerations in the Intensive Care Unit,” an article focused on a range of nutrition considerations. AACN also offers an NTI recorded session titled “Navigating Nutrition for Improved Patient Outcomes” and many other related resources.
Assignment-Free Charge Nurses
When she was opening a new unit during the pandemic, patient care manager Samantha Hendricks was a patient-free charge nurse. She witnessed firsthand the positive impact of this staffing model. Then she implemented the role in another unit and her team observed ideal staffing ratios, improved nurse satisfaction and enhanced patient care metrics. Learn the details of this innovative staffing model.