Emergency Palliative Care: Early Assessment of an Older Adult With a Fall and Hip Fracture.

In this segment of the emergency department (ED) palliative care case series, we present a patient who arrives to the ED after a fall resulting in a hip fracture. He is also found to have hypernatremia and an acute kidney injury and develops delirium while in the ED awaiting an inpatient bed. The ED-based integrated geriatric palliative care program is consulted and performs a multidimensional assessment. The geriatric palliative care clinician facilitates discussion with his daughter about surgical intervention based on the patient's goals and values, diagnoses delirium, and worsening depression, creates a plan for delirium and pain management, and accelerates postdischarge planning.

Integrative review of graduate entry programs in nursing.

In this integrative review, the authors report on, summarize, and analyze research conducted on non-nurse college graduates enrolled in master's degree programs in nursing in the United States and Canada, leading to preparation for advanced practice nurse roles. This review demonstrated that non-nurse college graduates successfully develop into registered nurses and advanced practice registered nurses (APRNs) or certified nurse-midwives (CNMs). What is conspicuously absent in the literature is articulation of the process whereby college graduates become nurses and APRNs or CNMs. Given the expansion of graduate entry programs for non-nurse college graduates, along with the recent clarion call to move advanced practice nursing to the postgraduate level, it is time to examine the process. Understanding the process will help faculty refine pedagogy and curricula to support students' transition from non-nurse to both nurse and APRN or CNM.

Developing a novel integrated geriatric palliative care consultation program for the emergency department.

With the aging of our population, older adults are living longer with multiple chronic conditions, frailty, and life-limiting illnesses, which creates specific challenges for emergency departments (EDs). Older adults and those with serious illnesses have high rates of ED use and hospitalization, and the emergency care they receive may be discordant with their goals and values. In response, new models of care delivery have begun to emerge to address both geriatric and palliative care needs in the ED. However, these programs are typically siloed from one another despite significant overlap. To develop a new combined model, we assembled stakeholders and thought leaders at the intersection of emergency medicine, palliative care, and geriatrics and used a consensus process to define elements of an ideal model of a combined palliative care and geriatric intervention in the ED. This article provides a brief history of geriatric and palliative care integration in EDs and presents the integrated geriatric and palliative care model developed.

Core curriculum and competencies: A multisite analysis of postgraduate training programs for primary care nurse practitioners.

The Institute of Medicine and the Affordable Care Act recommend intensified development and expansion of postgraduate training programs (residencies/fellowships) for primary care providers, including nurse practitioners. There is a paucity of literature regarding this innovative training medium for nurse practitioners. The purpose of this descriptive quality improvement project was to identify and characterize the core curricular learning outcomes among primary care postgraduate training programs for nurse practitioners. Semi-structured interviews with program directors across nine sites revealed 12 principal learning outcomes that represented a shared core curriculum among programs. The core curriculum was then mapped to nurse practitioner competencies from two leading nurse professional organizations. Despite the vast differences in programs' developmental stages, findings indicated concordance among program sites and between the core curriculum and the leading professional competencies. The information presented in this article serves to enhance the work of stakeholders involved in developing and standardizing nurse practitioner postgraduate training programs in primary care.