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Baptist Hospital, a member of Saint Thomas Health Services, is the largest not-for-profit community hospital in Middle Tennessee, licensed for 683 acute and rehab care beds. For 90 years Baptist Hospital has been devoted to physical, emotional, and spiritual healing with a heritage of continuous growth, community service, and superior care. Aligned with STHS mission of being "dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities," Baptist initiated their palliative care program in March of 2004. The grant requested in this application will fund the partial salary of a Nurse Practitioner. 80% of participants who attend a care-givers class (approximately 180 out of 225 attendees) over the course of 12 months will indicate on an evaluation that the class was beneficial to them and improved their ability to cope with the practical burdens of caring for a loved one with a chronic life-threatening illness. 80% of physicians ( approximately 20 out of 25) who collaborated with the Palliative Care Team to develop the Heart Failure and Chronic Kidney Disease patient protocols indicate that the guidelines specific to these diseases provide structure for consistent quality patient care.