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.

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.

The main message of this chapter is that a professional career requires sustained development in interpersonal, interprofessional, and communication effectiveness. Undergraduate and graduate courses are full of valuable information about communication—spoken, written, visual, electronic, and social media. Instead of trying to summarize the communication essentials that nurse leaders should have acquired along the way and will need to develop additionally over time, this chapter focuses on some communication skills important to goal achievement that the author learned to appreciate more with experience. They fall under the following headings: courtesies, self-presentation, negotiations, the importance of data arrays and publication, and the value of understanding the viewpoint of others. Self-monitoring, as a leadership ability, means the person seeks to shape how she or he is perceived in order to achieve professional objectives. Measurable outcomes and published results are important in building the image of the profession.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and the leading cause of death due to a respiratory cause. Development of this disease occurs as the result of cigarette smoking and exposure to environmental pollution. In addition, the normal physiologic changes due to the aging process place individuals at an increased risk for the development of complications, such as cor pulmonale and pneumonia. In order to reduce the risk of developing the complications of COPD, smoking cessation is recommended. Pharmacologic modalities focus on improving ventilation, reducing inflammation, and preventing complications. Nonpharmacologic interventions including exercise, rest, and improved nutrition can be valuable complementary therapies in the care of patients with COPD. To provide palliative care for patients at every stage of COPD, from diagnosis to the end of life, the nurse needs to acquire the knowledge and skills for expert nursing care.

Gastrointestinal (GI) symptomatology is common in patients receiving palliative care. Many patients have described the constant nausea, vomiting, and diarrhea as more disabling and disturbing than pain. Anorexia and subsequent cachexia are common in patients at the end of life with multiple potential and often overlapping causes. GI symptoms affect patients’ activities of daily living and influence their quality of life. Other common GI symptoms in palliative care patients include dysphagia, constipation and bowel obstructions, hiccups, and xerostomia. All of the GI symptoms may be related to the pathology of the diseases as well as treatments. Having an understanding of both is crucial for the nurse caring for patients in this setting. As in all palliative care, ongoing assessment of the patient is necessary to determine what interventions are working and which need modification. Interventions include pharmacological, nonpharmacological, and complementary therapies.

Strategic planning involves examining how your professional and/or organizational mission is being affected by changing circumstances, setting goals with concrete actions and a timeline, and then figuring out needed resources and expected outcomes. “The vision thing” at its best involves periodically embarking on a process of strategic planning whereby you examine how your professional or organizational mission is being affected by changing circumstances, and then set short-term and long-term goals with concrete actions and a timeline that moves you in desired new directions. Transformational leaders are deeply committed to the organization and its mission/values, make use of consultants so that they are not limited by the boundaries of their expertise, are willing to try something new knowing that not all good ideas work out, combine vision with practicality in figuring out how to operationalize the change process, and know how to use a range of individuals to the organization’s advantage.

This chapter discusses several common skin problems including skin tears, pressure injuries formerly known as pressure ulcers, skin tumors, treatment-related skin injuries, peristomal skin, and fistulas. Skin changes, including pressure injuries, are common occurrences during the dying process. The Wound Bed Preparation 2015 model can be used as a clinician guide to develop a care plan for a palliative care patient with an alteration in skin integrity. Focusing on the wound etiology and classifying wounds as healable, maintenance, or palliative (non-healable) can provide realistic expectations for patients, their family unit, and caregivers as well as the healthcare professional team. Wound care should be aimed at improving the patient’s quality of life by providing comfort, relieving pain, controlling odor, and containing exudate. It is paramount that the patient’s preference be prioritized in the decision-making process and the implementation of realistic treatment care plans.

This chapter focus is on sexual health. Sexual health is a broad concept made up of multiple facets such as sexual desire, self as a sexual being, sexual orientation, sexual lifestyles, and relationships. Intimacy, closeness, communication, and emotional support affect all facets of sexuality. Sexual health within the context of palliative care may be directly impacted by the disease on anatomical structures. However, direct anatomical effect is not the only concern; changes in a person’s sexual interest or desire may also be affected by direct or indirect consequences of medical treatment or in association with being terminally ill. Illness involving sexual organs increases the likelihood of retraumatization for those who have experienced previous sexual trauma. Healthcare practitioners (HCPs) frequently avoid talking about sexuality with cancer patients. HCPs’ barriers to discussing sexuality include embarrassment, misinformed beliefs and assumptions, lack of knowledge, inadequate communication skills, and time constraints.

Neediness cannot be banished, but it’s possible to learn from each shortcoming, determined not to be derailed by either hubris or core anxieties. Taking on new leadership roles, we have to get in touch with warring expectations on the way to a more textured view of leadership and our sense of ourselves as leaders. There are a number of normal-crazy thoughts that get in the way of leadership; for example, wanting to be liked by everyone; believing that if you’re not perfect then you’re no good; thinking things should not go wrong. To succeed, nurses must realize that failure is commonplace. Expect failure, recognize root causes, and then proceed to learn from the experience—this process builds personal resilience. Learning environments that foster a culture of potentiality enable fledgling practitioners to persist in the face of failure because the emphasis is on improving over time.

The principles of hospice care embrace holistic patient- and family-centered care, offered by an interprofessional team of practitioners. Built on the foundation of hospice care, palliative care (PC) addresses care of the mind, body, and spirit as health practitioners develop the most effective and appropriate plan of care for and with patients and families experiencing serious, life-threatening, progressive, or chronic illnesses. As a new paradigm of healthcare, PC is responsive to the need for healthcare reform in America and globally. This chapter presents an exemplary palliative care action plan developed in the state of Maryland. In both generalist and specialist roles in palliative and hospice care, nurses are leaders of healthcare reform in the United States as they combine knowledge, experience, and commitment to advancing the specialty and promoting quality palliative and end-of-life care. The chapter discusses the roles of advanced practice palliative care nurses.

Since ancient times, self-knowledge has been regarded as the key to effective leadership. No nurse is good at all aspects of nursing; therefore, each nurse needs to figure out what will be her or his area of special contributions. Instead of focusing largely on weaknesses, organizations should identify their employees’ strengths for the purpose of using them strategically and then managing to those strengths. It is better to admit one’s limitations early on, and deal with them, rather than spend years trying to hide them. No one really likes criticism, but criticism is the lifeblood of professional development and improvement; therefore, leaders need to know how to give and accept criticism in an ego-enhancing way. Self-knowledge is never complete; it is achieved through ongoing introspection, candor, figuring ourselves out in different situations, and looking at ourselves through the eyes of others.

Retirement isn’t a single event, but a process that varies in when it happens and how long it takes before the person adjusts to a new way of life. Planning for retirement should include developing financial literacy at the start of a career so earnings and savings are smartly invested; preparing for the time by figuring out how to structure newfound freedom; not stopping all work abruptly but providing for some period of transition; beginning to take on more activities that one prefers to do rather than what one has to do; and giving some thought to facilitating a smooth relationship with successors. Both those letting go and those coming on occupy different psychological and generational space, and their differences in perspective are normal. One’s perspective is no more right than the other’s, but they are viewing matters through different lenses, setting the stage for potential misunderstandings.

Health-promoting palliative care (HPPC) emerged in the 1990s as a concept that proposes that even in the event of advancing disease, a person can maintain a sense of health and wellness. The provision of palliative and end-of-life (EOL) care does not preclude interventions that optimize health, well-being, and functional status even in the presence of incurable illness. The application of the principles and practices of health promotion to palliative and EOL care enhances the health and well-being of individual, families, and communities. Health promotion and rehabilitation are critical to maximizing an individual’s function and well-being even in the face of life-threatening illness. Rehabilitation is a valid intervention in advanced disease, promoting optimal function and mitigating deficits in activities of daily living, well-being, and quality of life (QOL). The role of the nurse in rehabilitation is vital in responding to the complex needs of those with advanced disease.

There is a high likelihood that anyone who is receiving palliative care has been exposed to a traumatic event during his or her life that may place him or her at risk of posttraumatic stress disorder (PTSD). This chapter provides the reader with an overview of PTSD and evidence-based treatments within a palliative care setting. The criteria for PTSD are outlined along with a description of appropriate approaches to assessment. Currently available evidence-based treatments are described and illustrated with case examples. The importance of addressing PTSD in end-of-life (EOL) care for both the individual and family is highlighted. The chapter also highlights the importance of assessing for specific mental health disorders such as PTSD in order to allow both the individual and his or her family to receive state-of-the-art EOL care. PTSD can negatively impact patient–provider communication and lead to increased psychological distress at the end of life.

Patients and families facing a life-threatening illness have needs that are best addressed through an interprofessional palliative care team model. An effective interprofessional team will attend to these particular needs and will include specialists as warranted by the distinctive illness and needs of the patient and family. With a comprehensive palliative care program, the interprofessional team works with the patient and family in a coordinated and collaborative manner to achieve mutually established goals. A dynamic and outcome-oriented interprofessional team requires collaboration, leadership, coordinated decision making, and conflict resolution. Interprofessional palliative care teams ideally consist of a team leader (usually the advanced nurse practitioner or the physician), nurses, social workers, and chaplain. Interprofessional education is key to developing a workforce of the future that will provide comprehensive, compassionate, cost-effective, continuous, and evidence-based healthcare for varying patient populations, families, and communities.

When nurses communicate with their dying patients and the patients’ families, they have a clearer understanding of their patients’ needs and goals at the end of life. This chapter explores ways to encourage both nursing students and graduate nurses to facilitate communication with dying patients, their families, and their healthcare providers. It also explores ways in which nursing faculty members might assist undergraduate nursing students to enrich themselves by working with dying patients. The chapter is organized according to the phases of the therapeutic relationship because in many ways the phases of the therapeutic relationship—introductory, working, and termination—parallel the dying trajectory. When appropriate in the phases, distinctions are made between the roles and educational needs of the undergraduate nursing student, the nurse with an undergraduate degree, and the nurse with an advanced practice degree.

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

Heart failure (HF) is a terminal disease. Predicting the illness trajectory is much harder in HF than in cancer. Nursing has a key role in the management and outcomes of patients with HF. Patients often turn to nurses for information on their disease especially in the end stages of the disease. A coordinated effort by nursing has been developed as to how to help patients with not only the physical symptoms of HF but also the psychosocial aspects. In caring for the patient with advanced HF, there are clinical, evidence-based therapies that should drive clinical decision making. This chapter helps the reader to understand the disease of HF: how important disease management is, how nurse-based HF interventions can lead to positive outcomes, and, most importantly, how to communicate with patients and families regarding their treatment options and what is important to them in the final phase of their life.

When one thinks of the lofty qualities that leaders are supposed to have, one thinks of high-powered ones such as integrity, creativity, courage, and intelligence. Nurses don’t think of sustaining optimism and managing anger, because they seem more like givens than a stretch toward greatness. However, one of the most difficult but important aspects of leadership from the personal side is to take responsibility for managing our well-being so that one can stay optimistic enough to energize others. Managing anger is a part of sustaining optimism, but so are many other things. Sustaining optimism is inextricably connected to taking care of oneself. Anger can have benefits when it provides motivation for realistic confrontation of a problem. Body listening is an important part of self-regulation; the better one gets at figuring out one’s own energy fluctuations, the more likely one can use them to advantage.

This chapter focuses on leadership as transformational. Transformational leadership means moving a profession, an institution, or some aspect of healthcare down a new path with different expectations, structures, and ways of conceptualizing how the mission can be achieved in light of changing conditions. Looking back on all that nursing has achieved in the last half century can be energizing; it makes trying to do something different yourself not seem quite as daunting. Nursing is much stronger now as a profession than it has been in the past—larger, better educated, somewhat more diverse with a solid infrastructure, demonstrated outcomes, specialty expertise, a growing research base, more opportunities, and no longer time and place bound. Nursing’s commitment to the optimization of health and ability, alleviation of suffering, and advocacy hasn’t changed over time; values endure, but how they get expressed will vary as new sensibilities and knowledge become available.

“Doing good” is the prime directive of health profession education, but everyone doing her or his personal best is no guarantee that excellence will prevail. Building clusters of excellence, one can get more productivity as resources are shared and people play off of each other’s ideas, positioning all concerned more effectively to seize new opportunities. Excellence is a “stretch” goal, but if everyone stretches a little, the shape and quality of the organization can be transformed. Even if one achieves only a small portion of what one wanted to accomplish in the name of excellence, this improvement can be just the upstream redirection needed to achieve something even more substantive downstream. Excellence is a journey full of next steps that can only be seen as you move forward and are able to catch a glimpse of what is now on the changing horizon.

Holism focuses on unity, mutuality, meaning, and the interrelationship of all beings, events, and things. Holism is the theoretical and philosophical foundation for all complementary integrative healing modalities. Holistic integrative therapies can be used by the nurse, client/patient, and family. This chapter introduces the reader to a variety of holistic modalities that are used in nursing practice today and can be used in palliative care. It should be noted that centering, relaxation, imagery, meditation, reminiscence and life review, and journal writing are basic and can be practiced by nurses and students with little or no experience. The sense therapies, touch therapies, and Reiki body work necessitate further study. Whenever one learns these therapies, it is imperative that nurses practicing in palliative and hospice care be familiar with healing modalities and their beneficial effects for patients and families during the illness experience.

The diagnosis of end-stage renal disease (ESRD) can be difficult for patients and families to hear because this means they will need some form of kidney replacement therapy to survive (hemodialysis, peritoneal dialysis, transplantation). ESRD means a patient has severe end-organ kidney damage and failure. When confronted with the extensive list of medical and psychological problems often associated with patients with ESRD, healthcare professionals often focus on treating the medical issues by implementing strategies to address abnormal laboratory values and treating comorbid conditions. The goal for patients with ESRD cannot be simply to preserve life but also to promote quality of life. This chapter discusses palliative care in relation to three groups of patients with ESRD: undergoing dialysis, choosing conservative management, and withdrawing from dialysis. It also provides a brief review of the major comorbidities and complications associated with ESRD and available palliative treatment options.

Family is a cultural, legal, sociological, and individually defined concept. Family definitions can be discussed in terms of structure, function, and symbolism and family is whoever the patient says it is. A family caregiver is a member of this family who has chosen or who has been designated as the caregiver for one or more family members who cannot manage normal activities of daily living without help. The caregiving role begins immediately at the point of diagnosis and continues over the illness trajectory. Although many studies indicate many negative health outcomes related to family caregiving, there are also benefits to the caregiving role. Theoretical frameworks related to family caregiving can guide questions for family assessment and the development of family caregiver interventions. The needs and concerns of family caregivers should be addressed by all members of the interprofessional palliative or hospice care team.

This chapter focuses on management of people with stroke, chronic neurological disorders (CNDs), coma, and brain death. It presents a description of common symptoms experienced from stroke and CNDs, including Alzheimer’s disease, and related disorders, Parkinson’s disease, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). Comorbid conditions that frequently accompany the latter stages of these illnesses are described as well as interventions aimed to provide symptom management. Common problems faced by patients with these disorders include impairments in cognition, communication, sleep, swallowing, breathing, and mobility, as well as pain, fatigue, and depression. Issues unique to pediatric coma and brain death are also discussed. A growing body of evidence supports that symptoms associated with severe stroke and chronic neurological disorders are amenable to palliative treatment and that quality of life is increased from multidisciplinary approaches to care.

This chapter focuses on diversity and inclusion not as an administrative problem but as a leadership concern. Diversity and inclusion aren’t so much regarded as important in avoiding conflict and difficulties, but as crucial in fostering innovation and creativity. When people come together to solve problems or improve processes, they bring different sentiments, information, and view points. This makes sense when we talk about diversity of disciplinary backgrounds—think about the growing importance of interdisciplinary teams to healthcare education, practice, and research. Embracing diversity can be a competitive advantage for an organization because it is associated with creativity and innovation, but highlighting diversity can lead to suspicion and conflict, and leadership requires balancing these tensions. Developing an inclusive environment implies a respectful appreciation of individual attributes as you forge a sense of belonging and trust, with equitable access to opportunity and reward/recognition.

It has been said that working in interdisciplinary teams is a core competency all health professionals will need in the 21st century; they need to be able to collaborate, coordinate, and, most of all, communicate with one another in order to optimize care and maximize operational excellence. Nurses need to be active in interdisciplinary organizations from the start of their careers, and present/publish their work in interprofessional forums. Nurses have many advantages in interdisciplinary collaboration—sound basic education in humanities, social sciences, and basic sciences; many community connections; and experience in facilitating care across different providers. Interdisciplinary opportunities provide more prospects for effecting large-scale change than discipline-specific opportunities do. Moving beyond the discipline specific doesn’t mean that nurses leave nursing; it means they assume positions in which they can now advance the perspective of nursing in ways that others can appreciate, while attracting additional public support.

Anxiety, depression, and delirium are common symptoms experienced by patients with serious illness. In palliative care, anxiety and depression commonly arise from fear of death, loss of independence, fear of being a burden to others, hopelessness, and loneliness, in addition to concern about symptom burden and disease progression. Anxiety manifests itself in four ways: physical symptoms, affective symptoms, behavioral responses, and cognitive responses. The patient and the family should be reassured that symptoms of depression and anxiety are effectively treated most of the time with pharmacological and nonpharmacological interventions. Effective treatment of anxiety, depression, and delirium necessitates a collaborative effort between the patient, family, and the health team. This chapter addresses the comprehensive patient-centered and family-focused care necessary for effective diagnosis, assessment, and treatment of anxiety, depression, and delirium in the palliative care patient.

After completing the data collection process and reviewing the personal and family history, including pertinent tests and findings from the physical examination, all data should be synthesized and reviewed for red flags that are suspect for disease risk. The review may indicate frequent family members with chronic disease, which indicates a familial propensity or disease risk for the individual; alternatively, the reviewed data may be suspect for an inherited disease or genetic predisposition. This chapter discusses red flags in the family history that may be suspect for a genetic predisposition to disease and describes limitations in the family history regarding some genetic disorders. The family history is an important part of the genomic risk assessment, as it provides essential information that may aid in identifying at-risk individuals for genetic disorders/syndromes or familial diseases.

Once the data are assessed for elements of risk, or red flags, further evaluation should be conducted based on the identified risks to determine risk probability or empiric risk. Risk probability can be focused on the genetic risk based on the probability or likelihood for an inherited disease or syndrome or assessed for empiric risk regarding the chance of disease for noninherited diseases. This chapter differentiates between risk probability and empiric risk, describes measures of determining risk probability as part of the genomic risk assessment and states evidence-based models that can be used as empiric risk models. Careful review of personal and family history data is an important part of the risk-assessment process to determine if red flags exist that may be suggestive of an inherited disorder or syndrome. The use of empiric and/or risk-probability models, when available, may also aid in the risk-assessment process.

Genetics is the primary cause or plays an important role in many medical conditions and birth defects. Given that approximately 3" of newborns have a birth defect or genetic condition, many more develop significant conditions after birth, and more and more women with genetic conditions are having children, medical genetics is of prime importance in obstetric care. This chapter describes how RISK elements can be used when providing a genetic/genomic risk assessment for preconception care (PCC). It discusses ancillary and laboratory measures in obstetrics that are used as part of the genetic risk assessment for screening and diagnosis of the fetus. The risk-assessment process is important in preconception counseling and prenatal care. An important part of the process is a thorough personal and family history. Advanced practice registered nurses (APRNs) should be knowledgeable as to how the risk-assessment process impacts maternal and fetal well-being and the potential for genetic conditions.

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

Sleep disruption is a common occurrence for adults, with insomnia symptoms reported by as many as 33% to 50% of adults. This chapter reviews common sleep-wake disorders encountered in the geriatric population. Practitioners will initially learn about normal, basic sleep architecture before being introduced to some of the commonly encountered abnormal sleep issues constituting sleep-wake disorders. The chapter review tools that can be used to assess sleep and appropriate interprofessional collaboration and referrals. The goal of treatment of sleep disorders should be improved quality and quantity of sleep. The chapter helps the practitioners to: identify the basic physiological states of sleep; understand the importance of an electroencephalogram in sleep disorders; define insomnia disorder and the associated diagnostic criteria; identify differences between insomnia disorders and obstructive sleep apneas; identify how histamine and melatonin receptors work in sleep disorders; and evaluate the use of common sleep aids in geriatric mental health patients.

The end of life can have so many meanings for various cultures. Moments that lead to the end of life are of particular importance as during the process, longstanding effects as well as impressions on family and friends will continue after the patient’s death. Considering all of the factors that can correspond with end of life care, advanced practice nurses should reflect on how to best help patients and their families during this crucial time. While describing end of life care, it is important to distinguish that end of life care is not synonymous with palliative care. This chapter describes the goals, management of symptoms, and needs while providing palliative and end of life care for the elderly within the realm of mental health care. It discusses the ethical considerations of providing geriatric palliative care, and explains differences between end of life care and palliative care.

Definitions of aging continue to evolve. This chapter considers aging a part of normal life processes which consists of the acquisition of knowledge and skills over time, the honing and maximizing of these traits and eventually the time period in which all body systems decline from maximal functioning capacity. It reviews normal aging processes in addition to factors which can affect life longevity such as genetic and environmental factors and the human response to environmental stressors. The chapter also presents a brief review of healthy aging and holistic measures. After reviewing the chapter, practitioners will be able to: define aging, longevity and life expectancy; recognize factors that may impact longevity; summarize major normal age-related physiological and psychosocial changes in humans; explain domains that may promote healthy aging; and discuss the importance of the Annual Wellness Visit in supporting healthy aging.

Geriatric depression or late-life depression is a complex mood disorder that can comprise of various etiological pathways and often occurs in the context of medical illness or cognitive decline. Major depressive disorder (MDD) is one of the most commonly diagnosed mental illnesses in older adults and is often underrecognized and undertreated. Depressive symptoms are frequently associated with the normal aging process because depression in older adults may be disregarded as frailty, irritability, agitation, or helplessness; therefore, the need to seek medical attention is often overlooked. After reviewing this chapter, practitioners will be able to: describe the prevalence, risk factors, and protective factors for older adults with depression; differentiate between MDD and other mood disorders; discuss example screening tools to help screen older adults for depression and suicide risk; describe evidence-based general pharmacological and nonpharmacological treatment options for depression in older adults; and identify barriers and facilitators to promote treatment compliance.

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

As patients grow older, the incidence of sexual dysfunction increases while sexual activity decreases. Multiple factors contribute to sexual problems, and older age compounds and complicates those factors. Although sexual activity can diminish with age, it helps to acknowledge that more than half of older adults are sexually active. Further, the majority of men and women over the age of 65 report an interest in sex. This chapter helps the practitioners to: define sexuality and sexual dysfunction; distinguish differences in impotence and erectile dysfunction; explain the hormonal changes in aging adult women; apply principles of interdisciplinary collaboration to clinical practice; and identify risk factors genito-pelvic pain/penetration disorder, orgasmic disorder and female sexual interest/arousal disorder. It also helps to recommend evidence-based practice interventions to older adults suffering from reproductive changes; establish a differential for erectile dysfunction in the aging male; and explain options for medical management and treatment of erectile dysfunction.

This chapter introduces the practitioners to substance use disorders in geropsychiatric populations, identifying criteria for diagnosis, assessments and evaluating co-morbidities, including differential diagnoses and indications for treatment options. It discusses the differences in addiction, dependence, tolerance, intoxication, substance withdrawal and treatment options for geropsychiatric populations. The chapter presents a case study with differential diagnoses and risk factors for comorbidities. It discusses substance use disorder assessment tools including evidence based treatment options. Treatment options are dependent on the screening, diagnosis and assessment of the substance, psychosocial stressors and dual diagnosed psychiatric disorder. The chapter helps the practitioners to: identify diagnostic criterion for substance use disorders; analyze specific assessments for Alcohol Use Disorder, Benzodiazepine Use Disorder and Opioid Use Disorder; apply assessment tools and evaluate differential diagnoses to identify substance use disorders; evaluate risks and comorbidities of geropsychiatric populations with substance use disorders; and understand treatment options for substance use disorders.

This chapter introduces the practitioners to the psychiatric evaluation, in general, and specifically for geriatric mental health patients. Practitioners will learn about the essential components of an initial evaluation and review some of the basic methods for assessment such as rating scales and standardized assessment tools. The chapter considers common factors that practitioners may be confronted with specifically in a geriatric psychiatric evaluation. Common confounding and unique issues present during an initial psychiatric evaluation with geriatric patients should be appropriately documented. The chapter provides a general outline for the initial evaluation. After reviewing this chapter, practitioners will be able to: identify the essential components of an initial psychiatric evaluation; discuss unique components and requirements of an initial evaluation with geriatric mental health patients; and evaluate the results/outcome from the completion of an initial psychiatric exam to formulate an appropriate plan of treatment.

Family dynamics for the elderly patient are essential to better understanding the many components that can impede or enhance care. As an advanced practice nurse, considerations for family dynamics adds to an overall holistic approach to treatment that is often what differentiates nursing care. First, assessing the level of independence or what has changed in the management of the older adult’s day to day activities is vital. Secondly, family roles could interfere with the manner in which future affairs are handled, such as the plan of care differing from what a health care surrogate or medical power of attorney would want to see happen. Thirdly, family dynamics could vary widely by culture which could also impact the plan of care for the older adult. This chapter highlights how different factors related to family dynamics could impact care and how advanced practice nurses could approach care in such instances.

Bipolar disorders affect 2.5 million adults in the Unites States annually and approximately 6 million Americans have a bipolar spectrum disorder and 1 million are age 60 or older. Bipolar mood disorders are the sixth leading cause of disability worldwide. This chapter introduces practitioners to bipolar spectrum mood disorders, etiology, prevalence and comorbidities. In addition, it discusses the differences in bipolar 1, bipolar 2, cyclothymic disorders, and bipolar mixed episodes. The chapter presents a case study with differential diagnoses and risk factors for comorbidities. It discusses mood disorder assessment tools including evidence based treatment options. After reviewing this chapter, practitioners will be able to: identify diagnostic criterion for bipolar spectrum disorders; analyze unique differences in bipolar spectrum disorders; apply assessment tools and differential diagnosis to support bipolar diagnosis; evaluate risks and comorbidities of geropsychiatric populations with bipolar disorders; and understand treatment options for geropsychiatric populations with bipolar disorder.

Schizophrenia is a chronic, costly, and vast (across age groups) mental illness that has a prevalence of less than 1 percent worldwide with the average potential of life lost as 28.5 years. A small proportion of older adults experience an onset of schizophrenia after the age of 65, which is rare. Distinguishing whether an older adult has developed late-onset schizophrenia, a medical condition manifesting symptoms as psychosis, or a continuation of underlying schizophrenia symptoms are all integral components to assessment and diagnosis. This chapter discusses the assessment and treatment of schizophrenia spectrum disorders in geriatric patients. It helps the practitioners to recognize characteristics associated with dementia with lewy bodies, early-onset and late-onset schizophrenia; identify risk factors for schizophrenia; summarize treatment options for schizophrenia; and initiate a treatment plan that incorporates the nursing process of assessment, planning, implementation, and evaluation for with schizophrenia and other psychotic disorders.

Later life anxiety is often found in conjunction with major depressive disorders, and can have foundations in dietary issues as well as drug associations. There has been a correlation between long-term presence of anxiety in older adults associated with female gender, lower level of educational achievement, being unmarried as well as having three or more co-morbid chronic conditions. The most common diagnosed anxiety disorder in the geriatric population is generalized anxiety disorder. Other anxiety disorders frequently encountered in practice include social phobia, agoraphobia, panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder. This chapter briefly outlines and discusses each disorder. It helps the practitioners to: define anxiety; distinguish between anxiety disorders; discuss example tools that can be used to establish an anxiety disorder diagnosis; assess a geriatric patient for post-traumatic stress disorder using an appropriate clinical rating scale; and recommend general pharmacological (class) and non-pharmacological treatment options for anxiety disorders.

Step 1 of the genetic/genomic risk assessment process requires data collection through history-taking, physical examination, and review and interpretation of additional data (e.g., radiology, laboratory), if applicable. Data collection is an ongoing process that begins at the first clinic visit and then is updated through subsequent health provider and patient encounters. This chapter describes Step 1.a of the genetic/genomic risk assessment and discusses how the physical examination may aid in identifying certain genetic conditions. This chapter introduces the risk-assessment process. The process is an important part of identifying individuals who may be at risk for inherited, familial, multi-factorial, or behavioral disorders. The first step of the risk-assessment process is a thorough review of personal and family history as well as evaluation of physical findings, laboratory data, and other ancillary data if available.

The family history is a continuation of Step 1 of data collection for the genomic risk assessment. Family history represents the health and disease conditions experienced by family members over the course of their lives. It is the family tree. The use of a pedigree to capture the family history provides a visualization of the maternal and paternal lineages of multiple generations that can provide an excellent way to observe relationships and patterns that can be suspect or diagnostic of inherited disorders and familial diseases associated with complex chronic disorders or shared environmental issues. In fact, the family history is considered by some as the first genetic test. This chapter discusses common terms used in constructing a pedigree and describes basic elements of the pedigree. Obtaining an in-depth family history, which includes a minimum of a three-generation pedigree, is an important step in the risk-assessment process.

Risk assessment is an important part of health care that includes early identification or prevention of disease occurrence. The risk assessment process aids in determining who might have an above-average population risk that may warrant evaluation for genetic testing and/or implementation of management of care interventions that may reduce disease risk. Today genetic tests are available for a wide range of uses including newborn screening, as well as diagnostic, carrier, predictive, and presymptomatic testing. The future of whole genome or whole exome sequencing as well as the implication of variants regarding disease risk could play a major role in how we assess and manage patients. Advanced practice registered nurses (APRNs) providing care in clinical settings must keep abreast with these changes as they impact all aspects of patients across the life span and throughout the health and illness spectrum.

This chapter helps the reader to be familiar with the role coalitions play in advocacy and policy development and to understand the various types of coalitions that affect the policy landscape. It also helps the reader to be familiar with the various roles that exist within groups and coalitions that contribute to the success or non-success of the group process. A number of strategies can be used to develop initiatives to impact one’s advocacy efforts. These strategies can be used to promote the development of new programs and services and can include the use of and/or development of coalitions, the media and media advocacy, and consumer advocates. The chapter addresses each of these strategies in greater depth. It outlines a variety of issues related to coalitions, group development, and coalition building for aging policies and programs.

This chapter deals with one subset of these strategies, namely using media as a part of the advocacy process. The chapter reviews a number of specific media advocacy strategies and provides some innovative approaches to sending a message relevant to program or policy development. Media advocacy is the strategic use of any form of media to help advance an organization’s objectives or goals. Media advocacy explores a number of key issues and serves to present strategies that can be helpful in the development of innovative human service opportunities and educate the general public. These strategies can be used as stand-alone methods or in combination with each other. These strategies build on understanding one’s health and help-seeking behavior and enable advocates to influence a wide number and array of people with limited resources and energy.

This chapter address a number of areas that will affect the lives of people as they age or people who are older adults. Philosophical paradigms, statistics, evidence-based approaches, dealing with the media, making people aware of new technologies, and preparing for communities to best deal with issues of aging are all major issues of concern. It provides a range of issues; however, the chapter provides an overview of the most significant ones to be addressed or to require intervention. It cites 10 major challenges that the future will bring, in reality, policy advocates will have to be prepared to address and deal with these challenges by using innovative strategies for policy development and policy change. The chapter addresses policy development and program design to meet the needs of an aging and ability-challenged society are unique challenges.

This chapter helps the reader to understand what a needs assessment is and be acquainted with a framework within which to conduct a needs assessment. and to be familiar with the core concepts of a needs assessment. It helps the reader to be familiar with strategies that encompass a needs assessment. Needs assessments can be carried out by a wide cast of people. Social workers and public health workers, as well as city planners, can carry out needs assessments, as can government organizations. Local citizens or groups of people can also be responsible for carrying out a needs assessment. The chapter provides an overview of strategies to develop a needs assessment. When used in combination with a health behavior framework, a needs assessment can help one determine the needs of a community and attempt to build community support for this resource or policy change through media advocacy and coalition building.

This chapter explores health promotion frameworks, to showcase their role vis-à-vis health policy and programs, and discusses three specific frameworks. Health promotion frameworks are theoretical conceptions of how health behavior can be addressed. These frameworks are conceives for the purpose of program and policy development. The health promotion frameworks are the health belief model (HBM), the theory of reasoned action, the transtheoretical model of stages of change. This chapter addresses these three questions; however, prior to discussing these questions and answers, it is essential to understand some well-known health promotion frameworks. Although a number of health promotion frameworks exist in the literature. It focuses on three that can be specifically applied to older adults. The chapter showcases use of health promotion frameworks in the program planning process for older adults can have a number of positive outcomes.

This chapter highlights some of the current health programs and policies in place and changes in demographic trends for older adults living within American society. In addition, substantial changes within the social, political, and cultural expectations of communities over the past century pose challenges for policies and programs serving older adults. The chapter presents several issues emerge as realities within the context of policy development and program planning for older adults. These issues include changes in living arrangements, education levels, economic well-being, and rural population settings; trends in morbidity and mortality; and changes within the social, political, and cultural expectations of communities. Despite the availability of programs and services resulting from health policies, many programs have focused upon “medically necessary” services and have lacked a health promotion, health education, or community-based focus.

This chapter briefly discusses the history of the Caregiver Support Act and its specific components and explains how the Caregiver Support Act provides resources to older adults and people with disabilities. It provides an overview of the current status of family members serving as caregivers, with special attention to grandparents raising grandchildren. It then discusses a current profile of relative caregivers raising children in the United States; reasons for the increase in relative caregiving; and issues facing grandparents raising grandchildren. It also provides some background into the literature and promotes an awareness of issues that grandparents face as primary caregivers. A literature review examines some of the current issues and services needed. The chapter discusses resources and services designed to meet the needs of grandparents raising grandchildren, and reviews programmatic responses through the national resources. Finally, the chapter outlines some best practice interventions for review in the text.

This chapter helps the reader to understand the history of the Americans with Disabilities Act (ADA), specific components of the ADA and how the ADA provides resources to older adults and people with disabilities. The ADA, while groundbreaking, was not initially intended for people with disabilities rather than for older adults. As time progressed, however, the benefits of the ADA were much more far-reaching than originally intended, especially for aging adults with disabilities. The individual titles of the ADA have had some dramatically positive and specific impact for older adults wishing to remain in their homes or in their communities as long as possible. Although the ADA is still in its young adulthood, the benefits of the ADA have only grown as new and further linkages, such as the ADRCs, have developed in all regions of the United States.

This chapter provides a backdrop to our current social security program and an overview of some models for social security programs in Europe and Canada. It explores the genesis of the social program in the United States. The chapter also explores contents of the original social security act (SSA) and compares the titles and programs mandated through the current SSA. It offers some guidelines for the current administration of the program, examines the debate around current proposals for revision, and reviews why these proposals are current issues for consideration. The chapter then presents the current social security system, which provides for older adults, but has also grown to cover dependent women and children. Although many people have argued for their vision to privatize the system, the reality is that there is much more political support to maintain the program as a safety net program rather than a means-tested program.

This chapter presents a brief overview of some legislative efforts within the mental health (MH) arena and examined their limitations and application with respect to older adults and people living with mental illness. The chapter also takes us through a journey to examine the current status of MH and older adults, with a particular emphasis on depression, anxiety, and schizophrenia. It discusses and reviews the programs, services and issues still outstanding within the MH arena. The chapter helps the reader to understand specific components of the Community Mental Health Act and other MH-related legislation. Many of the community day hospital programs and community MH programs administered through the Community Mental Health Act are based on the deinstitutionalization paradigm since the goal is to treat people outside the institution and within community settings. It concludes with laying out some challenges for the future in the area of MH and older adults.

This chapter helps the reader to be familiar with the demographic and social factors that influence and shape aging and disability policy over time and to be aware of policy changes over the past century within disability and aging public policy. It explains the contrast between advances in science and technology and public policy related to people growing older and people with disabilities. Landmarks serve as essential tools to help us recall specific historical events in time. Historical landmarks, science, and technology have played significant roles in the evolution of social policies; however, aging and disability policies may not have made as many strides as other areas throughout history. The chapter briefly discusses: the role of historical landmarks in shaping social trends and public policies; the relationship between historical landmarks and aging and disability-related policies; and trends in policy, social, and political influences and landmarks in the United States.

This chapter briefly discusses the history of the Affordable Care Act (ACA) and community and presents specific components of the ACA in relationship to community prevention. The chapter deals with specific aspects of the legislation that impact older adults and people with disabilities. It presents a short review of the ten titles: Title one: quality, affordable health care for all Americans; Title two: role of public program; Title three: improving the quality and efficiency of health care; Title four: prevention of chronic disease and improving public health; Title five: health care workforce; Title six: transparency and program integrity; Title seven: improving access to innovative medical therapies; Title eight: Class Act; Title nine: revenue provision; Title ten: strengthening quality, affordable health care for all Americans. The chapter explains some of the legislative highlights, policies, and programs that have been articulated within each of the specific titles of the ACA.

This chapter focuses on sources of evidence for evidence-based policy development. It explores some of the dilemmas with developing an evidence base and provides a range of empirical sources within the aging and disabilities arenas that can be used in building an evidence-based approach to policy development. The journey, however, will not be without struggle—since philosophical paradigms, and social and economic factors will interface and play a role in the development of evidence-based policy. The chapter helps the reader to be aware of healthy people 2020 benchmarks that are used to guide program planning and policy development. Benchmarks currently have been established in order to identify where health goals for the nation and individual states should be, and the program is evaluated routinely by local and state health departments. Healthy people 2020 is also used to gauge the impact of health policy.

This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.

Aging policy is shaped by a variety of demographic, social, and economic factors. However, these factors are not the only influences on the development of public policy or aging/disability policies. Philosophical paradigms and theoretical frameworks also influence the actual development of policy and play a strong implicit role in how public policy is drafted. Values and philosophies guide the development of specific philosophical paradigms and shape how aging and disability policy is developed and implemented. This chapter explores how these realities play a role in the development and implementation of public policy and aging/disability policy. It showcases some of the realities that may prevent the implementation of the policy or program as envisioned. As a safeguard against a subjectively devised policy and program base, objective evidence and empirically driven initiatives can be developed by aging and disability policy advocates.

This chapter helps the reader to understand the history of the legislation related to substance use and misuse. It provides specific components of the Controlled Substances Act. The chapter discusses how legislation related to substance use and misuse provides resources to older adults and people with disabilities. Since substance use/misuse is often perceived as “blaming the victim”, models of care and rehabilitation are often not taken into serious consideration. Prevention, screening, detection, and intervention strategies to meet the needs of baby boomers as they age will be another challenge. Evidence suggests that substance use has been on the rise for the population in general among people living in the community. The chapter reviews programs and services and issues. The chapter concludes by laying out some challenges for the future in the area of substance use and abuse among older adults and people with disabilities.

Nurses caring for a patient who is near death should be aware of the patient’s and family’s physical and emotional experiences during the dying experience. Special considerations for children and elderly patients who cannot make their own decisions should be addressed with the family. Families should be informed of the physical processes that occur during the dying process and the nursing interventions and activities that occur after death. This chapter’s purpose is to relate the role of the nurse during the peri-death period and convey the core knowledge necessary for nurses to help facilitate a “good” death. The role of the advanced practice nurse regarding peri-death nursing includes mentoring and modeling appropriate behaviors for the novice nurse, as well as directing symptom management. Additionally, the role includes supporting the novice nurse through the dying experience and support of the family during the decision-making process regarding autopsy and funeral arrangements.

Culture and spirituality structure human experience, values, and behaviors. Spirituality plays a vital role in times of crisis and illness, as it provides a sense of connection to self, others, nature, and God, and is a means to cope with loss, grief, and death. Spiritual and cultural competences are central tenets of palliative care. Palliative care (PC) addresses the cultural and spiritual needs of patients and families. This chapter discusses the health beliefs of the African American, Chinese, Asian Indian, Latino and Hispanic, and Native American on the basis of recent studies or cultural inquiries. It provides a framework for offering culturally competent hospice and PC to members of these cultural groups. The chapter describes nurses’ cultural self-awareness and development of cultural competency. It also discusses nurses’ need for self-reflection and self-healing in palliative care.

This chapter focuses on ethical issues in nursing care for patients approaching death. It presents a case study of a 78-year-old woman who has end-stage dementia. Ethics and morals are frequently used interchangeably in nursing ethics to refer to conduct, character, and motivations involved in moral acts, although distinctions are sometimes made between these terms. The chapter includes resources to assist the nurse in managing ethical concerns or dilemmas effectively. Moral theories are methods of determining what counts when a decision must be made, and to offer a method for weighing or ranking considerations identified as morally relevant to that decision. There are two major approaches to theoretical considerations—deontological and teleological systems of ethics. The chapter explores issues of patient autonomy and decisions about end-of-life interventions that range from instances of allowing or permitting death to hastening or intentionally causing death, and how these decisions are understood by nurses.

Palliative care (PC) offers a comprehensive approach to address the physical, emotional, social, and spiritual needs of individuals with incurable progressive illness throughout the illness trajectory until death and into the bereavement period for families. For patients with HIV/AIDS, PC offers a combination of disease-modifying and supportive interventions throughout the disease trajectory to relieve the suffering associated with opportunistic infections and malignancies. Knowledge regarding HIV disease is important so that nurses can offer effective and compassionate care to patients and help to alleviate physical, emotional, social, and spiritual suffering at all stages of HIV disease. Through advanced care planning, patients can ensure that their end of life preferences and wishes are honored. The control of pain and symptoms associated with HIV/AIDS enables the patient and his or her family to expend their energies on spiritual and emotional healing, and the possibility for personal growth and transcendence even as death approaches.

Loss and suffering are universal experiences that occur across the life span. How one learns to accept, adapt to, and advance through these experiences determines how the individual will move through life itself. Although culture and ethnicity may influence an individual’s views on living with and dying from life-threatening illness, individuals must be recognized as unique and encouraged to grieve as is most appropriate for them. Traditional grieving theories view the process in stages with closure or resolution; more contemporary theories view the process as nonstaged, individual, and ongoing. Terminal illness can occur over an extended period of time or a brief period of time. The nurse functions as both facilitator and participant in this process. The nurse also can add objectivity while the patient and family resolve many feelings, issues, and decisions related to the living–dying experience.

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.

Chronic liver disease and cirrhosis are the 12th leading causes of death in the United States. There are many chronic liver diseases that lead to cirrhosis, such as viral hepatitis, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, nonalcoholic steatohepatitis, alcohol, some toxins, and inborn errors of metabolism. Liver cancer is one of the fastest growing cancers in the world. Patients with end-stage liver disease (ESLD) present with malnutrition, muscle wasting, hyperlipidemia, fatigue, jaundice, and renal disease. Nurses need to be aware of the pathophysiology and etiologies of liver disease. Nurses need to explore and acknowledge their assumptions and biases about patients with liver disease and their families. Nurses play a pivotal role in advocating for advance care planning and early palliative care for patients with ESLD and their families. Patients with liver disease benefit from physical, psychosocial, and spiritual interventions offered through palliative care.

This chapter discusses Older Americans Act (OAA). In the original act, the principles are defined through six specific titles. Title one: outlines the objectives and defines the administrative oversight for the OAA. It provides definitions for the administrative structure to carry out the OAA. This organization includes the secretary, commissioner, and the role that individual states will take on in the administration of the act. Title two: administration on aging establishes the infrastructure for the administration of aging services and outlines the main activities of this administrative structure. Title three outlines the authorization process of appropriations for the purpose of community planning, services, and training. Title four is about research and development projects. Title five: training projects outlines the provision of funds for training projects to benefit individual states. Title six outlines the advisory committees that govern the administration of the OAA.

This chapter helps the reader to understand how to use tools such as health behavior models, the media, coalitions, and needs assessments to bring a vision to fruition and how to use advocacy tools for policy and program development. It also helps them to understand how to use advocacy tools to influence the practice arena for older adults and people with disabilities. The chapter reviews the various tools and strategies, along with policies that have been addressed thus far, and integrate these issues and skills with one’s vision for either program planning or policy development. When considering program development, all tools and strategies related to policy development apply equally. Some additional strategies or tools to use for program development include the health behavior models. This chapter attempts to integrate the theories and concepts and suggest how a program planner or policy advocate can apply them.

This chapter helps the reader to understand the history of the Elder Justice Act (EJA). It provides specific components of the EJA and how programs and services flow for older adults and people with disabilities. The chapter discusses the limitations in programs and services within the EJA. The EJA requires the oversight and the appropriation of federal funding to protect people growing older and people with disabilities from abuse. It addresses legal issues with a special emphasis on the concept of a power of attorney. The chapter explores several legal issues that face older adults. It also address elder abuse, power of attorney, and a differentiation made between the types of power of attorney and the healthcare power of attorney. In addition, the chapter explores legal services provided to older adults as a result of the Older Americans Act, and outlines the challenges within the realm of legal issues.

This chapter helps the reader to understand the history of housing and long-term care for older adults and people with disabilities and specific components of the Long-Term Care Reconciliation Act. The chapter discusses how legislation related to housing and long-term care provides resources to older adults and people with disabilities. It explains community-based care options such as home health, seniors congregate living, assisted living options, skilled nursing facilities, and long-term care facilities. Although differences may exist from state to state relative to who qualifies for these options and when they qualify, these will be discussed in some detail specifically providing an overview of these as options for care management of older adults. The chapter describes different residential models of care for people as they require community-based settings or settings with supports and examines issues that will face the long-term and community-based care settings in the future.

An important part of the genomic risk assessment is having a basic knowledge and understanding of genetics, genomics, and patterns of inheritance. It is well known that genomics impacts all aspects of health and illness across the life span. It is important to know the basic elements of an individual’s deoxyribonucleic acid (DNA) and how variations or alterations in the structure of one’s DNA can impact health and lead to a variety of diseases, whether due to inherited or complex/multifactorial issues including the combination of genetics and environmental factors. This chapter discusses common terms related to genetics, differentiates between autosomes and sex chromosomes and also discusses gene sequencing and its significance in health and illness. It provides list of resources to assist in understanding basic genetic/genomic concepts.

Genomic risk assessment of the pediatric population includes the recognition of genetic disorders including physical and dysmorphology features that may be present in some disorders that are indicative of disease. Equally important is the monitoring of growth, development, and milestones of infants and children in order to identify disease. This chapter discusses the skills required to conduct a genetic/genomic risk assessment for the pediatrics patient, explains newborn screening (NBS), outlines the genomic RISK assessment process for the pediatric patient and discusses ethical, legal, and social issues related to genomic testing in the pediatric population. Risk assessment is an important tool to use in for the assessment of the pediatric patient in clinical practice. Advanced practice registered nurses (APRNs) specializing in the care of infants and children should have the knowledge and skills to recognize red flags that may be suggestive of a genetic disorder or syndrome.

It is estimated that approximately 5" to 10" of cancers are inherited as a result of germline mutations. Inherited cancer syndromes result in an increased risk of a specific type of cancer as well as other cancers or conditions. This chapter focuses on hereditary cancer syndromes associated with breast and colon cancers. Like that of other genetic conditions, the importance of risk assessment is key to early recognition of the syndromes so that appropriate management of risk can be implemented, which includes enhanced surveillance, chemoprevention, or risk-reduction surgery, if applicable. It discusses the RISK assessment process when evaluating individuals for inherited breast cancer syndromes, discusses the RISK assessment process when evaluating individuals for inherited colon cancer syndromes and Identifies resources for risk communication and risk management when suspecting individuals for inherited cancer syndromes. The chapter provides additional educational resources for the advanced practice registered nurses (APRNs) pertaining to cancer genetics.

Patterns of inheritance refer to the way in which a trait can be passed from one generation to the next. Understanding patterns of inheritance is important to the risk assessment process. It helps clinicians to determine if the history is suspect for a single-gene disorder in the family or if there is a familial tendency for common chronic diseases such as heart disease, obesity, or diabetes. There are different ways that individuals can inherit genetic disorders, particularly single-gene disorders. Comprehending patterns of inheritance is an important part of the risk assessment process, especially for the recognition and identification of red flags that may indicate a genetic condition. This chapter discusses a brief overview of the patterns of inheritance. It differentiates between various patterns of inheritance including autosomal dominant (AD), autosomal recessive (AR), X-linked dominant, and X-linked recessive and utilizes appropriate online resources to assist in learning inherited genetic conditions.

Core competencies are important to the nursing profession as they play a role in advancing mastery of nursing behaviors and skills essential to practice. Genetic/genomic-based health care is one essential core competency for today’s nursing practice; it also is vital for the future of nursing. The advances in genetics/genomics are important to practice as health care moves toward significant developments in risk assessment, diagnostics, treatments, pharmacogenomics, and personalized and precision medicine that impact individuals across the life span and throughout the health and illness spectrum. This chapter describes essential genetic and genomic competencies for nurses with graduate degrees and states specific skills required for advanced practice registered nurses (APRNs) regarding the risk assessment process. The Essential Genetic and Genomic Competencies for APRNs were introduced, as they are considered core competencies and skills that all APRNs should acquire.

Risk communication starts the process for appropriate risk management. Management is based on whether the individual is at population, moderate, or high risk (genetic disorder) for disease. If it is determined that the patient is suspect for a genetic disorder based upon his or her personal and/or family history, genetic counseling should begin, ensuring that ethical, legal, and social issues are considered. This chapter discusses complexities of risk communication in patients suspect for an inherited disorder, applies risk communication and risk management for a patient above population risk for a chronic disease and describes ethical, legal, and social implications of individuals suspect for a genetic disorder. It provides several resources to assist with the delivery of culturally sensitive genetic care; provides some basic techniques that can be used for risk communication; and provides additional genomic resources for use in risk communication and risk management.

Roughly 47 million individuals live with major and mild neurocognitive disorders (NCDs) worldwide. The DSM-V and assessment scales area used in the diagnosis of NCDs. Neuropsychological and neurological testing can also be utilized to identify NCDs syndromes. These assessment tools include, but are not limited to, the Mini Mental Status Exam, the Montreal Cognitive Assessment and the six-item cognitive impairment test. Lastly, both nonpharmacological and pharmacological are available in managing cognitive, mood, and behavioral symptoms related-to NCDs. This chapter helps the practitioners to: identify basic neurological changes in the geriatric client; discuss screening tools that can be used to establish a neurocognitive disorder diagnosis; define major and mild neurocognitive disorder; identify neurocognitive disorder subtypes; discuss basic etiology of neurocognitive disorder subtypes; identify and assess patients for symptoms corresponding to neurocognitive disorders; demonstrate basic understanding of pseudodementia; and recommend general pharmacological and non-pharmacological interventions for neuropsychiatric symptoms related to neurocognitive disorders.

During a pandemic such as COVID-19 that creates much uncertainty and rapid changes, supporting elderly patients as well as their families is more integral than ever before. Most individuals that are exposed to a crisis such as a pandemic can experience various challenges that can remain in effect even after the pandemic is over. Deaths associated with pandemics have been repeatedly reported to affect vulnerable populations at different rates including the elderly and women who are pregnant. This chapter helps the practitioners to: describe how elderly patients can connect to care during a pandemic such as COVID-19; explain potential barriers to care for elderly patients during a pandemic; list examples of approaches that can be used to alleviate exacerbations of psychiatric illness during a pandemic and identify any health disparities; and recommend resources and treatment supports that are available during and after a pandemic.

Opportunities for the use of virtual simulation in nursing education are vast, and the advantages for this teaching pedagogy are clear. Virtual simulations in nursing education use technology to provide safe and realistic simulation-based learning experiences (SBLEs) for nurses and nursing students. The use of virtual simulation in nursing education has been increasing in the past decade, but the evaluation of advantages of and opportunities for virtual technology integration and technology-enhanced healthcare simulation has only been explored in a fragmented manner as educators publish their own experiences with this educational pedagogy. This chapter explores the opportunities and advantages of virtual simulation and the integration of virtual technology in nursing education. Virtual simulation is a creative approach that provides interactive, engaging instruction. Virtual simulation, virtual patients, and virtual worlds are all valid tools applicable to nursing education in both the academic and practice setting.

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.

It is important that we explore ways to provide associations between recreation and education. Serious games (SGs) offer the opportunity to have fun playing a game while learning. This chapter helps the reader to explore the use of serious games as a viable method for educating nurses and assess present resources that use serious games for education in the health professions. It also helps the reader to explain the steps to consider when developing serious games and appreciate the challenges and opportunities for the use of virtual gaming in nursing education. The chapter relates to the faculty aspect of the Faculty Administrators Students Technology Strategic Integration Model^©. Faculty must be able to assume the beginner role of technology user, move to the experienced roles of designer/developer and innovator, and then move into the expert roles of researcher and pedagogy synthesizer.

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.