This chapter reviews prevention, including genetic counseling. It discusses genetic testing for diagnosis as opposed to screening and the treatment for genetic disease. Methods of prevention begin with education of the public and health care professionals and identification of those at risk. Genetic counseling is the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. The malignant cells often exhibit aneuploidy as well as translocations that are found only within the tumor cells. Genetic errors that arise from specific cell lines are somatic mutations. It is suggested that there is a thorough collection of family, genetic, and medical history for children entering the adoption process. Nurses may play a variety of roles in genetic counseling that reflect their preparation, area of practice, primary functions, and setting. The chapter explains the incidence of chromosome abnormalities.

The initial recognition of the need for a genetics referral may arise when a nurse suspects a genetic contribution to disease because of personal or family medical history and/or findings from a physical assessment. Family history is a valuable and cost-effective tool that is often underutilized in clinical practice. Many common genetic conditions result from complex interactions between genetic and environmental factors. It is critical to collect information about potential environmental exposures to help inform a patient’s risk assessment. Health care professionals should become familiar about toxic environmental agents that are common in their specific geographic location. A growing number of Food and Drug Administration (FDA) approved drugs have labeling that includes pharmacogenomic information, which can be used to optimize drug dosage and prevent adverse and life-threatening drug reactions in a patient or family member.

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.

This chapter examines pre- and postconference expectations and activities, explores forms to be used by the professor and the students, suggests care plans and patient assignments, and describes sample concept maps and a math skills assessment. A student with no experience in health care may be shy or sheepish when it comes to hands-on care. It may be of benefit for the students to be paired in the first few weeks of clinical classes. The care plan forms can help guide the student through the nursing process. Medication forms will help the student learn about various medications. Nursing education has adopted the use of concepts maps to assist students in gathering patient information. Patient safety is the number one priority for all health care professionals. Dose calculations are a daily activity for nurses.

This chapter discusses basic review of the admission process, and describes an admission assessment exercise that allows students to assume the roles of both patient and nurse. It also describes the role of nurse in which the student learns to collect patient data and record data appropriately, and also explains the role of the electronic medication administration record (eMAR). Preconference begins with a review of the skills previously mastered: hand washing, obtaining vital signs, and performing those daily nursing activities such as taking assessments and collecting data on patients. The student is responsible for making copies of the nursing notes for the required clinical assignments. With the admission assessment exercise, the clinical instructor can discuss the correlation of the vital signs, medications, past medical history, and familial history. New designs in technology have facilitated new medication administration practices that will reduce the number of medication errors in health care facilities.

As everyone knows, true creativity comes from simple formulas and the memorization of data. This chapter focuses on divergent thinking tests, which are still the most common way that creativity is measured. Guilford derived the core ideas behind divergent thinking as well as many popular measures. The people who score the Torrance Tests are specifically trained to distinguish responses that are truly original from those that are just bizarre. There are other tests that measure creativity, but most are either a variation on divergent thinking or use some type of raters. For example, the Evaluation of Potential Creativity (EPOC) has begun to be used in some studies and may be promising, but is still largely rooted in a mix of divergent thinking scoring and raters. Another test is the Finke Creative Invention Task, which is clever but also requires raters for scoring.

The Big Five, which this chapter discusses in more detail, are extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience. Each of these five factors represents a continuum of behavior, traits, and inclinations. There are some popular personality measures that use different theories, such as Eysenck’s Personality Questionnaire, which looks at extraversion and neuroticism as well as psychoticism. The personality factor most associated with creativity is openness to experience. Indeed, one way that researchers study creativity is by giving creative personality tests. Being open to new experiences may also help creative people be more productive. King found that people who were creative and high on openness to experience were more likely to report creative accomplishments. DeYoung and S. B. Kaufman, of course, are not the only people to blend or split different factors of personality to present new models. Fürst, Ghisletta, and Lubart suggest three factors: plasticity, divergence, and convergence.

This chapter explores three ’classic’ studies of creativity and mental illness. The first is Jamison whose focus is on the connection between bipolar disorder and creativity. The second is Andreasen, who used structured interviews to analyze 30 creative writers, 30 matched controls, and first-degree relatives of each group. The writers had a higher rate of mental illness, with a particular tendency toward bipolar and other affective disorders. The third major work is Ludwig, who utilized the historiometric technique. All three studies have come under serious criticism. Many of the studies of Big-C creators are historiometric, akin to Ludwig’s work. Some such studies claim that eminent creators show higher rates of mental illness. A much more common approach is to look at everyday people and give them measures of creativity and mental health. Typically, researchers look at what are called subclinical disorders—in other words, they’re not clinically significant.

One school admissions area that already uses creativity is gifted admissions—which students are chosen to enter gifted classes, programs, or after-school activities. Both education and business play great lip service to creativity. Puccio and Cabra review the literature on creativity and organizations and do a nice job of highlighting how every couple of years, a new report from industry emphasizes the importance of creativity. It is important to note that there is a large inconsistency between gender differences on creativity tests and actual creative accomplishment. Although gender differences on creativity tests are minor or nonexistent, differences in real-world creative accomplishment are large and significant. This chapter shows how creativity can play a role in admissions and hiring. Hiring measures tend to have better validity, even the general mental ability (GMA) measures; even if minorities score lower, the accuracy of prediction is consistent by ethnicity.

Creative people are also often seen as being outsiders and eccentric. Sen and Sharma’s examination of creativity beliefs in India tested beliefs about the Four P’s and found that creativity was more likely to be described as a holistic essence of an individual, and less likely to be focused on the product or process. Romo and Alfonso studied Spanish painters and found that one of the implicit theories that the painters held about creativity involved the role of psychological disorders. Plucker and Dana found that past histories of alcohol, marijuana, and tobacco usage were not correlated with creative achievements; familial drug and alcohol use also was not significantly associated with creative accomplishments or creative personality attributes. Humphrey, McKay, Primi, and Kaufman did find that illegal drug use predicted self-reported creative behaviors even when openness to experience was controlled.

Multiple physical changes can impair the mental health of the aging individual. These changes include: acid-based imbalances, dehydration, electrolyte changes, hypothermia or hyperthermia, and hypothyroidism. This chapter reviews the most common mental health disorders affecting the elderly population and trends affecting care delivery. Moreover, chronic, unresolved pain has been associated with an increased risk of a mental health disorder such as depression, suicide, or anxiety. The aging individual may exhibit signs and symptoms of insomnia such as sleeping for short periods during the night, sleeping during times of normal social activities, arising early in the morning while others sleep, and experiencing daytime sleepiness. The chapter concludes by applying the nursing process from an interpersonal perspective to the care of an elderly patient with a mental health disorder.

The learning landscape continues to evolve as new technological tools enable teachers to deliver robust learning experiences. It is important to help teachers, administrators, and students know where to begin so that the transition to virtual learning is smooth, without educational loss. This chapter consists of two sections: current trends and issues in technology integration and technological pedagogical content knowledge. The first section briefly reviews the trends in instructional or educational technologies that are causing administrators, teachers, and students to reflect on and modify their thinking about learning and educational content delivery. The second section explores constructivism, the scientific underpinnings of nursing informatics, and ethics. Nurse educators must also address the ethical challenges brought about by this evolving learning landscape. After reading this chapter, one can understand current trends and issues, as well as the influence of nursing informatics and ways to approach new ethical dilemmas.

Healthcare is in a state of rapid change. Although practice environments have become more complex, educational delivery methods have remained stagnant. Innovative technologies provide opportunities to enhance nursing student learning and help nursing programs become more responsive to changes in the practice environment; however, obstacles may hinder successful implementation. With the increasing complexity of today’s health care environment, innovations in nursing curricula are necessary. This chapter explores some of the general challenges associated with the integration of innovative educational technologies, as well as some challenges unique to virtual simulation. It helps the reader to analyze the challenges of integrating educational technologies into nursing education associated with faculty, administrators, and students. It also helps the reader to examine practical and philosophical barriers related to technology integration and explores challenges unique to the adoption of virtual simulation.

Simulation has many advantages for nursing education, some of which include creating safe learning environments for students and reinforcing information learned in the classroom; it also has the advantage of being available in inclement weather as well as 24 hours a day for student access. Simulation in nursing is one of many methods used for teaching students. Teaching and learning in a virtual learning environment has many advantages for administrators, faculty, and students. One of the advantages includes the use of other disciplines to help create or participate in a virtual world learning experience. The virtual learning environment can be created to look similar to real communities, disaster areas, or homes, with avatars populating that environment. The advantage to using virtual reality, rather than a real-life experience, is that in real life, students could be immersed in an environment that could cause them harm.

One of the best known psychologists of the 20th century was Jean Piaget. The memory he described was from when he was about 2 years old, a kidnapping attempt in which his nurse tried to protect him. According to the storehouse metaphor, memory is kind of a warehouse. When one remembers an event from one’s life, one looks through this warehouse. Remembering a past event is also a kind of simulation, a simulation of what happened in the past, rather than a veridical reproduction of the past. In fact, our best understanding is that brains are massively parallel simulation devices. Constructive theories deal with filling in gaps at encoding as the event transpires, whereas reconstructive theories deal with filling in gaps at retrieval as one tries to remember the event. When thinking about memory illusions it is important to make a similar distinction.

This chapter discusses the assessment and laboratory findings, imaging, diagnosis and management of ascites. A common complication of cirrhosis is ascites, or the accumulation of fluid in the abdominal cavity. Ascites that develops from cirrhosis is associated with portal hypertension. The patient with cirrhosis and ascites may complain of increased weight gain, lower extremity edema, and abdominal bloating or distension. Physical examination findings may reveal a distended or even tense abdomen, positive fluid wave, dullness to abdominal percussion, and peripheral edema. Routine laboratory testing, such as complete blood count, complete metabolic panel, and liver function testing, should be performed with new-onset ascites and at routine return visits. Patients with cirrhosis and ascites can develop electrolyte imbalances and renal failure. Ultrasound is helpful to determine whether ascites is present if there is any uncertainty upon physical examination. Patients should abstain from alcohol consumption and avoid using nonsteroidal anti-inflammatory drugs.

This chapter focuses on an area that has been at the center of the debate between the approaches: processing ambiguous words and sentences. Interestingly, an important factor for ambiguity resolution appears to be the frequency of the different meanings of the ambiguous words. Subordinate- bias effect is as follows: in a neutral, nonbiasing context, words that are balanced cause longer reading times than words that are either unbalanced or unambiguous. Different languages impose different rules about how grammatical categories may be combined. In the garden path model, sentence processing happens in two stages: an initial structure building stage in which the only information that is used is syntactic, and then a second stage in which the structure is checked against semantic and pragmatic information. Constraint-based models take a very different approach to how sentences are initially parsed and how mistakes are sometimes made.

This chapter shows the importance, for older persons, of support groups. In spite of the changes that have occurred in the American family, and all the negative things that fill the popular press concerning family relationships, the family is still the backbone of support for most older people. To some extent, the type of family support older people obtain depends on whether they are living in the community or in an institutional setting such as a group home, retirement village, or nursing facility. Whether a person is married, has great impact on that person’s support within a family setting including emotional, financial, and physical support, particularly in times of illness or infirmity. The success of a second marriage depends to a considerable extent on the reaction of the adult children of the elderly couple. Older grandparents, no matter how motivated, can find caring for grandchildren to be very tiring.

This chapter shows how the United States and the world are experiencing an aging evolution we are growing older. America is going through a revolution. As a whole, Americans are becoming older, and there are many more older people among people than ever before in our history. Obviously all cohorts of the population youth, young adults, middle-aged, young-old, oldest-old are heterogeneous. When some people think about the elderly as a whole, they picture frail, weak, dependent persons, some in nursing homes and many confined to their homes. The chapter demonstrates the differences the various age categories have in relation to selected chronic health conditions that cause limitations of activity. Widowhood is much more common for elderly American women than for older men. The aging of Baby Boomers will solidify the shift America is experiencing with the aging of its population. Centenarians make up a small percentage of the total U.S. population.

The researchers were specifically interested in whether they would get more incorrect responses depending on the type of sentence. From a certain perspective, passive sentences are more complicated than active sentences and so perhaps it is the case that passives are more difficult simply because they are more complicated. It appears that the important difference between subject cleft and actives on one hand, and passives on the other, is that the order of the roles is reversed between them: in active sentences, the agent comes first. Indeed, there is a growing body of evidence that languages allow English speakers to structure their utterances in a way that can flag certain parts of the sentence as particularly important or worthy of special attention. Recently, psycholinguists have been interested, too, in how information structure influences language processing.

Inflammatory bowel disease (IBD) is a broad diagnosis that includes two major chronic diseases: ulcerative colitis (UC) and Crohn’s disease (CD). IBD is typically diagnosed in young adulthood. Smoking has been associated with a higher risk of developing CD. UC is an inflammatory disease of the mucosa of the colon and rectum. Typical symptoms include bowel movement urgency, tenesmus and bloody diarrhea. CD is a chronic inflammatory disorder of the alimentary tract. It is associated with high levels of proinflammatory cytokines. Referral to a gastroenterologist specializing in IBD may be needed. To confirm diagnosis, a flexible sigmoidoscopy is necessary in cases of UC and a colonoscopy is necessary in cases of CD. The goal for treatment of IBD is to suppress the immune system and help heal the bowel. Initial treatment for patients with mild to moderate UC includes 5-aminosalicyclic acid compounds.

The study of the properties of language can be divided up into roughly five, somewhat overlapping categories: sound system, word structure, sentence structure, meaning, and real-world use. In spoken languages, segments are sounds—each language has a set of sounds that are produced by changing the positions of various parts of the vocal tract. The sound system of language is actually studied in two main parts: phonetics, phonology. Phonemes can be combined to make words, and words themselves have an internal structure and can even be ambiguous based on this structure. Syntax is the study of how sentences are formed. There are two noun phrases (NPs) in the sentence—the artist and a paintbrush. The field of semantics is concerned with meaning in language and can be divided into two major parts: lexical and propositional.

Some drugs, like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), have been blamed for peptic ulcer formation. The most common peptic ulcers are duodenal ulcers. Risk factors for the development of peptic ulcer disease are chronic NSAID use, older age, Helicobacter pylori infection, use of anticoagulant or anti-platelet medications, history of prior ulcers, use of corticosteroids, alcohol use, and smoking. One of the goals of treatment for the patient with peptic ulcer disease is eradication of H. pylori infection. Complications that develop if peptic ulcer is untreated include gastrointestinal bleeding, gastric cancer and gastric outlet obstruction, with bleeding the most common. Most patients with peptic ulcer disease are asymptomatic. When symptoms do arise, dyspepsia is a common complaint. Sucralfate, a formula of aluminum hydroxide and sulfated sucrose, is given to patients with peptic ulcer disease to protect the gastric and duodenal mucosa.

The idea of the mad genius persisted all the way to modern times and was even promulgated in scientific circles. Not only was genius mad, but it was associated with criminality and genetic degeneration. The empirical research relevant to the mad-genius issue uses three major methods: the historiometric, the psychometric and the psychiatric. The historical record is replete with putative exemplars of mad genius. The mental illness adopts a more subtle but still pernicious guise-alcoholism. In fact, it sometimes appears that alcoholism is one of the necessities of literary genius. Psychopathology can be found in other forms of genius besides creative genius. Of the available pathologies, depression seems to be the most frequent, along with its correlates of suicide and alcoholism or drug abuse. Family lineages that have higher than average rates of psychopathology will also feature higher than average rates of genius.

This chapter talks about questions related to how speakers and hearers influence each other. It looks at research on dialogue, and especially how a dialogue context influences speakers. Speakers have an impact on their listeners. The goal of a dialogue is successful communication and so it would make sense that a speaker would pay careful attention to the needs of a listener and do things like avoid ambiguity and package information in a way that flags particular information as important or new to the listener. Ambiguity may be avoided depending on the speaker’s choice of words and so a natural question is whether, and when, speakers appear to avoid ambiguous language. In terms of pronunciation, speakers reduce articulation and intelligibility over the course of a dialogue. There are some constraints and preferences on how to interpret pronouns and other coreferring expressions that appear to be structural or syntactic in nature.

This chapter discusses the incidence and risk factors, assessment, laboratory and image testing, diagnosis and treatment of constipation. Constipation affects 15" of adults in Western countries and 33" of patients older than 60. History is important when trying to determine the cause of constipation. The patient should be asked for a detailed description of bowel movements, including how many per day or week, how often, and how long has constipation been a problem. A complete blood count and complete metabolic panel should be obtained. Several electrolyte imbalances can cause constipation. Constipation is often caused by inadequate fiber intake or hydration, inactivity, or can be medication-related. Providers should encourage patients with acute constipation to increase hydration and fiber intake to 20 to 35 grams per day. Nutritional modification may be enough to resolve constipation and can likely prevent further episodes. In some cases of chronic constipation, nonpharmacologic treatments are helpful.

This chapter discusses the incidence and risk factors, assessment and laboratory findings, diagnosis and management of celiac disease. Celiac disease is considered an autoimmune disorder with a genetic component. If left untreated, patients with celiac disease have an increased risk of developing gastrointestinal cancers and enteropathy-associated T-cell lymphoma. Some of the disease’s symptoms are asymptomatic, whereas some have severe malabsorption issues with skin manifestations. Celiac disease is frequently found in patients who have other autoimmune disorders. A serologic test called immunoglobulin A (IgA) anti-tissue transglutaminase (tTGA) is performed to detect possible celiac disease in patients over two years old. Characteristic histological changes of celiac disease are villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis, and mucosal inflammation. The only curative treatment for celiac disease is strict adherence to a gluten-free diet (GFD). It is important to recognize other vitamin deficiencies in patients with celiac disease, including B 12, D, iron, and folate.

This chapter differentiates intelligence and related constructs such as creativity and intellectual giftedness, which helps people to better understand each construct. Sternberg proposed a way to classify the various approaches to studying the intelligence-creativity relationship. Guilford’s Structure of the Intellect (SOI) model is probably the most explicit, with divergent thinking specifically identified as one of his five cognitive operations. The relationship between intelligence and giftedness has also received substantial attention. Every gifted education program has a formal assessment procedure to identify potential participants, and creativity assessments are often included in the battery of measures in these identification systems. The Marland Definition suggests that giftedness and talent are manifest in six areas: general intellectual ability, specific academic aptitude, creative or productive thinking, leadership ability, visual and performing arts, and psychomotor ability. It has been extremely influential and is still used by many school districts in their identification of talented students.

Diarrheal diseases are one of the top leading causes of death worldwide. Although in normal healthy people diarrhea is considered a self-limiting illness, certain individuals can be susceptible to severe dehydration that can cause serious complications. Providers should ask about the patient’s definition of diarrhea, as individuals may differ on its meaning. Correcting dehydration and preventing worsened hydration status is the top priority when treating the patient with diarrhea. Patients must be educated to eat high-carbohydrate foods like bananas, rice, baked potatoes, applesauce, and saltine crackers for a day or two prior to resuming a normal diet. Probiotics have been shown to recolonize the intestine with healthy bacterial flora, which may have been lost from episodes of diarrhea. Multiple episodes of diarrhea cause perineal irritation and tenderness, even pain. To slow down or reduce the frequency of diarrhea, loperamidine or atropine can be used.

This chapter shows an overview of the techniques that are used to measure language processing. It shows at the things psycholinguists do when designing experiments in order to ensure that their results are valid. Online measures include any measure considered to give information about language processing as it happens. The prototypical off-line measure is the questionnaire—literally asking people for their judgments about what they’ve just encountered. In fact, all kinds of data can be collected from questionnaire studies. The button press task is perhaps the most versatile of all the things that people can do to collect data involving response times. The conscious responses discussed about here are vocal response. Like eye-tracking, event-related brain potentials (ERPs) help to understand the technique if people know a bit about the response measured—in this case, the brain. In many ways, functional magnetic resonance imaging (FMRI) can be considered the complement to ERPs.

So here the authors are, caught between two worldviews. In one camp, they have educators and academics, attempting to overthrow the “old guard”—those of them who define giftedness through the narrow lens of IQ tests. They are hoping to establish a raison d’etre for gifted education—a field with a wobbly foundation. In the other camp, the authors have parents and the psychologists who specialize in working with the gifted, railing against the externalizing of giftedness. They want the inner world of the gifted to be recognized and appreciated. Controversy has dogged the study of giftedness since its inception, and is likely to continue into the foreseeable future. Multiple views will somehow have to learn to coexist. The psychology of giftedness is a fledgling. An impressive number of people think they know more about the gifted than one does and they are delighted to share their opinions.

Irritable bowel syndrome (IBS) is a common disorder. It is characterized as a functional disturbance of bowel motility with symptoms of lower abdominal pain and alternating episodes of diarrhea and constipation. Risk factors for the development of IBS include alcohol consumption and high levels of psychological stress. Diagnosis is made by history and physical examination. If bloody stools are reported, then a complete blood count is necessary to rule out anemia. Patients report mucus-like stools with IBS. The management of IBS depends mostly on symptom control, especially stress management. Dietary changes are necessary and include no alcohol or caffeine, avoidance of substances to which one is allergic, and an increase in dietary fiber intake. Adequate hydration is important. Some patients report relief from pain and abdominal distension with the use of probiotics. For any patient suffering from IBS, tricyclic antidepressants and antispasmodics can be tried to improve symptoms.

This chapter reviews liver testing and some reasons for the liver abnormalities. The liver function test (LFT) is a combination of serum testing, including alkaline phosphate, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin levels. Alkaline phosphatase is a serum level that is derived from bone and liver cells. Albumin is a protein that is produced by the liver. Low levels are seen in patients who have chronic liver disease, malnutrition, or cancer. Imaging studies that are frequently ordered for the patient with abnormal LFT results are an initial abdominal ultrasound and/or CT scan if further imaging is required. Mild elevations are seen in patients with chronic hepatitis B or C, fatty liver disease, or alcoholic cirrhosis. There are certain medications that can cause acute elevations in LFT readings. Some of those include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, antiseizure medications, antituberculosis medications, antilipid agents, sulfonylureas, herbal medications, and illicit drugs.

Psycholinguist is someone who studies phenomena in the intersection of linguistics and psychology. The whole endeavor of psycholinguistics often finds a home in the broader research field of cognitive science—an interdisciplinary field that addresses the difficult question of how animals, people, and even computers think. The centrality of language in the daily lives means that any disruption to the ability to use it may be keenly felt—the worse the disruption, the more devastating the impact. From the beginning of psychology, there has been an interest in language. In psychology, behaviorism was a movement in which the study of mental states was more or less rejected, and the idea that one could account for human behavior in terms of mental states or representation was discounted. This book covers a number of topics that are very much relevant in current psycholinguistics, including child language acquisition, sign language, language perception, and grammatical structure.

To truly understand how important and central memory is to us, it is important to understand what life is like for people who experience memory loss, or amnesia. This chapter examines the amnestic syndrome, which has been widely studied and the knowledge of which has significantly influenced theories of memory. The abilities and nonabilities of those with amnestic syndrome demonstrate that there are multiple independent systems of memory. The chapter also examines two controversial diagnoses, the main feature of which is memory loss dissociative identity disorder (DID) and psychogenic or dissociative amnesia. It discusses a form of memory loss that does not fit the technical definition of amnesia because it eventually affects not just memory but all cognition: Alzheimer’s disease (AD). AD is common among older adults and demonstrates how a worsening loss of memory and cognition can lead to a complete disruption of everyday life.

In our success-oriented culture, optimal development of giftedness often is construed as fulfilling one’s potential for greatness. In humanistic psychology, optimal development has been conceptualized differently. Self-realization can be understood in terms of Maslow’s self-actualization, Dabrowski’s secondary integration, Jung’s individuation, or other theoretical perspectives of human development. The goals of inner development involve deepening the personality, overcoming conflicts, and actualizing one’s potential for becoming one’s best self. Many parents of the gifted complain that their children are the ones exerting the pressure. Their speed of learning and quest for knowledge often exceed their parents’ comfort level. The purpose of parent guidance is to foster “optimal development” through early intervention and prevention of social and emotional problems. Assessment can act as a prelude to family therapy. Family therapy usually involves a commitment to several successive sessions to deal with family interactions.

This chapter discusses the incidence, assessment, laboratory findings, additional studies, diagnosis and treatment options of nausea and vomiting (N/V). N/V are common complaints in primary care offices. Initial evaluation of the patient with N/V includes determining how long the patient has had symptoms. The most common complications of N/V are dehydration and conditions caused by electrolyte imbalances, mainly hypokalemia and metabolic alkalosis. Depending on the degree of dehydration, basic laboratory evaluation may be needed to evaluate specifically for anemia, infection, and electrolyte imbalances. Esophagogastroduodenoscopy (EGD) can be performed for patients with unexplained N/V. Abdominal X-rays can be performed if there is concern about a bowel obstruction. For patients who are dehydrated, intravenous fluids (IVFs) are usually needed to assist with hydration until oral intake is possible. Antiemetics are medications that works by controlling response from the central nervous system.

This chapter discusses the incidence and risk factors, assessment and laboratory findings, diagnosis, and management of food intolerances or allergies. Food allergies are common and recognized more frequently as a cause of gastrointestinal distress. Most common reactions occur from peanuts and tree nuts, followed by fish and shellfish allergies. Patients at risk are those who have asthma and/or a history of allergic reactions to food. Symptoms can range from mild to severe anaphylactic-type reactions. Patients should be questioned regarding skin lesions, rash, difficulty breathing, palpitations, chest pain, nausea and diarrhea. Patients with an immunological reaction to food develop symptoms acutely, usually within minutes to two hours after consumption of the offending food. Antigen leukocyte cellular antibody test (ALCAT) measures body’s response to food antigens. The key to managing the patient with a food allergy is to identify the trigger. An accurate dietary history is important in identifying the possible allergen.

Abdominal pain can occur in a patient for any number of reasons. When evaluating the patient with abdominal pain, obtaining a detailed history is important in determining the proper diagnosis. Vital signs should be obtained and a detailed abdominal examination including a rectal examination, and pelvic examination, should be performed. In the patient with acute abdominal pain, laboratory testing should include complete blood count with differential, complete metabolic panel, lipase and amylase tests, liver function tests, urinalysis, and pregnancy test. Abdominal flat and upright films are useful in the patient presenting with abdominal pain. Bowel obstruction or intestinal perforation can be seen on these films. Abdominal ultrasound imaging is preferred in cases in which peritonitis is a concern and/or if the patient is pregnant or possibly pregnant. Surgical and acute abdomen are terms used to describe abdominal pain that quickly worsens and will likely continue to do so without surgery.

The abdominal assessment is an essential tool for providers to diagnose and treat gastrointestinal (GI) illnesses appropriately. Good assessment skills begin with taking a thorough patient history. A thorough history must include a diet history, presence of abdominal distension or bloating, nausea, vomiting, diarrhea, constipation and so on. The provider should auscultate the abdomen using a systematic approach, moving through all abdominal quadrants. Percussion, followed by palpation, is next in the abdominal examination. A stool test for occult blood is recommended if there is concern about GI bleeding or if the patient has anemia. CT scan is a useful and frequently ordered test when trying to determine cause of acute abdominal pain. Esophagogastroduodenoscopy (EGD) is a procedure performed by a gastroenterologist to evaluate the upper structures of the GI tract. Colonoscopy is a procedure performed by a gastroenterologist to evaluate the large intestine and rectum.

Hepatorenal syndrome (HRS) is a condition seen in patients with cirrhosis and ascites in which there is deterioration of the kidneys. Patients with HRS may present without symptoms. Others may have acute worsening of liver function such as worsening jaundice and hepatic encephalopathy, fever, chills, hypotension, tachycardia, dry skin and mucous membranes, dizziness, cold intolerance, or other signs of anemia. Blood and urine cultures may be required to evaluate for sepsis. Careful monitoring of renal function to re-evaluate for improvement or deterioration is essential. A renal ultrasound is usually obtained when there is an acute rise in creatinine to ensure no other etiologies are contributing to the rise in creatinine level, such as kidney stone, chronic renal damage, or other issues. All possible precipitants for development of HRS should be investigated, including evaluating for sepsis, gastrointestinal bleeding, malnutrition issues, electrolyte imbalances, and acute hepatitis.

Cirrhosis, also known as end-stage liver disease, is the final stage of liver fibrosis progression. Cirrhosis can develop for a variety of reasons with the most common causes being alcohol consumption, viral hepatitis, and nonalcoholic steatohepatitis. Management goals are to prevent complications and to preserve quality of life. Cirrhosis is divided into two subsets: compensated and decompensated. There are many nonspecific symptoms that can be associated with cirrhosis, including fatigue, weakness, loss of appetite, and weight loss. Patients with cirrhosis may have abnormal liver function test (LFT) readings, hyperbilirubinemia, elevated international normalized ratio (INR), thrombocytopenia, anemia, leukopenia, hyponatremia, hypoalbuminemia, renal insufficiency, and glucose intolerance. The gold standard for determining the presence and staging of cirrhosis is a liver biopsy. Patients with cirrhosis should undergo screening measures to avoid complications, including regular esophagogastroduodenoscopy (EGD) to appropriately manage varices and prevent bleeding episodes, and imaging studies to rule out hepatocellular carcinoma.

Gastroesophageal reflux disease (GERD) is a common condition in which stomach contents flow upward causing bothersome symptoms, including a burning sensation in the esophagus and throat, and other complications. Normally, the lower esophageal sphincter (LES) maintains a pressure barrier between the stomach and the esophagus. Complications of GERD include Barrett’s esophagus, peptic stricture, asthma, chronic cough, and esophageal adenocarcinoma. Patients with GERD often complain of heartburn, dysphagia, and regurgitation. Diagnosis of GERD is made by clinical symptoms. The differential diagnosis of the patient with GERD may include infectious or eosinophilic esophagitis, cancer, peptic ulcer disease, coronary artery disease, or stricture motor impairment of the esophagus. For medication management, most providers recommend prescribing a proton pump inhibitor (PPI) twice a day for symptom control. Antireflux surgery is an option for patients with GERD who are unable to take medications to treat the symptoms.

Intelligence is a hypothesized quality whose ontology, etiology, and scale must be inferred through indirect means. Personal definitions of intelligence are not the same as constructs of intelligence. Psychological constructs are highly technical, painstakingly crafted, and subjected to rigorous theoretical examination and empirical testing. Intellectual abilities are organized at a general level into two general intelligences, viz., fluid intelligence and crystallized intelligence. Intelligence is the sum total of all cognitive processes. It entails planning, coding of information and attention, as well as arousal. Given his personal history and society’s attitudes toward heredity, that Galton concluded that the development of genius, must be understood in terms of hereditary processes. The chapter concludes with two tables presenting definitions of intelligence provided by several prominent historical and living intelligence theorists. They convince readers that human intelligence is a fascinating and complex subject, and to provide a foreshadowing of many of the essential issues.

This chapter discusses the assessment and laboratory findings, diagnostic studies imaging studies and management of gastrointestinal bleeding. It also discusses the signs and symptoms of esophageal varices and variceal hemorrhage. Risk factors for variceal hemorrhage or bleeding include advanced cirrhosis, increased size of varices, and presence of red wale signs seen on esophagogastroduodenoscopy (EGD). Complications of variceal hemorrhage can include infection, severe anemia, and death. Providers should note patient history of melena, hematemesis, hematochezia, syncope, dizziness, palpitations, or prior history of gastrointestinal (GI) bleeding. Routine laboratory testing, such as complete blood count, complete metabolic panel, prothrombin/international normalized ratio (PT/INR), and liver function testing, should be performed on all patients suspected of having variceal hemorrhage. Patients may require serial hemoglobin and hematocrit to check for worsening anemia. Prevention of variceal hemorrhage is key for variceal management. Patients with variceal hemorrhage require urgent hospital admission to the intensive care unit (ICU).

This chapter focuses on the causes of liver disease, including alpha-1 antitrypsin deficiency, Budd-Chiari syndrome (BCS), hereditary hemochromatosis (HH), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), polycystic liver disease, and Wilson’s disease. Vascular disorders of the liver include congenital vascular malformations, portal vein thrombosis, sinusoidal obstruction syndrome, and BCS. PBC is an autoimmune disorder that affects the bile ducts. A serologic marker that is highly suggestive of PBC is antimitochondrial antibody (AMA). BCS should be considered in patients with abdominal pain, hepatomegaly, ascites, or with known risk factors of thrombosis. Ultrasonography is performed to evaluate the hepatic vasculature for thrombosis or blood-flow issues. There can be some laboratory abnormalities in patients with PSC and PBC. These include mild alkaline phosphatase, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Treatment for the patient with hemochromatosis includes phlebotomy weekly or twice a week, removing one unit of whole blood.

Acute liver failure (ALF) is a condition in which there is severe liver dysfunction with hepatic encephalopathy and compromised liver function. This chapter helps the readers to Identify two prophylactic approaches that are important to minimize risk of complications in the patient with ALF, and discusses treatment strategies for the patient with ALF. The patient with ALF has a high risk of mortality. These patients have a degree of hepatic encephalopathy and coagulopathy with highly elevated transaminases. Multisystem organ failure (MSOF) can develop, including respiratory and renal failure. Laboratory testing that is performed includes serial liver profiles, bilirubin levels, coagulation factors, complete blood count, and complete metabolic panel to check for electrolyte imbalances and renal failure. Patients should be on stress ulcer prophylaxis with a proton pump inhibitor to minimize risk of gastrointestinal (GI) bleeding. All patients with ALF should have routine chest radiographs, and blood, urine, and sputum cultures.

In theory, the construction of an autobiographical memory begins with a retrieval model being generated in the brain. This retrieval model activates general knowledge about the self, which is used to retrieve episodic memory details consistent with the desired memory. Autobiographical memory is a complicated skill that results from the union of episodic memory and an abstract concept of self laid out over time. This transformation of episodic into autobiographical memories results in forgetting of some incidents, and mashups the details from two or more separate incidents into a single memory that feels like it happened to the self at a particular point in time. Autobiographical memory is said to serve at least three important functions: identity, directive, and social. Autobiographical memories also serve as guides for future behavior. A function of autobiographical memory is to create and strengthen bonds between people.

The ideas of Aristotle, Socrates, and Plato all contribute to the foundation of our understanding of the nature of human intelligence. Their ideas on topics as diverse as the origin of ability, the mind-body relationship, and general inquiry methods continued to inspire thinkers centuries later and influenced those who shaped modern psychology and intelligence theory. This chapter provides an overview of recent research on how people’s beliefs about intelligence impact their behaviors, a body of research that has significant implications for education. The emergence of reliable genetic and neurological research methodologies is creating a new area of study in which environmental, biological, and psychological facets of intelligence are studied simultaneously. Structure of Intellect (SOI) model represents a very different approach to theories of intelligence. Recent technological advances have encouraged explorations into the relationship between brain function and specific types of cognitive functioning.

This chapter discusses the assessment and laboratory findings, imaging studies and management of spontaneous bacterial peritonitis (SBP). SBP is a complication of cirrhosis that can develop in patients with cirrhosis and ascites, occurring in approximately 25" of these patients. Risk factors associated with the development of SBP include gastrointestinal bleeding, prior SBP episodes, and low ascitic total protein levels. Some patients with SBP may present with fever, chills, abdominal pain or tenderness, altered mental status or worsened hepatic encephalopathy, presence of systemic inflammatory response syndrome (SIRS) criteria, nausea, vomiting, constipation, or diarrhea. Fluid should be sent for tests of cell count with differential, albumin, total protein, Gram stain, bacterial aerobic and anaerobic cultures, glucose, lactate dehydrogenase, and amylase. Ultrasound is performed at the time of diagnostic paracentesis to ensure that an adequate fluid pocket is available for sampling. Patients with neutrocytic ascites or SBP should be treated with broad-spectrum antibiotics.

This chapter talks about the representation of language in the brain— including what parts of the brain are known to be involved in language. It talks about how multiple languages are represented and interact in bilingual speakers. The most important lobes for language are the temporal lobe and the frontal lobe. In terms of language, in right-handed people it is the left hemisphere that supports the majority of language function. There are two areas in particular that appear to be especially important for language: an area toward the front of the brain in the frontal lobe that includes Broca’s area and an area more or less beneath and behind the ear toward the back of the temporal lobe called Wernicke’s area. Broca’s aphasia is characterized by difficulty with language production—with effortful, slow speech, and the striking absence of function words like prepositions, determiners, conjunctions, and grammatical inflections.

Research on both sign language and how it is processed has been growing quickly over the last decade, with researchers from a number of different fields increasingly interested in it. This chapter addresses two common misconceptions about sign language to understand exactly what sign language is. French sign language is just a version of spoken French, British Sign Language (BSL) is just a version of English, and so on. Variations in hand shape and other differences can differentiate dialects of sign language. Sound symbolism shows that there are cases in spoken language when sounds are linked in a nonarbitrary way to meaning. Further, there are phonotactic rules that differ from language to language about how signs may be formed. Speech errors are mistakes that speakers make when they intend to say one thing but something else comes out instead.

This chapter examines performing effective student evaluations, evaluating a student’s strengths and weaknesses, and documenting student progress, including sample forms and templates. It also provides coaching tips and interventions for poorly performing students. As the instructor it is our fundamental responsibility to provide daily assessments on your students’ progress. Verbal feedback must be given immediately and often. Always start with the positive aspects of the students’ performance. It is our responsibility to write down our immediate thoughts and observations of each student in an objective, anecdotal format after any interaction, whether positive or negative. Sample action verbs will help to describe the students’ actions while in the clinical setting. The chapter also helps us to identify and address behaviors or patterns of behavior that require documentation and intervention. It offers some helpful tips to use when counseling students regarding their performance deficiencies.

This chapter examines final clinical evaluation, provides tools and guidance to determine whether the student has gained adequate knowledge of terms, calculations, and critical thinking, and explores instructions regarding grading. Final evaluations will be given during Week 13. Final grades will not be distributed until Week 14 to ensure that the final quiz has been added to the grade calculation total. The final grade will be based on the final evaluation, final quiz, and all assignments. Patient assignments should be given out after the quiz has been completed. The clinical evaluation tool is used to achieve a consistent means of evaluating the students’ progress in clinical. It provides a guideline for instructors to ascertain students’ deficiencies and knowledge base. The clinical evaluation criteria includes: core learning outcome, satisfactory behavior, needs improvement, and unsatisfactory behavior. The clinical instructor may use attendance as part of the students’ grades.

This chapter examines missed classes and material for makeup classes, critical thinking skills exercises, and stress-reduction techniques. Each clinical course must meet for a certain number of hours to ensure the student is meeting attendance requirements. When a student misses a clinical class, a makeup assignment should be given to meet the attendance requirement. There are several types of assignments on makeup assignments includes individual makeup assignments, group scenario makeup assignments, and library assignments. The chapter also offers some questions that may be used for individual makeup assignments or may be used to help the group discuss ethics in nursing. The challenges faced by both the senior and middle-aged adult populations: examination of cultural attitudes and concerning their own thoughts. The patient education scenarios can also be used for group discussions to further aid in the development of critical thinking skills. Stress is a necessary factor in life.

The term genius is peculiar. It can be applied to a diversity of phenomena or confined to just one or two. The tremendous range in usage reflects the fact that genius is both a humanistic concept with a long history and a scientific concept with a much shorter history. The word genius goes way, way back to the time of the ancient Romans. Roman mythology included the idea of a guardian spirit or tutelary deity. This spiritual entity was assigned to a particular person or place. Expressed differently, geniuses exert influence over others. They have an impact on both contemporaries and posterity. The exemplars of intelligence have a feature in common: They are called as exceptional creators. The favored definition is that creativity satisfies few separate requirements. First, to be creative is to be original. In main, genius in the leadership domain of achievement appears to fall into several groups.

This chapter examines the musculoskeletal and integumentary systems and reviews physiological and systematic assessment of the musculoskeletal system and related nursing tools. It describes pressure ulcers, passive range of motion (PROM) and active range of motion (AROM), burn management, traction, and the effects of decreased mobility. Instructors are encouraged to discuss the costs of pressure ulcers and the reimbursement process related to health care organizations when patients develop nosocomial pressure ulcers. Pressure ulcers are also costly to the patient in terms of pain and suffering. PROM exercises are exercises that the nurse or nursing student can perform for the patient who cannot independently exercise or move an extremity. AROM exercises are an exercise therapy that the patient can perform independently. There are three phases of burn management: emergent phase, acute phase, and rehabilitation phase.

This chapter discusses the importance of written communication in nursing practice. Effective writing promotes the use of critical thinking and analysis, and ensures that those individuals with whom the nurse interacts will understand what is being said. E-mail communications with other members of the health care team necessitate proper writing skills. Professional writing in nursing is an important way to communicate with others, express ideas, present information, advance research, and teach others about the discipline of nursing. The nurse explains the present situation, shares present assessment findings, and makes recommendations for solving the problem. Situation, Background, Assessment, Recommendation (SBAR) provides a common and predictable structure for communication and can be used in any clinical domain. Labor pain can be influenced by a number of factors, such as culture, anxiety, and environment. The chapter also discusses the PICOT method, a mnemonic that encompasses the key components of a well-focused question.

This chapter examines basic medications that are important for all students to know and reviews medication terminology and accompanying abbreviations. It explains about medication “rights” and dosage calculations, and also offers medication administration guide. Students should be encouraged to learn the characteristics of a variety of medications. The chapter provides medication list that contains the most common drugs used and students must learn their uses, the typical dosage of each, side effects, and so forth. Nurses must possess a wide range of knowledge about the vast number of drugs currently available, including their classification, actions and indications, routes of administration, appropriate dosages, side effects and adverse reactions, and antidotes. Analgesics are drugs used to provide relief from pain. Anticoagulants are drugs that prevent the clotting of blood. Vitamin and mineral supplements are used to treat various conditions caused by nutritional deficiencies.

This chapter provides an introductory overview of selected works for further reflection and study. It provides more in-depth discussions on nursing theoretical frameworks, starting with the references. Nursing has incorporated theories from other disciplines, including theories of systems, human needs, change, problem solving, and decision making. Health generally addresses the person’s state of well-being, while the concept of nursing is central to all nursing theories. Benner provided examples of nursing practice based on observation and interviews with professionals ranging from those just starting their professional careers to veteran nurses. In Betty Neuman’s Systems Model (NSM), the individual is viewed as an open system interacting with both internal and external environment forces and stressors. Client variables are physiological, psychological, sociocultural, developmental, and spiritual stressors. The physiological mode deals with the maintenance of the physical body.

This chapter examines the urinary system, reviews physiological and systematic assessments and related nursing tools, and also presents an analysis of the various types of dialysis. Various types of filtration will be discussed during Week 11. The filtration methods discussed include the body’s own filtration system and artificial filtration, such as hemodialysis and peritoneal dialysis, as well as a brief discussion of continuous renal replacement therapy (CRRT). Most health care facilities have reduced their usage of indwelling Foley catheters. Measuring intake allows the nurse to determine whether the patient is adequately maintaining hydration, adequately hydrated, or rehydrating per the physician’s orders. Intake includes oral and intravenous (IV) fluids as well as nasogastric tube (NGT), oral gastric tube (OGT), and percutaneous endoscopic gastrostomy (PEG) feedings and fluids. A pyelogram is a radiological procedure that permits the visualization of the urinary system.

This chapter examines final discussion of the examination results, initiating student-led discussions, giving students their final clinical grade, and challenges the students may face. Although the final clinical class will not involve any patient care assignments, the last class will offer a unique opportunity to discuss any questions the students may have. The nursing program is based on learning new knowledge and skills while building on previously learned material. Reinforcing the students’ knowledge base is essential and will assist the students in their continued efforts to build on their theoretical knowledge. Students should also be encouraged either to join nursing organizations to experience evidence-based material on existing and new professional practices or to subscribe to nursing journals to ensure a link to new professional nursing knowledge and practices.

This chapter provides an introduction to nursing informatics (NI), the organization of data, information, and knowledge important to nursing. It examines the responsibilities, challenges, and opportunities presented to the nurse in working with information systems at the point of care, the importance of attending educational programs to expand knowledge on and to impact nursing practice, and the management of continuously evolving research data. Nurses must embrace and integrate technology skills into their daily professional practice. Informatics technology strengthens an evidence-based approach through open, complete, and current access to continuously emerging data surrounding the nursing profession. With the incorporation of electronic health records (EHRs) into health care professions, nursing is challenged to build informatics competencies into their knowledge base. Informatics technology (IT) is no longer a recommended addition to current nursing curricula; it must be integrated into all clinical courses.

This chapter examines critical thinking development, and building a foundation of knowledge of injections and intravenous (IV) therapy, medications and laboratory values. Students will be quizzed on their knowledge of intramuscular (IM), subcutaneous (SC), and dermal injections during Week 4. Week 4 is also a good week to begin teaching laboratory values and their relationship to medications. This is also a good time to begin teaching IV therapy concepts. Critical thinking is a difficult concept to understand and a difficult skill to develop. Students will need to demonstrate their knowledge regarding medications given via the different injection routes. When an IV is needed for the patient or when the health care facility requires a saline lock for all patients, the nurse will need to insert an IV catheter. Nursing students will often discover the lattice format among the notes of other interdisciplinary team members.

This chapter examines physiological and systematic assessment of the respiratory system and related nursing tools. It explores review of arterial blood gas results (ABG), and also examines handouts to test knowledge of breath sounds and supplemental oxygen resources. Week 9 continues the systematic process of learning body systems by reviewing the respiratory system. Students will learn how to interpret ABG results. Tracheostomy care can also be included during Week 9. The respiratory system is balanced by the carbon dioxide (CO2) that is produced by cellular metabolism and removed by the lungs. Pulmonary edema is an excess of fluid in the extravascular tissues and spaces of the lungs. Pleurisy is an inflammation of the pleura of the lungs. Most patients with respiratory disease often require supplemental oxygen. The chest tube is a used to re-expand the lung.

This chapter explores the application of critical thinking, nursing process, and current evidence as a foundation for informed, safe, and professional nursing practice. The American Nurses Association (ANA) Standards provide the framework necessary for critical thinking in the application of the nursing process. The nature of evidence-based practice, its relevance to nursing, and the skills needed to support it are essential components of baccalaureate nursing education, all of which lead to the development of independent, self-directed learners, and, ultimately, professional nurses. Evidence-based nursing is the practice of making clinical decisions based on the best available current research evidence, clinical expertise, and the needs and preferences of the client. According to guidelines from The Joint Commission (TJC), the care planning process is the structural framework for coordinating communication that will result in safe and effective care.

An adjunct instructor is a part-time instructor working without the benefit of fulltime employment. Clinical instructors may also be observed by peers, who complete evaluation forms and submit them to the institution. In addition, instructors and students are required to evaluate the clinical site at the conclusion of the class. The primary responsibility of a nurse educator or instructor is to facilitate learning for the nursing student. Failure to mention distance learning or online education would be a mistake. Today’s technology offers students weekly instruction in a variety of forms and methods. A contract is entered into between the educational institution and the instructor. The contract will describe the terms and responsibilities of employment of the adjunct professor. Full- and part-time faculty regularly participate in self-assessments and invite colleagues to observe their teaching to strengthen their instructional skills and to advance excellence in instruction.

Leadership is defined as the “process of influencing people to accomplish goals”. Management involves not only leadership but also “coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives”. The nurse must demonstrate leadership and management skills in interacting with clients and their families and with nursing colleagues. The contemporary view is that the manager focuses on planning, monitoring results, decision making, decision analysis, resource control, and development. Critical thinking, active listening, and coping skills are essential at all levels in today’s nursing workforce. Creating a healthy work environment requires strong nursing leadership at all levels of the organization. Shared governance impacts client care by including nurses at all levels in organizational decision making regarding client care. Nursing role in shared governance may be included in their job description.

This chapter introduces the student to nursing in a culturally diverse world. Nurses need to become informed about and sensitive to culturally diverse subjective meanings of health, illness, caring, and healing practice. Clients benefit when nurses learn more about and become confident in their ability to care for diverse cultural groups. Multiculturalism refers to the viewpoint that there are many diverse cultures and subcultures in the world that need to be recognized, valued, and understood for their differences and similarities. The Kleinman questions apply therapeutic communication skills in order to assess the client’s cultural needs. Information, treatments, and education relating to self-care skills can then be presented within the client’s framework. Sharing stories may also provide concrete examples of interactions with clients from diverse cultures. In client-centered care, the clients themselves are viewed as experts in their life experiences relating to health.

This chapter examines the medical-surgical courses, and learning skills students are required to master. It offers a comprehensive skills checklist that outlines and explains the necessary didactic skills, and also provides a sample course syllabus including a weekly teaching plan. At the start of their clinical classes nursing students need an overview of the numerous skills they must acquire before they can graduate into the field of nursing. Instruct the students to print out the tasks, review the nursing skills beforehand, and bring them to the hospital. Most health care facilities have a skills book useful for reviewing the nursing skills needed. Students should learn where the laboratory, respiratory department, intravenous (IV) therapy department, and radiology departments are located. The student handbook will define “plagiarism”. Students are responsible for learning the skills and/or possessing the knowledge to complete or perform the steps on comprehensive skills checklist.

Kurt Lewin developed his classic Change Theory in 1951, identifying three stages of change: unfreezing, transition, and refreezing. Lewin’s theory is based on restraining and driving forces, creating a “push-pull” effect. In pursuing a baccalaureate degree in nursing, licensed practical nurses (LPNs) may experience many interpersonal and intrapersonal emotions and conflicts along the way. LPNs are better equipped to successfully face and navigate the challenging “waters” during a nursing career of lifelong learning. Patricia Benner incorporates the concepts of change, transition, and socialization in her iconic work, From Novice to Expert. Following her nursing experience on an intensive care unit, Benner began researching the pathways by which individuals became nurses. Deliberate practice involves a personal, goal-oriented approach to skill and knowledge development. Concepts may come from the American Nurses Association (ANA) Code for Nurses and may incorporate ethics, professionalism, autonomy, accountability, caring, confidentiality, and integrity.

This chapter presents a basic overview of the influence of law, legal issues, and the field of ethics and bioethics on the professional practice of nursing. Consumers are more knowledgeable and informed about their rights within the health care delivery system. Applying legal concepts within an ethical framework enhances client care through examining how these issues affect one’s clinical practice. Nursing ethics is sometimes viewed as a subgroup of bioethics because of the unique variety of ethical problems that arise in relation to working with clients, families, and other members of the health care team. The major principles of health care ethics that must be upheld in all situations are autonomy, beneficence, nonmaleficence, justice, and fidelity. In 1990, the Patient Self-Determination Act (PSDA) stated that competent people could make their wishes known regarding the end-of-life experience.

This chapter examines concepts in nursing, and explains delegation, including a student survey research project, prioritization, leadership styles, team management, and supporting research. It describes personal protective equipment (PPE) and palliative care. Nursing students must learn how to delegate. Delegation involves giving another person the authority to be responsible for completion of a task. The licensed practical nurse or licensed vocational nurse (LPN/LVN) can perform wound care, suctioning, urinary catheter care, and blood glucose readings. The nursing student can perform simple concepts such as patient coughing and deep-breathing exercises, simple assessments, and administer oral medications under the instructor’s supervision. The nursing student must review certain terminology in order to engage in a decision-making process that provides optimal nursing care. Leadership, or the ability to lead, must be developed at every level of nursing. Palliative care is the umbrella concept that includes both comfort care and hospice care.

This chapter examines preoperative, intraoperative, and postoperative nursing responsibilities. Students will be introduced to the nursing responsibilities associated with preoperative, intraoperative, and postoperative patient care. Nurses in the surgical field assess, plan, and implement nursing care for patients before, during, and after surgery. The nurse must properly assess the patient’s physical and emotional well-being throughout this entire process. Nurses must also maintain a sterile and safe surgical environment and provide pre- and postoperative patient education. The nursing process for preoperative patients is derived from the needs of the entire surgical nursing process. Nursing interventions are based on the surgical patient’s current health status and the surgical intervention to be performed. Postoperative patients may require a transfusion. Transfusions may include one of the following: packed red blood cells (PRBC), red blood cells (RBC), fresh frozen plasma (FFP), platelets (PLTS), albumin, or factor VII.

This chapter reviews gastrointestinal (GI) system and physiological and systematic assessment and related nursing tools. It provides guidelines to perform abdominal girth measurements and nasogastric tube insertion. The chapter describes GI function, disorders, treatment including nasogastric tube (NGT)/oral gastric tube (OGT), surgery, and diet issues. Week 10 introduces the GI system. The instructor should point out that the GI system houses many organs. Students who understand the process of ascites can validate the need for daily weights and abdominal girth measurements on their assigned patients. Nursing students should be able to determine both the abdominal quadrants and the abdominal regions. General signs and symptoms of a GI disorder are pain, anorexia, nausea, vomiting, constipation, or diarrhea. Nausea and vomiting are the most common manifestation of GI disease. Dehydration can be a result of prolonged nausea and vomiting.

This chapter examines the neurological system from a nursing perspective, reviews physiological and systematic assessment, and also describes neurological examination and related nursing tools and also neurological conditions and symptoms. The neurological assessment is a very important learning tool. All students should be encouraged to offer input into problem-solving activities focused on any difficulties encountered in implementing the examinations or assessments. Students should understand the normal responses and assessment findings for the neurological and cranial nerve examination as well as the neurological scale. Babinski reflex, prior to initiating patient care and conducting their patient assessments, test should be used when there is any change in the neurological system. A cerebrovascular accident (CVA) stems from inadequate blood flow to the brain that results in motor or sensory deficits. Meningitis is an inflammation of the meningeal tissues that surround the brain and spinal cord. Meningitis may be bacterial or viral.

This chapter presents an overview of standards, initiatives, organizations, and reports to inform the student returning to academia about significant issues that have shaped current practice and trends in the nursing profession. Creating and applying standards of practice are key responsibilities of a professional organization. In professional nursing practice, standards of care (SOCs) refer to a competent level of nursing care. Focusing on the knowledge level required by health care professionals to provide quality care, the findings revealed that students in the health professions were unprepared to meet the country’s current demographic shift. Educators should use both formative and summative assessments, including simulation exercises, skills laboratories, and classrooms with actor patients, and assessments done directly in the clinical setting. The Essentials of Baccalaureate Education for Professional Nursing Practice is a set of central standards for baccalaureate-degree nursing education programs.

The purposes of client education are to maintain health, improve health, or slow the deterioration of health. Malcolm Knowles developed a body of work on learning theory and provided an important framework for teaching adults. The nurse’s role is to think critically about clients and their circumstances in order to create a learning opportunity for the patient that promotes safety and optimizes independence. Client-teaching plans often break down because of a lack of individualized client assessment. Linguistic visual learners learn through use of the written word. Computer-based instruction, books, and articles are examples of linguistic visual learning tools. Whenever teaching a new skill, nursing documentation is important. Deficient knowledge related to unfamiliarity with information resources secondary to new diagnosis of diabetes mellitus as evidenced by inaccurate performance of test. The teach-back method into your daily practice can improve client knowledge and self-management skills.

This chapter describes the cardiac system, examines physiological and systematic assessment, and explores review of electrocardiogram (EKG) wave forms. Week 8 introduces the students to the cardiac system. Students will be given the opportunity to review causes of cardiac diseases or problems. Along with heart sounds, students should learn the various parameters for hypertension (HTN), murmurs, and edema. Pass out the cardiac wave form exercise and heart sounds exercise material to the students and instruct them to complete the forms as instructed on each individual form. Congestive heart failure (CHF) is the insufficient ability of the heart to pump effectively. A pacemaker is indicated when failure of the natural cardiac conduction system is diagnosed. The nursing profession has assumed that experience in actual clinical settings is the “gold standard” for students to learn how to assimilate nursing care.

This chapter examines fundamental skills review and assessment, and also explains how to test the students’ performance of accurate vital signs, hand washing, and taking an oral report on assigned patients per instructor’s observation. It describes benefits to students of shadowing interdisciplinary team members, and providing feedback on the student shadowing experience. The chapter discusses data collection. Information for care plans will be obtained from the physical assessment and data collected from the patient’s chart. Medications should be listed. Learning the correct method of hand washing is a must to prevent the spread of nosocomial pathogens from one patient to another. Obtaining vital signs correctly and appropriately is an important method used to monitor a patient’s health status. Students should learn the appropriate way to assess pulses, respiratory status and rate, temperature, and blood pressure. Bathing the patient allows the nurse to perform an in-depth skin assessment.

This chapter switches gears, away from what leadership means from the view-point of personal qualities to the perspective of what one need to do to achieve the goals of our workplace. Leadership is increasingly defined as the ability to work successfully with others to achieve the organization’s mission and goals. Stereotyped views of nursing stress virtue and busyness but not strength and innovation, thus reinforcing the notion that nurses are helpers, not leaders. The point of naming what one do is for others to see what one does and how one contributes to the organization as a whole. The more others see the contributions of nurses to the organization, the more nurses will be included in key decision-making forums. The more all nurses are expected to be leaders, the more nurse leaders cannot operate from a command-and-control framework but must lead by developing the leadership of others.

Pain remains a common symptom experienced in the palliative care patient population. Despite advances in pain management, patients remain at risk for inadequate relief, especially at end of life (EOL). In order to provide quality pain relief, nurses must possess appropriate knowledge regarding assessment and treatment including pharmacological and nonpharmacological interventions. This chapter provides nurses with a basic overview of the principles of pain assessment and pharmacological management throughout the illness continuum and at EOL. The needs of special populations who have been identified as “at risk” of inadequate pain control are highlighted, including older adults, children, persons with communication impairment, patients with a history of substance abuse, and cancer survivors. These groups represent those in whom pain is often unrecognized, not respected or not believed. Many of the principles of pain assessment and management reviewed can be applied to children.

An adult is presumed to have the ability to make his or her own healthcare decisions—including termination of life-sustaining technology—unless he or she is shown to be incapacitated by clinical examination or ruled incompetent by a court of law. Advance care directives are legal vehicles used by people to provide guidance to their healthcare providers concerning the care they would desire in the event they become incapacitated and cannot make their own decisions. Problems with advance directives may arise when they do not seem to apply to the patient’s situation. Nurses roles include educating the patient and family about the patient’s condition and legal end-of-life (EOL) choices, identifying the patient’s and family’s wishes for EOL care, articulating the patient’s and family’s desires to other members of the healthcare team, and assisting the patient and family to obtain necessary and appropriate EOL care.

This chapter examines pre- and post conference expectations and activities, and forms to be used by the professor and the students. Prior to the first class, make copies of the syllabus, contact information sheet, weekly attendance sheet, scavenger hunt sheets, chart check form, guidelines for care plans, care plan form, math quiz, vocabulary quiz, medication forms, and resource materials. Medical-Surgical II students should be able to perform a physical assessment independently. The chapter introduces detailed guidelines for conducting modified physical assessments that balance obtaining the information required for health care interventions against the limited time available to the students in clinical classes. The clinical instructor should also notify the students that each of them will be tested on medications, side effects, desired effects, interactions, and dose calculations prior to being allowed to pass medications or regulate IV fluids on his or her assigned patient.

There is no aspect of leadership as gratifying as helping others reach their potential. It is rewarding in a way that other things aren’t because any investment in people pays dividends forevermore. Appreciating others includes giving feedback that is customized to the person. There is growing evidence that indiscriminate praise doesn’t change behavior positively, particularly if the commendation is for something relatively immutable like being smart. Appreciating others includes a broad range of behaviors—valuing the contributions of different kinds of people; respecting what each generation contributes to the mix; developing a community of learning so all continue to grow and develop throughout their careers; understanding that investments in people have a ripple effect because those who have been helped tend to “pay it forward” and providing timely and effective feedback that encourages improvement or advancement. Appreciating others also means valuing what others have done to help your advancement.

This chapter examines assessment, treatment, and decision-making skills and discusses emergency levels and triage decisions, emergent nursing situations, and illicit and illegal drug emergencies. An emergency nurse is a nurse with specialized diagnostic and treatment skills in emergency nursing. This nurse has to be able to handle life-threatening emergencies and must be aware of a wide range of illnesses, injuries, treatments, medications, and complications. The nurse must also be knowledgeable in advanced monitoring and treatment equipment. Patient emergency levels are labeled as Priority Levels I, II, III, or IV based on their medical, psychological, community, and substance-abuse requirements. There may be patients who are admitted to the emergency room under the influence of illicit and illegal drugs. Drug screening should be done if there appears to be any changes in the patient’s mental status or trauma or injury.

Career opportunities are projected to grow faster for nursing than all other occupations through 2026. The advantage of a career framework with multiple stages is that one doesn’t start out expecting to be fully developed at the beginning. Mentoring is needed throughout a career, not just at the start. This chapter provides an overview of the career model that the author has fleshed out over time, greatly influenced by Dalton, Thompson, and Price’s classic article (1977) on stages of a professional career and subsequent work. There are five career stages whereby the individual moves from: (a) becoming prepared, to (b) demonstrating the ability to work independently and interdependently in achieving professional goals, then (c) developing others and the home institution, then (d) advancing the profession and healthcare, and eventually (e) daring to be a truth teller. Exerting leadership presupposes complete career development, going through all five career stages.

Aiming for impact means that one not only thinks that one can transform clinical service, but wants to develop and provide patients and their families with the kind of positive moments that are remembered 20 years later. Leadership presupposes aiming for impact; that is, a determination to address the challenges inherent in the current healthcare system. Impact means always giving some thought to how something good can be parlayed into something better. If one is aiming for impact, developmental learning will inevitably move from focusing on mastery of what today is considered to be best practice to imagining and developing a new and improved version of future practice. Nurses have historically been socialized in the direction of convergent thinking, but leadership requires divergent thinking, experiences that promote creativity and innovation.

This chapter showcases the preparation phases necessary to apply for and accept different nursing leadership positions. It explores the components of lifelong learning that are needed to foster new career endeavors. The chapter helps the reader to distinguish between a resume and a curriculum vitae. It provides more in-depth skills to enhance this application process as the nurses continue to move forward in their nursing career. Nurses have so many opportunities within healthcare, but it is up to each individual to best position himself or herself for those opportunities. Nurses who take ownership of their professional development will be able to revaluate their careers at different points to determine where there may be gaps in professional development. Nurses who address an identified gap in their professional development will position themselves in the best possible light for future potential promotional opportunities.

Cancer is a devastating diagnosis that many individuals still associate with death. Upon initial diagnosis, individuals embark on a treatment journey that is overwhelming with medical jargon, new healthcare providers, unknown outcomes, and fluctuations of hope amid the distressing effects of the disease and its treatment. The most frequently diagnosed adult cancer types are female breast, prostate, lung, and colorectal cancer. These four most commonly occurring cancers will be the focus of this chapter. The overall incidence and prevalence of cancer has increased with individuals living with cancer as a chronic illness. Treatment options have improved survival rates, decreased toxicity, and provided palliation. Symptoms associated with the disease and the toxicities of treatment require a commitment to an interprofessional model of care across healthcare settings. Palliative care focuses on the physical, psychosocial, and spiritual needs of the cancer patient and family as well as bereavement needs of families.