In recent years, the rural hospital closure crisis has escalated with 2015 closure rates six times higher than in 2010. The National Rural Health Association (2020) reported that currently one in three rural hospitals may be at risk of closure. Much of the blame for closures has long been attributed to factors external to rural communities, such as reduced Medicare reimbursement, a declining rural economy, provider shortages, and being located in states that did not expand Medicaid under the Affordable Care Act. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. This chapter focuses on the Acceptability Scale.

Evidence-based practice (EBP) is a seven-step problem-solving approach to the delivery of healthcare that integrates the best evidence from well-designed studies with a clinician’s expertise and the values/preferences of the patient/family. This chapter discusses the importance of EBP in achieving the quadruple aim in healthcare, describes the current state of EBP in healthcare, including EBP competencies, identifies the barriers and facilitators of EBP, and discusses the key leadership strategies to ignite and sustain EBP in healthcare. It briefly describes EBP competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings. Leaders must first understand that EBP is the direct pathway to achieve the quadruple aim in healthcare and be willing to invest in it knowing that healthcare quality and safety will be enhanced, population health outcomes will improve, healthcare costs will diminish, and clinician job satisfaction will increase as EBP diffuses throughout the organization.

This chapter explores the use of virtual simulation from an administrative perspective. Nursing education is moving from PowerPoint lectures and technical skills laboratories on static body parts to engaged learning with high-fidelity simulation, learner-centered experiential teaching, and simulated and standardized patients, all of which help students learn to think, act, and reflect like nurses. Virtual simulation is one way of teaching and learning professional skills, assisting with the integration of acquired scientific knowledge, theory, and practice to promote clinical reasoning and critical thinking. The chapter explores ways in which administrators can support faculty and students while enhancing the educational experience at their institutions. It is important that administrators manage faculty and student expectations and needs while assessing university support for a variety of options; they must address the challenges and opportunities, and explore ideas for leveraging support by developing partnerships.

Administrators must make a decisive, purposeful, realistic, and practical allocation of resources to lead and support the effort to adopt new, cost-effective, and learning enhancing instructional technologies. Nursing education administrators facilitate faculty development and active engagement in the area of virtual simulation and the use of technology in the teaching–learning process. The nurse administrator’s role is to ensure that technological systems are transformed effectively and that financial, ethical, and legal implications are considered. This chapter focuses on the positive aspects of the administrator’s roles as they relate to the integration of virtual simulation. The roles described provide a brief overview of the influence administrators can have on their institution’s technology plan, faculty’s willingness to engage in technology integration, and student learning. Visionary administrators are able to inspire, motivate, and support their faculty and students while paving the path to a smooth transition into virtual simulation integration.

One important goal of Healthy People 2020 is to improve the healthy development, health, safety, and well-being of both adolescents and young adults. Patterns of behavior during adolescence and young adulthood determine adult health status and health risks. While youth are generally healthy, it is important to assess and screen for issues that begin or peak during this developmental phase. These issues include mental health concerns, substance and tobacco/nicotine use, nutrition and weight concerns, sexually transmitted infections (STIs) and HIV, unintended pregnancy, homelessness, academic issues, homicide and suicide, and accidents such as motor vehicle collisions.

Nurses play a key role in the field of epidemiology and in population health. Population-focused nursing demands application of nursing theory and practice while integrating the tenets of public health to contribute to the improvement of community and population health. While advanced practice nurses may not all specialize in public health, it is essential that advanced practice nurses have a foundational knowledge of concepts on the health and illness continuum from a population perspective. This chapter articulates the meaning of advanced practice nursing. It describes the role of the advanced practice nurse in epidemiology and population health. Consistent themes emerge across all functional roles of advanced practice nursing. Advanced assessment and analytic skills to include use of epidemiologic data and concepts to better understand disease occurrence and distribution are crucial to optimal health outcomes.

This chapter addresses the influence of the student role, especially in relation to students studying nursing informatics (NI). The NI student’s influence moves beyond the beginner roles and should be in the expert role. As students learn about NI, they also explore emerging technologies that provide opportunities for student-to-student collaboration. With the advent of virtual learning environments (VLEs) and virtual simulation, there is a greater need for faculty to develop informatics skills and competencies. The chapter provides a description of an educational process used to develop and deploy a program of simulation previously lacking in the graduate program and now used to improve NI skills and knowledge for both student and faculty. The foundations and framework for this project are based on needs and mandates identified by industry, healthcare, and professional organizations such as the American Nurses Association, Quality and Safety Education for Nurses Initiative, and National League for Nursing.

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.

In the United States (U.S.) there are 574 federally recognized tribes across 35 states. According to the 2010 U.S. census, about 5.2 million (1.6%) reported their race as American Indian/Alaska Native (AI/AN) and 2.9 million (0.9%) reported AI/AN as their only race. Fifty-four percent of AIs/ANs live in rural regions, with 68% residing in or close to their tribal reservation. Provision of healthcare services is a “federal promise” granted to federally recognized AI/AN tribes through treaties with the federal government. The Indian Health Service (IHS) is the federally designated healthcare provider for AIs/ANs from federally recognized tribes. This chapter briefly reviews healthcare services for AI/AN people. It defines hospice and palliative care, and describes their individual approaches to understanding end-of-life (EOL) and palliative care in two AI tribal communities. The chapter concludes with lessons learned and implications for rural nursing practice, research, and education.

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.

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.

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.

The process of technology integration is continually shifting. Successful integration of technology into the nursing curriculum is contingent on a myriad of contributing factors, not the least of which is that technology and curriculum continue to develop. The Faculty Administrators Students Technology Strategic Integration Model (FAST SIM) provides a framework for guiding the process of technology integration with the nursing curriculum. As stakeholders, faculty, administrators, or students may find relevance in applying the model from their individual perspective and particular needs. Paying particular attention to the influence and contribution from faculty, administrators, and students plays a significant role in the success of a technology integration plan or strategy. This chapter provides an overview of the key contributors to the technology integration process. It also offers suggestions as to how faculty, administrators, and students influence the process and identify opportunities to apply the FAST SIM.

As a health-care provider, one must be able to accurately and efficiently correlate subjective information with objective findings. This is especially important in electrocardiogram (EKG) interpretation. This chapter presents patient’s basic history and a corresponding EKG for clinical practice. Space is provided to document the pertinent findings. The exercises include heart rate calculation, rhythm evaluation, axis evaluation and heart block assessment including sinus block; first-, second-, or third-degree atrioventricular (AV) block; bundle branch block; and QT prolongation. It also includes evaluation for signs of ischemia and infarction and strain patterns such as those seen in ventricular hypertrophy and consider atrial enlargement. The chapter aims to improve EKG interpretation skills.

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.

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.

This chapter describes the cardiac axis. Axis refers to the general direction of electrical conduction through the heart. The QRS complex represents ventricular depolarization. Each lead represents a different angle or vector of depolarization through the ventricular myocardium. All of these added together represent one average QRS vector, referred to as the axis. The four axis categories are: normal, left, right, or indeterminate. This is determined based on the four quadrants that are created by the intersection of leads I and aVF. These two leads are the most important in determining axis. They intersect at the center of the heart and form four right angles. The normal vector points down and to the patient’s left side. Axis is described in degrees.

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.

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.

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.

This chapter reports the findings of a literature review designed to examine the level of support for the Symptom–Action–Timeline process and O’Lynn’s Symptom Action Process (SAP) model. It addresses the recommendations proposed by O’Lynn to: (a) expand the definition of symptom to include psychological symptoms; (b) expand the definition of symptom to be more reflective of a health need so that self-care measures to prevent illness or promote health are included; (c) recognize that intentional disregard of a health need is a type of self-care action, especially when mental health needs are involved; (d) embed the model within an environmental context external to the decision tree to account for demographic variables, access to resources, and so on; and (e) design the model to be more circular in nature, allowing for sequential or concurrent health-related actions.

Statistics is all about recognizing and addressing sources of variability, either through study design or statistical analysis. Variability is both essential for understanding associations and a nuisance that encumbers our efforts at measuring them. This chapter provides a description of the properties of variables. Variables are measurable characteristics or traits that vary from object to object. It is useful to classify variables by their scale of measurement. Two goals of research are to characterize attributes or features of a population and assess associations of interest. These activities necessitate the need for observing characteristics of members of a population. Sensitivity can be expressed as the conditional probability that a diagnostic test produces a positive test result given an individual has the disease. Specificity is the conditional probability that a diagnostic test produces a negative test result given an individual is disease free.

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.

This chapter discusses breast conditions such as breast cancer screening guidelines, abnormal breast discharge, breast mass, and mastalgia/breast pain. Evidence-based guidelines for breast cancer screening continue to evolve with research findings. National organizations publish their own guidelines that can vary slightly. Practicing clinicians must decide which organizational recommendation they will adhere to and stay updated on any published changes and the rationale for the change. The chapter discusses etiology, history, physical examination, laboratory/radiologic testing, differential diagnosis, treatment, complications, consultation/referral, and follow-up for abnormal breast discharge, breast mass, and mastalgia/breast pain.

Primary care providers have become the main providers of mental health services for their patients. Building on long standing relationships with children and their families along with an emphasis on development, early intervention and prevention, pediatric practices are the ideal setting for the integration of mental health into primary care. One model for working with families that is being used successfully in many health care settings is SBIRT, which stands for screening, brief intervention, referral and treatment. This chapter presents brief interventions that are evidence-based interventions and can be provided by primary care providers in the context of brief office visits or several standard office visits. Brief interventions can be used as a stand-alone treatment for those at-risk as well as a vehicle for engaging those in need of more intensive specialized care.

The importance of mentoring to nurses gathered steam in the 1980s with the growth of graduate education and specialty practice, the development of nursing research, and awareness of the paucity of role models as more nurses took on leadership positions. Building a mentoring network is the means by which one keeps up-to-date, surmounts limitations, discovers opportunities, and continue to evolve as a leader. The feminist critique of mentoring pointed out that not only had gender been ignored in who got mentored, but race and social class were also disregarded. The best way to grow our mentoring network is through professional organizations. Understanding the reciprocal nature of collegiality can be especially useful to top performers because their triumphs can engender envy and retaliatory behaviors; to counteract such competition, they should make sure that anyone who works with them profits from the relationship.

Regardless of the setting and the structure of our pitch, we first to understand how to develop a pitch that compels our target audience to help provide us with the resources we need. This chapter explores eight essential components that will help us find success when pitching our idea/product/service. The eight essential components include: evoking emotion through story; knowing your audience; grabbing attention; painting your unique value proposition; providing enticing solutions; showing results (or evidence); keeping it conversational; and asking for what you need. These components should serve as the foundation for all pitches. Also covered are the three main structures of commonly used pitches: the elevator pitch, the sales pitch, and the venture pitch.

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.

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.

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.

One important goal of Healthy People 2020 is to improve the health, safety, and well-being of persons who are sexual or gender minorities. This chapter reviews basic concepts for clinicians to support delivery of culturally competent and affirming health care to foster health for all individuals, no matter how they identify their sexual orientation or gender identity. It also reviews language, development of affirming environments, and clinical care considerations. Receipt of culturally competent affirming care is directly associated with increased mental and physical well-being, reductions in disease transmission and progression, reduction of health care costs, and increased longevity. Understanding and using correct and clearly defined language and terminology helps clinicians: understand the unique needs and experiences of varied subgroups of minority individuals, measure health disparities in the practice, locally, and nationally, and provides a foundation to foster understanding, build trusting relationships, and provide affirming and culturally competent care.

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.

Nursing as a practice discipline positions nurses to encounter unique events and situations that can serve as the foundation for future research exploration. Case control studies serve as a catalyst to differentiate the occurrence of disease among cases and controls to generate hypotheses. Nurses should remain astute and vigilant for unique situations encountered that could be the tipping point for exploration of unique cases. A case control study design groups the research subjects into cases or controls. This chapter helps the reader calculate an odds ratio from a case control study design, differentiates prospective and retrospective research designs, and describes other research designs such as historical, exploratory, methodological, and correlational. It also differentiates the types of triangulation. Epidemiologic research study appraisal is the systematic evaluation of a research study’s quality based on scientific merit and methodological rigor. The epidemiologic research study appraisal is dependent upon the research study design.

This chapter presents brief case studies that correspond to chapters 10–24: These studies refer to contraception, preconception care, breast conditions, HPV and cervical abnormalities, genitourinary tract conditions, infertility, pelvic floor dysfunction, medical abortion, menstrual disorders, gynecologic conditions, peri-and postmenopause, polycystic ovary syndrome, sexual dysfunction and sexually transmitted infections as well as vaginitis and vaginosis.

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.

Rural Veterans are an important subset of both the Veteran and the rural population with differing healthcare needs that are sometimes misunderstood. The majority of rural Veterans have multiple, complex, physical and mental health needs that require ongoing care throughout their lives. Concurrent palliative care, when delivered as a critical component of comprehensive primary care in rural areas, may offer the best opportunity for rural Veterans to remain productive amid the increasing incidence of multiple chronic conditions (MCCs). Rural Veterans suffering from diabetes, heart disease, Parkinson’s, Alzheimer’s or other dementias, multiple sclerosis, cancer, kidney disease, and rheumatoid arthritis may be candidates for concurrent palliative care. This chapter describes the rural Veteran culture. It outlines the current research on the barriers to palliative care in the rural setting, and provides direction in the opportunities that exist addressing the concerns of the rural Veteran population.

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.

“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.

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.

Clinical epidemiology is considered a basic science of medical practice that informs diagnostic, prognostic and therapeutic clinical decisions related to individual healthcare. Healthcare epidemiology broadens the scope of clinical epidemiology to include various types of healthcare settings not limited to the acute care setting. It is a more comprehensive term to use to designate epidemiology of clinical care in both acute and primary care settings. This chapter provides an overview of healthcare epidemiology, inclusive of clinical infectious hospital-acquired infections, and the basis of health care epidemiologic data in evidence-based healthcare. Healthcare epidemiologists are expert clinicians who provide information and education in areas such as but not limited to infectious diseases, infection control and prevention principles, antibiotic stewardship, occupational health and safety, and prevention of hospital- or healthcare-acquired infections or health conditions, along with regulatory compliance guidance.

The 12-lead electrocardiogram (EKG) can be a valuable resource to utilize in the diagnosis and management of clinical conditions. Many medical conditions can cause a change in the structure and/or electrical excitation of the cardiac anatomy. This chapter focuses on some of the more common diagnoses encountered in everyday practice that affect the EKG. There is a variance in sensitivity and specificity for each finding; however, any association that can be identified may prove invaluable to the clinician. The chapter describes the impact of the following conditions on the EKG: left ventricular hypertrophy, right ventricular hypertrophy, right atrial enlargement, left atrial enlargement, biatrial enlargement, pericarditis, pericardial effusion, pulmonary embolism, hypothermia, acute neurologic injury.

Predictions that the current nursing shortage will continue and most likely intensify as the demand for nurses grows have resulted in a variety of recommendations for strategies to reduce the shortage and meet the demands for additional nurses. Despite the growing numbers of nursing school applicants, the number of graduates from nursing programs has not sufficiently increased to meet the demand for registered nurses. In many cases, nursing school applicants are turned away due to a shortage of faculty and inadequate numbers of clinical sites or financial constraints. Rural hospitals can provide nursing students with experiences surrounding the interprofessional collaboration of acute care settings with community networks through community/public health agencies. This chapter describes opportunities for clinical in rural hospitals, implementation of one new program, and benefits and challenges of placing students in rural facilities for their clinical rotations.

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.

The basic philosophy of cognitive behavioral therapy (CBT) is that psychological issues and psychiatric disorders are the result of distortions of automatic thoughts and core beliefs; and, these distortions are learned and reinforced through life experiences. Once the core belief system is known, the therapist targets automatic thoughts and conclusions that may no longer be useful to the client. CBT is the treatment of choice for clients with dysfunction automatic thoughts and core beliefs. CBT aids in developing skills and tools that will enhance internal resources and coping skills. This chapter initially describes the author's experience with Adlerian psychology and CBT while working as a psychiatric nurse. It then elaborates the key concepts, goals, assessment and interventions of CBT. Finally, the chapter presents a case study of a client who was treated with CBT for shock and grief after the sudden death of her only sister.

Cohort study designs are a population-based observational epidemiologic study. Cohort studies evolve over time as diagnostic and medical science advances; for example, improved diagnostic screening and testing methods will be integrated into a cohort study design as they are developed or improved. This chapter describes an epidemiologic cohort study design, differentiates a prospective and retrospective cohort study design, and shows how to calculate a risk ratio and rate ratio. Cohort study designs can be developed with an integration of other study designs. A case-control study design can be nested into a cohort study design. In addition, there can be a nested case-control study design within a cohort study design with matching of cases and controls to account for confounding variables. Other study designs can be combined with or integrated into a cohort study design as a strategy to increase internal and external validity of the research study design.

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.