Palliative care (PC) and hospice nursing reflects a holistic philosophy of care implemented across the life span and diverse health settings. PC and hospice nurses relieve suffering along the course of illness, through the death of the patient, and into the bereavement period of the family. This chapter presents an evolutionary perspective of hospice and palliative care nursing. The standards of practice in PC and hospice nursing describe a competent level of generalist and advanced practice registered nursing care as demonstrated by the nursing process. The standards of professional performance require the integration of specific core competencies aimed at ensuring the delivery of safe, quality patient-centered care, including the demonstration of competent professional role behaviors in practice, education, research, and leadership. PC nurses collaborate with all members of the interprofessional team, to insure quality and continuity of care in meeting the needs of patients and their families.

There exist historical and current methods in which technology is used to improve transitions of care across the continuum. These programs include applications, software, and electronic tools that can improve transitions between providers in the inpatient and outpatient settings. This chapter provides the background, describes the many transitions of care that patients encounter, and identified some challenges created by the transitions. It focuses on the ways electronic health records (EHR) and cloud-based systems have thus far improved transitions and review any data related to read missions, patient safety, and patient quality of care. Additionally, it explores ways in which technology is expected to be integrated into transitions into the future. Technology will play a critical role in making transitions of care as safe and efficient as possible.

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.

This chapter explores the health of individual older people and how they behave when they feel ill. Throughout history, humans have sought many means of improving their health and delaying death, but just as modern biomedicine has begun to gain the upper hand on a broad range of communicable diseases, most the world’s national populations are aging and in need of a different sort of health care intervention, one for older people with chronic diseases and disabilities that is just beginning to be made a priority around the world. The health status of an older person is influenced by many social and behavioral factors, including lifelong health habits (such as diet and exercise), genetics, exposure to occupational and environmental hazards, and psychological stress. The quality and availability of health care throughout life also play a role in health in later life, though not as much as most of us might think.

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.