Sudden changes in a resident’s status may indicate a life-threatening health problem and need to be addressed promptly. It is essential that the resident’s baseline status be known by staff so that changes can be identified. Pain, nausea, vomiting, dyspnea, bleeding, and other signs and symptoms also need to be noted. Changes in status demand assessment. Unusual findings and symptoms reported by the resident should be explored and thoroughly described, as should recent relevant events, such as a fall or administration of a new medication. This chapter describes the general changes that can indicate emergency conditions and explains the actions to take when an emergency condition occurs. It explores the signs of and nursing responses to possible: acute glaucoma, angina pectoris, congestive heart failure, detached retina, hypothermia, myocardial infarction, pneumonia, pulmonary embolism, and transient ischemic attack.

This chapter describes the differences between management and leadership. The complexities of the nursing department demand both leaders and managers. Leaders also can possess management responsibilities and skills; likewise, managers, as well as people who do not carry management titles, can demonstrate leadership. Critical thinking is an important skill for both leaders and managers. Leaders and managers need to display the behaviors they desire and expect in staff, such as a positive attitude, team spirit, openness to learn, and adherence to high standards. Various styles can be used to lead a department or team to accomplish goals. Some of the common leadership styles include: Autocratic/authoritarian, Laissez faire, Democratic/participative, and Inconsistent. The chapter describes strategies to enhance communication and explains the steps in effective delegation. It discusses the methods that can be used in performance appraisal and explores measures for managing complaints. The chapter also reviews methods to improve time management.

Basic assessment skills of observation, interview, and examination can aid in differentiating normal from abnormal findings and identifying changes. In addition to using these skills when completing the Minimum Data Set (MDS), nurses can incorporate them into general nursing activities so that every nurse–resident interaction provides an opportunity for assessment. This chapter describes the basic skills used in assessment and outlines the components and skills used in conducting a comprehensive physical assessment. Physical examination utilizes several major skills, such as: inspection, auscultation, percussion, and palpation. The chapter also explains the method of conducting a mental status assessment. Mental status is examined by: observations of general attention to grooming, appropriateness of dress, body language, and general behavior, language and speech, affect, responses to questions, and the use of standardized assessment tools.

Heart failure (HF) is a terminal disease. Predicting the illness trajectory is much harder in HF than in cancer. Nursing has a key role in the management and outcomes of patients with HF. Patients often turn to nurses for information on their disease especially in the end stages of the disease. A coordinated effort by nursing has been developed as to how to help patients with not only the physical symptoms of HF but also the psychosocial aspects. In caring for the patient with advanced HF, there are clinical, evidence-based therapies that should drive clinical decision making. This chapter helps the reader to understand the disease of HF: how important disease management is, how nurse-based HF interventions can lead to positive outcomes, and, most importantly, how to communicate with patients and families regarding their treatment options and what is important to them in the final phase of their life.

Existing technologies in healthcare, now commonplace, were once novel ideas, care models and devices, and new treatments. Today emerging technologies (ETs) are developed and implemented in healthcare organizations at a rapid rate. Nurses, nurse informaticists, and nurse educators should have a clear comprehension of the role of emerging technology in healthcare to optimize clinical practice. Innovation and innovators are essential to revolutionizing antiquated healthcare business models to offer new products, services, and models to modernize practice and serve the Quadruple Aim better. Divergent collaborations and innovation centers in healthcare organizations provide nurses the opportunity to be champions and early adopters and enforcers of ETs and responsible innovation, thereby improving safety and quality outcomes and promoting health equity. This chapter defines emerging technology and essential components. It explores the transformation of healthcare as a technology industry. The chapter provides specific innovation concepts as they relate to the healthcare industry and nursing.

Nurses often address questions about prescription drugs used for the medical management of dementia. They also address questions about the many nonprescription agents that are promoted for improving cognition not only for people with dementia but also for all adults for preventing dementia or improving cognitive function. This chapter provides an overview of current research and guidelines related to the medical management of dementia. The chapter discusses nursing considerations about medications for dementia and considerations for non-Alzheimer's dementia and describes nonprescription agents and medications for behavioral manifestations of dementia.

Supporting the rights of the person with dementia is one of the greatest challenges—and a core aspect—of person-centered care. During the course of dementia, many questions arise about the person's rights to carry out activities that become risky or unsafe because of cognitive impairments. These issues typically arise during mild and moderate dementia and continue until people with dementia are no longer able to participate in decisions about their care. This chapter helps the reader learn the ethical issues related to the rights of people with dementia and discusses the nursing considerations related to decisional capacity. The chapter provides legal documents for the protection of the rights of people with dementia and nursing responsibilities related to advance directives.

The equation of cost over quality equals value. In healthcare, this equation stands as new value-based care initiatives abound, where nursing can be at the forefront. The use of health information technology (IT) in practice impacts value. Where currently the cost of nursing care goes mostly unnoticed, the use of emerging technologies significantly impacts practice and adds value. Nurse informaticists and innovators add value to healthcare. Novel technologies used in clinical practice rely on core data to feed the health IT ecosystem for the development, use, and sustainment of emerging technologies. This chapter defines value-based care in the current healthcare landscape. It describes how nursing value directly impacts the Quadruple Aim. The chapter helps the reader to understand Big Data characteristics and flow of end-to-end processing of Big Data. It comprehends the imperatives of data-driven emerging technology adoption and application in practice.

Nurses who care for older adults in any healthcare setting are likely to care for patients who have dementia as a secondary diagnosis. It is not unusual or unprofessional to feel frustrated and unprepared and view these situations as challenging and time-consuming. Because the primary focus in usual healthcare settings is on the presenting medical problems, issues related to dementia may be overlooked. Although nurses generally have guidelines for managing chronic medical conditions, they are less likely to have clear guidelines related to the needs of people who have dementia. This chapter provides an overview of challenges in caring for patients with dementia in acute care settings. It discusses nursing strategies to obtain accurate information and detecting elder abuse in acute care settings. The chapter provides resources within hospitals and considerations related to skilled care and rehabilitation settings.