Nurse Practitioners: Knowledge, Skills, and Leadership for the End-of-Life Conversation in Intensive Care.

An impending policy change in Medicare will provide reimbursement for the end-of-life conversation. The rise in numbers of older adults who face serious illness coupled with advances in healthcare technology are increasing the need for providers to address end of life issues in the acute care setting. Doctoral-level nurse practitioners who specialize in acute care of older adults are poised to be leaders and facilitators of this conversation in a particularly challenging context-the intensive care unit. The focus of this article is the new end-of-life policy in relation to the particular contributions that adult gerontology acute care nurse practitioners offer in the acute care setting.

The impact of an electronic medical record surveillance program on outcomes for patients with sepsis.

OBJECTIVES: To evaluate the effects of this EMR surveillance on sepsis, severe sepsis or septic shock outcomes in patients admitted to a medical telemetry unit, including length of hospital stay, patient discharge and mortality. METHODS: A retrospective review of pre- and post-implementation of a pilot electronic medical record (EMR) sepsis surveillance. RESULTS: Implementing EMR sepsis surveillance significantly improved home discharge (49.0% versus 25.3%, p < .05) and reduced hospital mortality (1.0% versus 9.3%, p < .05). Although there was no difference in the length of hospital stay for the whole group, patients in the surveillance group who triggered an alert on the EMR surveillance had a decreased length of hospital stay compared to those without an alert (7.2 ± 4.2 versus 11.6 ± 9.4 days, p < .05). CONCLUSION: These results offer promising evidence that the use of an EMR sepsis surveillance alert could decrease the ravishing effects of sepsis, severe sepsis and septic shock by early identification and treatment.

Using massage and music therapy to improve postoperative outcomes.

An experimental pilot study was conducted to investigate the effects of preoperative massage and music therapy on patients' preoperative, intraoperative, and postoperative experiences. Participants were assigned randomly to one of four groups--a group that received massage with music therapy, a group that received massage only, a group that received music therapy only, or a control group. Hemodynamics, serum cortisol and prolactin levels, and anxiety were measured preoperatively and postoperatively. Postoperative anxiety levels were significantly lower and postoperative prolactin levels were significantly higher for all groups.