All citizens, regardless of their state or setting, must adhere to a variety of laws. Additional laws apply to licensed health care workers and specific settings of practice. There are public and private laws. This chapter enables the reader to list the sources of laws. It describes the actions that could potentially cause legal problems or liability related to: abuse, advance directives, assault and battery, competency, confidentiality, consent, defamation, do-not-resuscitate (DNR) orders, false imprisonment, incidents and accidents, malpractice, restraint use, supervisory responsibilities, and telephone orders. Because of the risks present in long-term care nursing, nurses must be knowledgeable about laws affecting their practice, current on evidence-based best practice, and proactive in assuring they practice in a legally sound manner. The chapter describes the actions to promote a legally sound practice.

In most long-term care settings, nurses must rely on unlicensed personnel who have the most direct contact with residents to recognize changes and properly report them. This requires that nurses ensure that unlicensed staff has the knowledge to recognize these changes and understand the importance of properly reporting them. If it is determined that the direct caregivers may not fully understand the type of observations that should be brought to nurses’ attention, educational programs can be offered, as well as resource materials. This chapter reviews the observations that unlicensed personnel can be instructed to report. As nurses often have limited direct contact with residents, maximizing the contact that does occur to identify changes in status can prove useful. The chapter explores changes that could be detected in residents and their possible causes. It describes information that should be communicated to the medical provider when a change in status is identified.

An adult is presumed to have the ability to make his or her own healthcare decisions—including termination of life-sustaining technology—unless he or she is shown to be incapacitated by clinical examination or ruled incompetent by a court of law. Advance care directives are legal vehicles used by people to provide guidance to their healthcare providers concerning the care they would desire in the event they become incapacitated and cannot make their own decisions. Problems with advance directives may arise when they do not seem to apply to the patient’s situation. Nurses roles include educating the patient and family about the patient’s condition and legal end-of-life (EOL) choices, identifying the patient’s and family’s wishes for EOL care, articulating the patient’s and family’s desires to other members of the healthcare team, and assisting the patient and family to obtain necessary and appropriate EOL care.

Cancer is a devastating diagnosis that many individuals still associate with death. Upon initial diagnosis, individuals embark on a treatment journey that is overwhelming with medical jargon, new healthcare providers, unknown outcomes, and fluctuations of hope amid the distressing effects of the disease and its treatment. The most frequently diagnosed adult cancer types are female breast, prostate, lung, and colorectal cancer. These four most commonly occurring cancers will be the focus of this chapter. The overall incidence and prevalence of cancer has increased with individuals living with cancer as a chronic illness. Treatment options have improved survival rates, decreased toxicity, and provided palliation. Symptoms associated with the disease and the toxicities of treatment require a commitment to an interprofessional model of care across healthcare settings. Palliative care focuses on the physical, psychosocial, and spiritual needs of the cancer patient and family as well as bereavement needs of families.

This chapter focus is on sexual health. Sexual health is a broad concept made up of multiple facets such as sexual desire, self as a sexual being, sexual orientation, sexual lifestyles, and relationships. Intimacy, closeness, communication, and emotional support affect all facets of sexuality. Sexual health within the context of palliative care may be directly impacted by the disease on anatomical structures. However, direct anatomical effect is not the only concern; changes in a person’s sexual interest or desire may also be affected by direct or indirect consequences of medical treatment or in association with being terminally ill. Illness involving sexual organs increases the likelihood of retraumatization for those who have experienced previous sexual trauma. Healthcare practitioners (HCPs) frequently avoid talking about sexuality with cancer patients. HCPs’ barriers to discussing sexuality include embarrassment, misinformed beliefs and assumptions, lack of knowledge, inadequate communication skills, and time constraints.

When nurses communicate with their dying patients and the patients’ families, they have a clearer understanding of their patients’ needs and goals at the end of life. This chapter explores ways to encourage both nursing students and graduate nurses to facilitate communication with dying patients, their families, and their healthcare providers. It also explores ways in which nursing faculty members might assist undergraduate nursing students to enrich themselves by working with dying patients. The chapter is organized according to the phases of the therapeutic relationship because in many ways the phases of the therapeutic relationship—introductory, working, and termination—parallel the dying trajectory. When appropriate in the phases, distinctions are made between the roles and educational needs of the undergraduate nursing student, the nurse with an undergraduate degree, and the nurse with an advanced practice degree.

The diagnosis of end-stage renal disease (ESRD) can be difficult for patients and families to hear because this means they will need some form of kidney replacement therapy to survive (hemodialysis, peritoneal dialysis, transplantation). ESRD means a patient has severe end-organ kidney damage and failure. When confronted with the extensive list of medical and psychological problems often associated with patients with ESRD, healthcare professionals often focus on treating the medical issues by implementing strategies to address abnormal laboratory values and treating comorbid conditions. The goal for patients with ESRD cannot be simply to preserve life but also to promote quality of life. This chapter discusses palliative care in relation to three groups of patients with ESRD: undergoing dialysis, choosing conservative management, and withdrawing from dialysis. It also provides a brief review of the major comorbidities and complications associated with ESRD and available palliative treatment options.

Geriatric patients typically can present with a variety of diseases and conditions that require the administration of a variety of medications for proper management of symptoms and overall patient condition. Given the potential adverse outcomes that can result from a number of medications that can be given to geriatric patients, it is important for clinicians to be mindful of the most common ones. This chapter discusses the complexities that might exist with dosing geriatric patients and reviews glomerular filtration rate and renal dosing. It analyzes drugs or drug classes to avoid in those with chronic kidney disease, and discusses clinician awareness of how psychological changes can impact medication selection and dosing in geriatric patients. The approach of a case-by-case assessment of older adults will most likely aid a clinician in determining what will deliver optimal therapeutic outcomes.

This chapter presents a case study of substantiated self-neglect and discusses medication use and polypharmacy. The case study of substantiated self-neglect highlights polypharmacy in an older adult. Negative social and physical conditions and outcomes of self-neglect may be associated with medication usage patterns and polypharmacy. An interprofessional team (IPT) approach is imperative for a comprehensive plan of care in older adults with substantiated self-neglect and polypharmacy. Elder self-neglect is a prevalent condition among older adults and increases their risks for hospitalization, emergency room visits, nursing home placement, and mortality. Hazardous medication-use patterns share many of the same potentially harmful outcomes as self-neglect, yet it has been a widely understudied and overlooked component of self-neglect. New evidence highlights its importance among self-neglecters; health care professionals should consider polypharmacy, medication nonadherence, drug-drug interactions and the use of potentially harmful medications as possible contributors to self-neglect.

Nurses caring for people with dementia frequently address safety issues, including falls and unsafe wandering. Safety concerns are usually heightened when people with dementia are in unfamiliar environments and when they have medical problems. Although physical restraints have been used in the past, healthcare professionals now recognize that restraints are rarely an appropriate intervention for ensuring safety. Nurses need to address safety issues as an important aspect of care for people with dementia. This chapter helps the reader to learn how to assess fall risks in people with dementia. It discusses the interventions for preventing falls and fall-related injuries. The chapter helps the reader to learn how to avoid the use of restraints and address wandering.