• 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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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. AORN J 89 (May 2009) 875–882. © AORN, Inc, 2009.

Reports on a professional formation course in integrative clinical learning for senior nursing students. Outlines the objectives and methods utilized in the course. Concludes that, given the characteristics and results of the course, vocational formation for ministry needs to include similar dimensions in designing educational curricula.