This chapter reviews prevention, including genetic counseling. It discusses genetic testing for diagnosis as opposed to screening and the treatment for genetic disease. Methods of prevention begin with education of the public and health care professionals and identification of those at risk. Genetic counseling is the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. The malignant cells often exhibit aneuploidy as well as translocations that are found only within the tumor cells. Genetic errors that arise from specific cell lines are somatic mutations. It is suggested that there is a thorough collection of family, genetic, and medical history for children entering the adoption process. Nurses may play a variety of roles in genetic counseling that reflect their preparation, area of practice, primary functions, and setting. The chapter explains the incidence of chromosome abnormalities.

Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.

This chapter provides the doctor of nursing practice (DNP)/nurse leader with knowledge of the financial, scheduling, staffing, reporting tools, and leadership commitment required to be successful in the management and retention of their workforce and the delivery of care to the patients. The DNP/nurse leader has ultimate accountability for the cost center budget for labor resources, salary and expense dollars, staff satisfaction, and the delivery of care to the patients on the unit. Accountability and teamwork are crucial to achieving best practices, engagement by frontline staff to improve patient safety and the quality of care. There is no question that nursing care and quality patient care are inseparable. Safe staffing saves lives and a growing body of evidence documents that adequate nurse staffing improves patient outcomes, resulting in shorter lengths of stay, fewer complications, and patient deaths.

Nurses with a doctor of nursing practice (DNP) degree possess the specific skills needed to address the issues and achieve the goals related to better access, reduced health disparities, balanced quality and cost, improved health literacy, enhanced practice, and sustainability of health care and health care systems. This chapter explains the DNP abilities and proficiencies on financial and business management, applying evidence-based practice (EBPs) to build systems of care, and evaluating outcomes, with specific concentration on grant writing for health care programs. Generally, contemporary operating budgets in the acute hospital, ambulatory, or community settings are based on historic operating expenses and revenues, or increasingly are zero based. This leaves the DNP with little to no margin for increases related to redesigning care delivery models, implementing quality initiatives, initiating performance improvement strategies, or creating new service lines; except, of course, to become leaner.

This chapter explores how three successful nursing leaders, using different leadership approaches, demonstrate traditional leadership attributes such as strategic vision; risk-taking and creativity; interpersonal and communication effectiveness; and inspiring and leading change. It discusses the opportunities and implications for nursing leaders and those external to the profession to develop collaborative and transformative partnerships to advance quality health care. Pragmatic leaders demonstrate leadership excellence by effectively translating their nursing care assessment skills into the ability to approach organizational problem solving and decision making in a systematic, logical manner. In contrast to the present-needs focus of pragmatic leaders, charismatic leaders are vision-based leaders who predicate their leadership agenda on attaining future goals. Each of the three nursing leaders profiled understands the importance of being politically astute and effectively leveraging power and influence to make value-added contributions. To varying degrees, the various constituents of the nursing leaders profiled view them as socialized leaders.

This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.

In order to function effectively, clinicians need to have both confidence in their professional judgment and belief in their clinical competence. The overconfident clinician who ignores opposing evidence or overlooks additional information runs considerable risk of not only making mistakes but alienating patients and families. Hubris is a major source of mistakes within health care. It is this hubris that also accounts for much of the downstream impact of medical mistakes. Patient-provider relationships are especially harmed when clinician hubris inevitably proves unwarranted, the diagnostic conclusions are erroneous, and/or mistakes occur. Mindfulness allows for self-correction, a recalibrating of one’s compassion capacity and an energy re-orientation away from ineffective self-enhancement and a refocus on patient treatment. However, when mistakes do happen, apologies are necessary. Apologies are best when they are sincere and delivered with humility and understanding.

Humans thrive on relationships. Positive interactions are the essence of one’s happiness. Connecting to others, in a positive way, is affirming. There is no more important time for people to feel connected to and supported by others as when they face a serious illness or trauma. When entering the health care system, patients move through seemingly countless encounters with a variety of personnel. Interactions that strain patient-provider relationships are costly for the patient than for the caregiver. Patients who are perceived to be difficult are at greater risk for experiencing nontherapeutic encounters. In order to provide patient-centered care, clinicians need guidelines for how they can consistently assume the kind of demeanor that makes such care part of a conscious choice, a way of being in the health care world. The power of positive regard, conveyed to patients through even the shortest of encounters, can be life changing and life saving.

Neurorehabilitation has become more of a global phenomenon and is not necessarily limited to industrialized or Westernized societies. Culture often connotes concepts of race and ethnicity when discussed in the context of health care disparities. Socioeconomic and other demographic variables make up the majority of the balance on discussion regarding culture in health care. Multicultural neurorehabilitation must emphasis “multiple”, and do so in a dynamic manner. In other words, at any given time, multiple cultures operate in each interaction and in each therapy delivered in the neurorehabilitation setting. Recently, there has been increased interest and research into the newly developing field of cultural neuroscience. Several models are available to conceptualize the influence of culture in human functioning. The most persuasive model is one that mirrors a dynamic, ecological system.

The author, Arthur G. Cosby speaks about his mother, Lillie Mae Mclntire Cosby; a nurse who led him to understand what constitutes leadership, his responsibilities to others, and the role of women in the modern world. In his mother’s mind, discipline was a critical aspect of good health care. As head nurse, she supervised large number of junior nurses, aids and orderlies, many of whom had limited formal health care training. It was very important to him that he had a mother who could do so many things and do them well. Not only was she a mother and nurturer, she was also a woman who was the breadwinner, who could successfully carry out most any job even the most difficult. Over the course of her career, she actively carried out the health care responsibilities of head nurse, hospital administrator, emergency room nurse, obstetrics nurse, public health nurse and nurse practitioner.