According to the National Institute on Aging (2019), hundreds of thousands of adults over the age of 60 are abused each year. Elder abuse is often under the umbrella of elder mistreatment, which includes abuse, neglect, and exploitation among individuals aged 65 or older. This chapter describes risk factors, types of elder abuse, and approaches for prevention and treatment. Advanced practice nurses must be prepared to report as mandated by law, be advocates for prevention and treatment while meeting the needs of elderly patients to ensure quality care. Elder abuse is defined as an act or lack of an appropriate action that results in harm or distress to an older person. The chapter helps the practitioners to: recognize signs and symptoms of elder abuse; summarize laws pertinent to elder abuse; describe factors that contribute to elder abuse; and identify how to respond to needs related to elder abuse.

Nurses are faced with numerous stressors within the work environment. Successfully overcoming conflict may involve the use of conflict mediation strategies or mediation from a third party. When the workplace itself is riddled with negativity, it can be considered toxic. Nurses must be aware of how to traverse a toxic work environment in order to protect themselves and maintain quality patient care. Both employees and employers suffer the consequences of workplace stress. This chapter helps the nurse to identify approaches to mitigating workplace stress and the steps of conflict resolution. It helps to navigate a toxic workplace. Employers have traditionally used two different approaches to address workplace stress. The first is to address organization culture and processes. Another approach to reducing occupational stress is to focus on employees through targeted educational or stress-reduction programs.

Reporting requirements for hospices include both internal and external measures. Specific quality indicators include patient-specific components such as pain and symptom management as well as data regarding how well patients’ families are supported throughout the hospice experience. Consistent quality monitoring is essential for ensuring quality care within individual hospice agencies and across the country. Numerous initiatives have been launched to define how quality is measured in end-of-life care settings. This chapter defines required reporting structures for hospice and discusses the development of a Quality Assessment and Performance Improvement (QAPI) plan. Beginning in 2009, all Medicare-certified hospice programs were required to develop a Quality Assessment and Performance Improvement (QAPI) plan as part of their Hospice Quality Reporting Program (HQRP) in order to remain eligible for Medicare funding. The chapter helps the nurse to identify key features of the Hospice Item Set (HIS) that must be collected.

Within the interdisciplinary team, the nurse coordinates the plan of care and helps facilitate effective communication to foster quality end-of-life care. Key competencies for the well-functioning interdisciplinary team include effective communication and collaboration. Conflict resolution is an important skill for those working in interdisciplinary teams since varying disciplinary perspectives can sometimes lead to disagreement. Hospice care is a holistic approach to the care of terminally patients and their families. Patients who are facing end-of-life issues have multidimensional needs that require the expertise of a team of professionals who work together to develop an individualized, comprehensive plan of care. This chapter helps the nurse to identify members of the hospice interdisciplinary team and explains how the hospice team collaborates to develop a plan of care. It discusses the role of the nurse within the interdisciplinary team.

Geriatric psychiatric care in today’s world requires comprehensive and astute participation among healthcare providers as older adults are living longer - some with complex co-occurring chronic medical conditions. The emphasis in healthcare provided is on outcomes and quality care. Advanced practice nurses have the distinguishing ability to provide care that incorporates undergraduate nursing experiences, advanced education in pharmacology, and pathophysiology. This chapter highlights medication issues and offers guidance for prescribing for geriatric populations across health care settings. Advanced practice nurses must have a clear understanding of their role, methods for assessing issues, and an evaluation of needs to provide high quality care. The chapter helps the practitioners to recognize methods to assess medication issues when prescribing for the older adult; identify contributing factors to medication issues; summarize common black box warning(s) of medications for elderly patients; and initiate ways to decrease medication issues and prescribing in the older adult.

Hospice care in the United States has evolved rapidly over the past several decades. What began as a grassroots movement to improve care of the dying soon became more and more uniform as best practices emerged and standardization of care became the norm. Numerous initiatives have led to the development of a framework of the essential components of hospice and palliative care, which later became the platform for reliable quality measures. The Institute of Medicine (IOM) defined quality in healthcare as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’. The chapter discusses the evolution of quality initiatives in end-of-life care and defines quality of care in the hospice setting. It helps the nurse to identify quality indicators for hospice care.

Working in healthcare is extremely rewarding but also presents many challenges that can lead to burnout. Building resilience is critical for sustaining a lifelong, rewarding career in nursing. Resilience is a personality trait that enables one to overcome challenges and resolve negative emotions. Through a combination of consistent use of self-care techniques and engaging in workplace initiatives to decrease stress and foster a positive work environment, nurses can reduce their risk of burnout and other work-related issues. Self-care helps nurses to consistently deliver quality patient care over the course of their careers. To cope with the numerous pressures of nursing work, nurses must find ways to release negative emotions, deal with conflict, and promote their own well-being. This chapter discusses ways to build resilience, cope with multiple patient losses, and employ self-care practices.

The original Christian perspective that Sanders infused into hospice work ensured that each life was valued until its natural end and that each person received the highest quality of care until that time came. This chapter remains the bedrock for hospice nursing. However, over time, the development of scope and standards for hospice nursing has helped clarify and delineate the role of the hospice nurse. The role of the nurse in hospice and palliative care has expanding exponentially within the past 40 years. As a valued member of the hospice team, the nurse is responsible for coordinating the plan of care and must have the essential expertise to do so. The chapter helps the nurse to define the role of the nurse in hospice and palliative care. It explains how patient care differs in the hospice setting and identifies resources for hospice and palliative nurses.

At the end of life, patients experience a variety of symptoms that may or may not follow a predictable pattern. The goal of care for terminally ill patients is to promote comfort by managing symptoms using pharmacological and/or nonpharmacological interventions. Nursing assessments and interventions are critical for the provision of quality end-of-life care as death approaches. Although each person’s death is as unique as the life lived, there are common symptoms that occur at the end of life. Hospice nurses possess expertise in assessing and treating symptoms and in providing family support and teaching throughout the end-of-life process. This chapter helps the nurse to identify common end-of-life symptoms. It discusses appropriate nursing interventions used to treat end-of-life symptoms and name medications used to treat end-of-life symptoms.

Communication is more than simply the transmission of information. Nurse-patient communication forms the basis of the therapeutic relationship. Verbal and nonverbal communication affects patient responses and overall health outcomes. Communicating with patients from various cultural backgrounds requires awareness of one’s own comfort level with cross-cultural communication as well as the ability to work with patients who do not speak English or have limited English proficiency (LEP). Therapeutic communication that transcends differences between providers and patients is the cornerstone of quality healthcare. In the end-of-life care setting, effective communication is especially important as patients are faced with decisions that potentially affect their treatment choices or choices to discontinue curative care. This chapter helps the nurse to identify how culture and language proficiency affect end-of-life care. It provides examples of ways to overcome communication barriers. The chapter discusses how nurses can enhance verbal and nonverbal communication.