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With the creation of its Wellness Program, the American Association of Nurse Anesthetists (AANA) has advocated for renewed emphasis in education, research, and practice on anesthesia provider wellness. This research was designed to explore the relationship between student registered nurse anesthetists' perceived wellness and students' thriving throughout their academic program. Because of the multifactorial nature of wellness and its alignment with the AANA's wellness model, a salutogenic wellness framework provided the theoretical basis for this study. Four variables related to thriving in a nurse anesthesia program were studied in relationship to students' perceived wellness, measured using the Salutogenic Wellness Promotion Scale (SWPS): self-efficacy, academic achievement, technical clinical competence, and patients' perceptions of students' relational skills. Measurements were taken at 5 points during the academic program. There was a significant correlation, using multiple regression analysis, between SWPS and self-efficacy at times 1, 2, and 3, but not at times 4 and 5. The Emotional Score subscale of the SWPS significantly correlated with self-efficacy at the same intervals. Within the variable of student academic achievement, overall wellness negatively correlated with the National Board of Certification & Recertification for Nurse Anesthetists' Self-Evaluation Examination scores. These results have potential implications on nurse anesthesia education.

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Nurses recognize the importance of spiritual care for facilitating healing and positive outcomes. Nurses caring for patients in highly technical surgical environments have unique opportunities and challenges when attending to patients' spiritual needs. Patients facing surgery often regard the event and the health implications associated with it as having meaning and significance for their lives. They draw upon spiritual resources to respond to the challenges of their illness and surgery. This article addresses the effect of life transition and uncertainty on a patient's surgical experience. Suggestions are made for ways perioperative nurses can provide spiritual care to help create healing environments.

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OBJECTIVES: To identify and describe pharmaceutical care practices implemented by independent community pharmacists who provide compounding services. DESIGN: Qualitative study. SETTING: Independent community pharmacies in Illinois, Missouri, and Iowa in July 2006. PARTICIPANTS: 12 independent community pharmacists with compounding practices. INTERVENTIONS: Semistructured telephone interviews. MAIN OUTCOME MEASURES: Response themes describing pharmaceutical care in compounding practices. RESULTS: Most participants described having a closer relationship with patients receiving compounded preparations than with patients receiving only manufactured products. Higher compounded prescription volume was associated with a higher level of pharmaceutical care services for patients receiving compounded preparations. Patient health and prescription records, the nature and duration of patient counseling, and interaction with physicians differed depending on the type of preparation (compounded or manufactured) provided. CONCLUSION: Community pharmacists provided descriptions of pharmaceutical care and their satisfaction with patient and pharmacist relationships in the context of providing compounded preparations. Pharmacists, especially those providing compounded hormone replacement therapy, developed a hybrid clinical-community practice.

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BACKGROUND: Inadequate communication persists between healthcare professionals and patients and patients' families in intensive care units. Unwanted or ineffective treatments can occur when patients' goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients' outcomes and resource utilization. OBJECTIVES: To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit. METHODS: During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician. RESULTS: Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15,559 vs $24,080) and variable ($5087 vs $8035) costs. CONCLUSIONS: Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients' families reduced lengths of stay and resource utilization.

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