Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.

Nurses with a doctor of nursing practice (DNP) degree possess the specific skills needed to address the issues and achieve the goals related to better access, reduced health disparities, balanced quality and cost, improved health literacy, enhanced practice, and sustainability of health care and health care systems. This chapter explains the DNP abilities and proficiencies on financial and business management, applying evidence-based practice (EBPs) to build systems of care, and evaluating outcomes, with specific concentration on grant writing for health care programs. Generally, contemporary operating budgets in the acute hospital, ambulatory, or community settings are based on historic operating expenses and revenues, or increasingly are zero based. This leaves the DNP with little to no margin for increases related to redesigning care delivery models, implementing quality initiatives, initiating performance improvement strategies, or creating new service lines; except, of course, to become leaner.

This chapter explores how three successful nursing leaders, using different leadership approaches, demonstrate traditional leadership attributes such as strategic vision; risk-taking and creativity; interpersonal and communication effectiveness; and inspiring and leading change. It discusses the opportunities and implications for nursing leaders and those external to the profession to develop collaborative and transformative partnerships to advance quality health care. Pragmatic leaders demonstrate leadership excellence by effectively translating their nursing care assessment skills into the ability to approach organizational problem solving and decision making in a systematic, logical manner. In contrast to the present-needs focus of pragmatic leaders, charismatic leaders are vision-based leaders who predicate their leadership agenda on attaining future goals. Each of the three nursing leaders profiled understands the importance of being politically astute and effectively leveraging power and influence to make value-added contributions. To varying degrees, the various constituents of the nursing leaders profiled view them as socialized leaders.

This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.

In order to function effectively, clinicians need to have both confidence in their professional judgment and belief in their clinical competence. The overconfident clinician who ignores opposing evidence or overlooks additional information runs considerable risk of not only making mistakes but alienating patients and families. Hubris is a major source of mistakes within health care. It is this hubris that also accounts for much of the downstream impact of medical mistakes. Patient-provider relationships are especially harmed when clinician hubris inevitably proves unwarranted, the diagnostic conclusions are erroneous, and/or mistakes occur. Mindfulness allows for self-correction, a recalibrating of one’s compassion capacity and an energy re-orientation away from ineffective self-enhancement and a refocus on patient treatment. However, when mistakes do happen, apologies are necessary. Apologies are best when they are sincere and delivered with humility and understanding.

Neurorehabilitation has become more of a global phenomenon and is not necessarily limited to industrialized or Westernized societies. Culture often connotes concepts of race and ethnicity when discussed in the context of health care disparities. Socioeconomic and other demographic variables make up the majority of the balance on discussion regarding culture in health care. Multicultural neurorehabilitation must emphasis “multiple”, and do so in a dynamic manner. In other words, at any given time, multiple cultures operate in each interaction and in each therapy delivered in the neurorehabilitation setting. Recently, there has been increased interest and research into the newly developing field of cultural neuroscience. Several models are available to conceptualize the influence of culture in human functioning. The most persuasive model is one that mirrors a dynamic, ecological system.

The author, Arthur G. Cosby speaks about his mother, Lillie Mae Mclntire Cosby; a nurse who led him to understand what constitutes leadership, his responsibilities to others, and the role of women in the modern world. In his mother’s mind, discipline was a critical aspect of good health care. As head nurse, she supervised large number of junior nurses, aids and orderlies, many of whom had limited formal health care training. It was very important to him that he had a mother who could do so many things and do them well. Not only was she a mother and nurturer, she was also a woman who was the breadwinner, who could successfully carry out most any job even the most difficult. Over the course of her career, she actively carried out the health care responsibilities of head nurse, hospital administrator, emergency room nurse, obstetrics nurse, public health nurse and nurse practitioner.

Nurse leaders should be poised for change. One of the common themes across entries was that nurses are central to the changes occurring in health care and that they should seize the opportunities to be in charge of the redesign of the U.S. health care system. There was another strong theme that permeated the entries: that of the knowledge necessary for nurse leaders in health care delivery. To assume leadership roles in a new delivery system, nurse leaders are advised to understand policy and finance and the roles of all team members. Furthermore, leadership must be about the organizational goals, not one’s individual goals. Self-knowledge is essential, including the understanding of how you are reflected in the eyes of others. A high level of self-confidence is essential for leadership. Other important developmental needs for nurse leaders include quantitative skills and technological expertise, including electronic and digital forms of communication.

Steven A. Wartman, the author, provides key advice for potential and aspiring nurse leaders. He advises to let go of the guild mentality, particularly important for nurses who aspire to leadership positions that transcend nursing. Nurse’s perspectives are invaluable in bridging the gap between the technical experience of health care and its meaning in the lives of patients and their families. Nurse leaders are advised to become transformational rather than transactional leaders, and to move beyond the rewards and punishments inherent in transactional leadership styles. Transformational leadership is especially challenging, given the traditional hierarchies in the medical fields and academia. To provide the most effective and “transformational” leadership, potential nurse leaders should focus their efforts on four areas: eliminate the “guild mentality”; change restrictive policies and regulations that weaken the role of nursing; seek to become a “transformational” leader; and learn to take the ego out of the job.

Disgust may seem like an odd topic to highlight in a book dedicated to enhancing patient-provider relationships, but it bears special consideration given that it is rarely openly discussed even though it is a common phenomenon. In the course of the authors’ work, clinicians are exposed to patients’ most basic human products: urine, feces, pus, blood, and vomit, to name a few. The authors encounter smells, see anatomical parts, hear bodily sounds, and touch things that people outside of health care can only imagine. Some of these things are very difficult to experience, and yet doing so is not only part of the job, but doing so graciously, with acceptance and sensitivity, is a gesture of compassion. Being in a state of mind to make that compassion happen is aided by mindfulness. This chapter provides an example of a forty five year-old woman with end-stage pancreatic cancer.