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.

This chapter discusses paced electrocardiograms (EKGs), which are often a confusing topic. The ability of the clinician to interpret a paced EKG is vital, as it is the best tool available in everyday practice to observe for proper function of the pacemaker or implantable cardioverter defibrillator (ICD). It is invaluable in correlating clinical findings with normally or abnormally functioning devices. Pacemakers are implanted to improve the morbidity that is associated with abnormally slow heart rates that cause a decrease in cardiac output and put a patient at risk for bodily injury or death. They also allow for appropriate medical treatment of tachyarrhythmias or ischemic heart disease if there are periods of bradycardia that may limit optimal medical therapy. Pacemakers are generally indicated to improve morbidity, whereas ICDs improve mortality. All ICDs are also pacemakers and, therefore, the information regarding paced rhythms applies to both pacemakers and ICDs.

Palliative care (PC) has come into its own as a medical specialty, primarily for adults with serious, life-threatening, and/or chronic illness. PC has been thought to be synonymous with end-of-life (EOL) care and hospice. Typically, PC is described as being an umbrella specialty, within which EOL care and hospice reside. Both PC and hospice emphasize a palliative approach to symptom management and an interprofessional, team-based, holistic model of individualized care that focuses both on the patient and his or her loved ones. This chapter reports on the state of PC in rural settings, comparing it to what is assumed to be the standard, PC in urban/suburban settings. It presents a case study that illustrates the need for home-based PC services for chronically but not yet terminally ill patients. The chapter also describes the most commonly identified challenges for rural PC, as well as strengths and recommendations for future programs.

Rural patients see themselves as self-reliant and independent. No one knows this better than a Nurse Practitioner (NP) in a rural clinic. The NP role was the vision of rural pediatric public health nurses in Colorado. These nurses were advocating for their patients and wanted to provide more services while performing home visits in rural areas. NPs have been steadily increasing in number and are working to break down barriers to a full scope-of-practice. Evidence supports full scope NP practice and the ability of advanced practice nurses to lead the way in formulating new and better primary care models. This chapter provides insight into the contributions of NPs as healthcare providers in the rural setting and includes a brief background on the NP role, a section on access to healthcare, and a look at the unique patient-centered care provided by NPs.

Gestalt therapy embraces a humanistic–existential worldview and thus believes that people are endowed with an inherent tendency to develop their potential and are free to choose how to live their lives. It has a commitment to holism, the phenomenological perspective, and the existential themes of authenticity, freedom, and personal responsibility. Gestalt therapy emphasizes the notion of awareness and contact with self, others, and the environment. The goal of Gestalt therapy is to assist clients in restoring excitement and growth. Clients reclaim awareness and return to their natural state of organismic self-regulation. This chapter initially describes the author's experience with Gestalt therapy. It then describes the key concepts and therapeutic interventions in Gestalt therapy. The chapter then provides an outline of the case study where a client was successfully treated for psychogenic nonepileptic seizure. It concludes with commentary on the case study and questions for reflection.

Cognitive behavioral therapy (CBT) is a structured, short-term, present-oriented psychotherapy, which is well received by adolescents and their parents. In CBT, the therapist works with clients on cognitive restructuring, problem-solving, and behavioral activation. Cognitive restructuring refers to identifying, evaluating, and modifying faulty thoughts and beliefs that are responsible for negative mood states. The goal of CBT is for clients to develop thought patterns that allow them to live a more functional and satisfying life. This chapter initially provides a brief description of the author's experience with using cognitive behavioral therapy in their pediatric medical practice. It then elaborates the key concepts, goals and interventions in cognitive behavioral therapy. It also presents a case study of a 16-year-old high school junior who was diagnosed with depression and underwent COPE (Creating Opportunities for Personal Empowerment) CBT program. The chapter ends with questions for reflection.

Problematic substance use and its sequelae of interpersonal and social problems are common among individuals seeking psychotherapy. This chapter presents the authors' experience working with clients having substance use issues. Harm reduction approaches are facilitative rather than coercive, and aim to reinforce positive change in a client's life, no matter how small the increment of change may be. Harm Reduction psychotherapy is a person-centered approach that views the relationship between the client and therapist as a collaborative partnership. It encompasses concepts and interventions to reduce the problematic effects of substance use. Harm Reduction psychotherapy assumes that harm is decreased when individuals are empowered to make small changes in their behavior, specifically designed to reduce harmful consequences. The chapter presents a case study of a high-functioning client with problematic substance use, who was treated with harm reduction psychotherapy.

Existential psychotherapy is a philosophical approach to psychotherapy. It addresses the large, universal themes of life. These themes, considered to be the givens of existence, create a focus for existential psychotherapy. In existential psychotherapy, mental health exists when the existential themes are worked through and resolved. Many older adults seek psychotherapy, not just for psychiatric or medical disorders, but for psychological issues that are developmentally common to this age group. The goal of existential psychotherapy is to help clients face the anxieties of life, freely choose their life direction, take responsibility for their choices, and create a meaningful and purposeful existence. This chapter initially presents the author's experience in treating older adult clients. It then describes the key concepts of existential psychotherapy. The chapter finally presents a case study of a client who was at crossroads regarding their decision to retire and ends with a few questions for reflection.