This chapter reviews prevention, including genetic counseling. It discusses genetic testing for diagnosis as opposed to screening and the treatment for genetic disease. Methods of prevention begin with education of the public and health care professionals and identification of those at risk. Genetic counseling is the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. The malignant cells often exhibit aneuploidy as well as translocations that are found only within the tumor cells. Genetic errors that arise from specific cell lines are somatic mutations. It is suggested that there is a thorough collection of family, genetic, and medical history for children entering the adoption process. Nurses may play a variety of roles in genetic counseling that reflect their preparation, area of practice, primary functions, and setting. The chapter explains the incidence of chromosome abnormalities.
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The initial recognition of the need for a genetics referral may arise when a nurse suspects a genetic contribution to disease because of personal or family medical history and/or findings from a physical assessment. Family history is a valuable and cost-effective tool that is often underutilized in clinical practice. Many common genetic conditions result from complex interactions between genetic and environmental factors. It is critical to collect information about potential environmental exposures to help inform a patient’s risk assessment. Health care professionals should become familiar about toxic environmental agents that are common in their specific geographic location. A growing number of Food and Drug Administration (FDA) approved drugs have labeling that includes pharmacogenomic information, which can be used to optimize drug dosage and prevent adverse and life-threatening drug reactions in a patient or family member.
Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.
- Go to chapter: Social Work and the Law: An Overview of Ethics, Social Work, and Civil and Criminal Law
This chapter demonstrates how social work ethics apply to ethical and legal decision making in forensic social work practice. It discusses the context of social work practice in legal systems. The chapter also details the basic structures of the United States (U.S.) civil and criminal legal systems. It lays the foundation for the criminal and civil court processes in the United States and introduces basic terminology and a description of associated activities and progression through these systems. The chapter focuses on providing an introductory, and overarching, picture of both civil and criminal law in the U.S. and introduces the roles social workers play in these systems. It focuses on the ETHICA model of ethical decision making as a resource and tool that can be used to help forensic social workers process difficult and complex situations across multiple systems.
This chapter explains the theoretical basis for motivational interviewing (MI). It reviews the empirical evidence for the use of MI with diverse populations in forensic settings. MI involves attention to the language of change, and is designed to strengthen personal motivation and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. It is now internationally recognized as an evidence-based practice intervention for alcohol and drug problems. MI involves an underlying spirit made up of partnership, acceptance, compassion, and evocation. The chapter discusses four key processes involved in MI: engaging, focusing, evoking, and planning. It also describes five key communication microskills used throughout MI: asking open-ended questions, providing affirmations, offering summarizing statements, providing information and advice with permission, and reflective statements.
The learning landscape continues to evolve as new technological tools enable teachers to deliver robust learning experiences. It is important to help teachers, administrators, and students know where to begin so that the transition to virtual learning is smooth, without educational loss. This chapter consists of two sections: current trends and issues in technology integration and technological pedagogical content knowledge. The first section briefly reviews the trends in instructional or educational technologies that are causing administrators, teachers, and students to reflect on and modify their thinking about learning and educational content delivery. The second section explores constructivism, the scientific underpinnings of nursing informatics, and ethics. Nurse educators must also address the ethical challenges brought about by this evolving learning landscape. After reading this chapter, one can understand current trends and issues, as well as the influence of nursing informatics and ways to approach new ethical dilemmas.
Healthcare is in a state of rapid change. Although practice environments have become more complex, educational delivery methods have remained stagnant. Innovative technologies provide opportunities to enhance nursing student learning and help nursing programs become more responsive to changes in the practice environment; however, obstacles may hinder successful implementation. With the increasing complexity of today’s health care environment, innovations in nursing curricula are necessary. This chapter explores some of the general challenges associated with the integration of innovative educational technologies, as well as some challenges unique to virtual simulation. It helps the reader to analyze the challenges of integrating educational technologies into nursing education associated with faculty, administrators, and students. It also helps the reader to examine practical and philosophical barriers related to technology integration and explores challenges unique to the adoption of virtual simulation.
Simulation has many advantages for nursing education, some of which include creating safe learning environments for students and reinforcing information learned in the classroom; it also has the advantage of being available in inclement weather as well as 24 hours a day for student access. Simulation in nursing is one of many methods used for teaching students. Teaching and learning in a virtual learning environment has many advantages for administrators, faculty, and students. One of the advantages includes the use of other disciplines to help create or participate in a virtual world learning experience. The virtual learning environment can be created to look similar to real communities, disaster areas, or homes, with avatars populating that environment. The advantage to using virtual reality, rather than a real-life experience, is that in real life, students could be immersed in an environment that could cause them harm.
To think today that health issues in one country are confined to that country indicates a lack of understanding of disease transmission, cultural practices, and migration patterns at the least. This chapter presents health problem or issues and policies that impact populations around the globe. To highlight the worldwide impact, the content is framed within the seven continents. The health issues are not exclusive but selected to reflect the extent of political or governmental impact. It briefly describes government structures, and presents an overview of the policy-making process of Africa, Antarctica, Asia, Australia, Europe, Italy, North America, and South America. The policy process will vary among countries depending on the type of government. Some issues may reflect cultural practices that may not be amenable to government intervention. The reader should determine the extent to which citizens, especially nurses, can be involved in the policy process as advocates and change agents.
This chapter opens with the challenge Nightingale and her close colleagues faced in establishing nursing as a profession when the ethical standards of the existing (secular) nurses were (generally) so low. The ethical issues she had to deal with in her own school, soon after it opened, are discussed three thorny problems with appointments. Anyone reading Nightingale’s writing on nursing will be struck by how often and how forcefully she insisted on high ethical standards. The reason for the emphasis on ethical standards is obvious enough in the task Nightingale faced in raising the new profession from its disreputable past. The International Council on Nursing (ICN) established its Code of Ethics in 1953, again based on Nightingale principles. It identified four responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering. The code asks nurses not only to act ethically themselves, but to challenge unethical practices.
- Go to article: Sexual Teen Dating Violence Victimization: Associations With Sexual Risk Behaviors Among U.S. High School Students
Sexual Teen Dating Violence Victimization: Associations With Sexual Risk Behaviors Among U.S. High School Students
Adolescent dating violence may lead to adverse health behaviors. We examined associations between sexual teen dating violence victimization (TDVV) and sexual risk behaviors among U.S. high school students using 2013 and 2015 National Youth Risk Behavior Survey data (combined n = 29,346). Sex-stratified logistic regression models were used to estimate these associations among students who had dated or gone out with someone during the past 12 months (n = 20,093). Among these students, 10.5% experienced sexual TDVV. Sexual TDVV was positively associated with sexual intercourse before age 13, four or more lifetime sexual partners, current sexual activity, alcohol or drug use before last sexual intercourse, and no pregnancy prevention during last sexual intercourse. Given significant findings among both sexes, it is valuable for dating violence prevention efforts to target both female and male students.Source:
This chapter explores how three successful nursing leaders, using different leadership approaches, demonstrate traditional leadership attributes such as strategic vision; risk-taking and creativity; interpersonal and communication effectiveness; and inspiring and leading change. It discusses the opportunities and implications for nursing leaders and those external to the profession to develop collaborative and transformative partnerships to advance quality health care. Pragmatic leaders demonstrate leadership excellence by effectively translating their nursing care assessment skills into the ability to approach organizational problem solving and decision making in a systematic, logical manner. In contrast to the present-needs focus of pragmatic leaders, charismatic leaders are vision-based leaders who predicate their leadership agenda on attaining future goals. Each of the three nursing leaders profiled understands the importance of being politically astute and effectively leveraging power and influence to make value-added contributions. To varying degrees, the various constituents of the nursing leaders profiled view them as socialized leaders.
This chapter shows the importance, for older persons, of support groups. In spite of the changes that have occurred in the American family, and all the negative things that fill the popular press concerning family relationships, the family is still the backbone of support for most older people. To some extent, the type of family support older people obtain depends on whether they are living in the community or in an institutional setting such as a group home, retirement village, or nursing facility. Whether a person is married, has great impact on that person’s support within a family setting including emotional, financial, and physical support, particularly in times of illness or infirmity. The success of a second marriage depends to a considerable extent on the reaction of the adult children of the elderly couple. Older grandparents, no matter how motivated, can find caring for grandchildren to be very tiring.
Delirium, also known as acute confusional state, organic brain syndrome, brain failure, and encephalopathy, is a common occurrence among medical and surgical patients and causes extensive morbidity and mortality. This chapter provides an updated review of delirium, including pathophysiological correlates, clinical features, diagnostic considerations, and contemporary treatment options. The defining features of delirium include an acute change in mental status characterized by altered consciousness, cognition, and fluctuations. The chapter explores the risk factors for delirium. These can be divided into two categories: predisposing factors and precipitating factors. Imbalances in the synthesis, release, and degradation in gamma-aminobutyric acid (GABA), glutamate, acetylcholine, and the monoamines have also been hypothesized to have roles in delirium. GABA is the primary inhibitory neurotransmitter in the central nervous system (CNS) and medications such as benzodiazepines and propofol have known actions at GABA receptors and have been associated with delirium.
This chapter shows how the United States and the world are experiencing an aging evolution we are growing older. America is going through a revolution. As a whole, Americans are becoming older, and there are many more older people among people than ever before in our history. Obviously all cohorts of the population youth, young adults, middle-aged, young-old, oldest-old are heterogeneous. When some people think about the elderly as a whole, they picture frail, weak, dependent persons, some in nursing homes and many confined to their homes. The chapter demonstrates the differences the various age categories have in relation to selected chronic health conditions that cause limitations of activity. Widowhood is much more common for elderly American women than for older men. The aging of Baby Boomers will solidify the shift America is experiencing with the aging of its population. Centenarians make up a small percentage of the total U.S. population.
The author, Martin Alpert, presents a method by which individual nurses can be independent, improve patient care, have fun, and earn more money. He proposes that the nursing profession become the leader in a shift to sustainable, least invasive therapies and evaluations (LITE). LITE represents a major profit opportunity for nurses. Many of these new therapies require medical professionals, but not necessarily doctors. They can be administered by dedicated and trained nurses. The impact of LITE on the global society of nursing leading this area of medicine could be transformational for nursing, medicine, and society. Nursing could lead in diagnosis and treatment under the LITE paradigm. Acupuncture is becoming part of conventional therapy. It can be a part of nursing practice. Recently, the World Health Organization estimated that 80” of people worldwide rely on herbal medicines for some part of their primary health care.
Mindfulness provides a framework for monitoring the emotions and examining the thoughts as one move through their professional lives. However, for mindfulness to become a way of life, deliberate and consistent practice is required. For many people, that practice is fostered through meditation. Meditation is a cognitive practice where the goal is to focus the mind and foster the capacity to remain centered in the present moment, here and now, rather than be ruminating about the past or worrying about the future. Some practice walking meditation as methods that help to keep attention focused on the present moment and on the immediate sensations within the body. Through meditation, people can easily shift into calm centeredness, a state of balanced equilibrium that allows them to achieve a tranquil state, able to strategically think through the steps of mindful patient care. This chapter shows several techniques that enhance mindfulness and mindful practice.
As a clinical pharmacist, Al Patterson has shared-many experiences with nurses; he reflects on the key dimensions of nursing leadership and describes the similarities between the professions of pharmacy and nursing. He believes that nursing leaders recognize the societal responsibility inherent in their role, and the professional responsibility to provide the most meaningful care to each patient and to structure the environment to ensure safety and quality. There are several things that stand out to me as examples of the transformational nature of nursing leadership: patient advocacy, professional development, and most important, the focus on quality and safety. Initially many department leaders volunteered staff for quality advisor (QA) training, and over 160 teams were formed to address a wide array of problems. Central to the concepts of shared leadership/shared governance is the recognition that the profession must continually improve itself.
Primary progressive aphasia (PPA) is the term applied to a clinical syndrome characterized by insidious progressive language impairment that is initially unaccompanied by other cognitive deficits. This chapter describes several variants of PPA and more than one etiology. It explains three main variants of PPA, namely, semantic Variant of PPA (svPPA), nonfluent/agrammatic variant of PPA (nfvPPA) and logopenic variant of PPA (lvPPA), and also describes criteria for their diagnoses. The defining symptom of PPA is the presence of a language impairment for at least 2 years in the absence of any other significant cognitive problem. Assessment of other cognitive domains is challenging because many tests of memory, attention, executive functioning, and visual-spatial skills rely on language processes in some manner. There are no drug therapies proven to arrest progression of signs and symptoms of PPA due to frontotemporal lobar dementia (FTLD) or Alzheimer’s disease (AD) pathologies.
In order to function effectively, clinicians need to have both confidence in their professional judgment and belief in their clinical competence. The overconfident clinician who ignores opposing evidence or overlooks additional information runs considerable risk of not only making mistakes but alienating patients and families. Hubris is a major source of mistakes within health care. It is this hubris that also accounts for much of the downstream impact of medical mistakes. Patient-provider relationships are especially harmed when clinician hubris inevitably proves unwarranted, the diagnostic conclusions are erroneous, and/or mistakes occur. Mindfulness allows for self-correction, a recalibrating of one’s compassion capacity and an energy re-orientation away from ineffective self-enhancement and a refocus on patient treatment. However, when mistakes do happen, apologies are necessary. Apologies are best when they are sincere and delivered with humility and understanding.
Dementia is an umbrella term for conditions such as Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and frontotemporal dementia (FTD). Under that umbrella, FTD, also known as frontotemporal lobar degeneration (FTLD), can be further categorized to define a group of neurodegenerative disorders resulting from a progressive deterioration of the cells in the anterior temporal and/or frontal lobes of the brain. More specifically, ventromedial-frontopolar cortex is identified with metabolic impairment in FTD. This chapter elaborates on the history, epidemiology, pathophysiology, clinical features, treatment, and outcomes of FTD. The history and background section of each of the FTD categories highlights the evolution of the disease conceptualization. The FTD subtypes are conceptualized in three categories: neurobehavioral variant, motor variant, and language variant. The chapter illustrates the features of all three categories of FTD.
Humans thrive on relationships. Positive interactions are the essence of one’s happiness. Connecting to others, in a positive way, is affirming. There is no more important time for people to feel connected to and supported by others as when they face a serious illness or trauma. When entering the health care system, patients move through seemingly countless encounters with a variety of personnel. Interactions that strain patient-provider relationships are costly for the patient than for the caregiver. Patients who are perceived to be difficult are at greater risk for experiencing nontherapeutic encounters. In order to provide patient-centered care, clinicians need guidelines for how they can consistently assume the kind of demeanor that makes such care part of a conscious choice, a way of being in the health care world. The power of positive regard, conveyed to patients through even the shortest of encounters, can be life changing and life saving.
The author, Arthur G. Cosby speaks about his mother, Lillie Mae Mclntire Cosby; a nurse who led him to understand what constitutes leadership, his responsibilities to others, and the role of women in the modern world. In his mother’s mind, discipline was a critical aspect of good health care. As head nurse, she supervised large number of junior nurses, aids and orderlies, many of whom had limited formal health care training. It was very important to him that he had a mother who could do so many things and do them well. Not only was she a mother and nurturer, she was also a woman who was the breadwinner, who could successfully carry out most any job even the most difficult. Over the course of her career, she actively carried out the health care responsibilities of head nurse, hospital administrator, emergency room nurse, obstetrics nurse, public health nurse and nurse practitioner.
The concept of Mild cognitive impairment (MCI) makes a lot of sense in that individuals are typically not “normal” one day and “demented” the next. In theory, especially for progressive neurodegenerative conditions, such as Alzheimer’s disease (AD), frontotemporal dementia (FTD), the development of dementia may take months or years. The clinical syndrome of MCI due to AD can be identified via a neuropsychological evaluation or less-sensitive cognitive screening measures. Much of what we are learning about MCI, and therefore refining its diagnostic criteria, is coming from two large-scale studies of cognition and aging: Alzheimer’s Disease Neuroimaging Initiative (ADNI) and Australian Imaging, Biomarkers and Lifestyle (AIBL). According to the most recent research diagnostic criteria for MCI due to AD, evidence of beta-amyloid deposition, neuronal injury, and/or other biochemical changes needs to be seen to increase confidence of the etiology of MCI. Cholinesterase inhibitors remain the primary pharmacological treatment for AD.
This book offers leadership lessons for aspiring nurse leaders from luminaries in business, medicine, philanthropy, government, academia, research, and health care. It offers practical advice, lessons learned, and testimonials as to how nurses can prepare themselves for leadership, which in turn, will help them to provide exceptional patient care. As per the report of the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF), the heightened roles of the professional nurse allow nurses of all practices to more fully develop their leadership skills. Nurse leaders are moving the interprofessional collaboration agenda forward by serving in key leadership positions. A nurse leader who led public research in the Kent State University and Bowling Green State University challenged the common perception that successful leaders are born, complete with the requisite temperament and talents. Nurses who play leadership roles can fill in research on health care policy formulation and implementation that will change the course of health care payment, delivery, and quality. The book discusses nurse research leadership from an economist’s perspective, hiring leaders to understand leadership, and nursing leadership lessons from an association executive’s perspective, from a physician’s chief executive officer’s perspective, from a nursing friend’s perspective and from a collaborative team’s perspective. The book also highlights nursing leadership’s contributions to safety and quality, how leadership can usher in health reforms and achieve better health for all people, and advancing the cause of transformational nurse leadership.
This chapter suggests that the dysexecutive syndrome associated with vascular dementia (VaD) is caused by impairment in separate but related cognitive concepts; that is, pathological inertia, mental bradyphrenia, disengagement, and temporal reordering. During the late 19th and early 20th centuries, cerebrovascular dementia was a well-established clinical syndrome. Multi-infarct dementia (MID) generally became associated with all types of vascular syndromes. Recent research suggests the presence of considerable overlap between the neuropathology underlying Alzheimer’s disease (AD) and VaD. Patients diagnosed with VaD tend to produce hyperkinetic/interminable perseverations, suggesting an inability to appropriately terminate a motor response. Other aspects of the dysexecutive syndrome associated with VaD revolve around constructs related to interference inhibition, flexibility of response selection, and sustained attention. From the view point of diagnosis, the neuropathology of VaD often differentially impacts the frontal lobes, whereas the neuropathology associated with AD revolves more around circumscribed temporal lobe involvement.
Karen Gross shares eight lessons learned about leadership that occurred not from leading per se but from the process of hiring an academic nursing leader. The search now successfully concluded gave her an opportunity to reflect on what type of health care leader they were seeking at Southern Vermont College (SVC). Although not a health care professional, she spent more than 15 months thinking about leadership in the context of nursing. The whole search process from creating the job description to identifying a quality candidates’ pool to interviewing and ultimately selecting a divisional chair to helping the successful candidate see the fit with the institution allowed her to consider what qualities are critical to nursing leadership within the academy. In an interesting way, the search for a leader in nursing enabled her to think more effectively about leadership, and in the world of unintended consequences, made her a better leader.
Dementia pugilistica (DP) is a form of chronic traumatic encephalopathy (CTE) that involves gross impairment of cognitive and motor functioning due to repetitive blows to the head from boxing. Rapidly increasing in popularity among fight fans and fighters is mixed martial arts (MMA). In the area of sport-related concussion, there are two other frequently used terms that are necessary to distinguish from DP and CTE: postconcussion syndrome (PCS) and second impact syndrome (SIS). The classical clinical signs and symptoms of DP include combinations of dysarthria, incoordination, gait disturbance, pyramidal and extrapyramidal dysfunction, and cognitive impairment. Some media reports about concussion and the potential link between repetitive concussions and long-term problems include eye-catching and emotionally provocative titles. This chapter has provided an overview of the many complex issues surrounding the effects of repeat concussive trauma, particularly in sports.
Nurse leaders should be poised for change. One of the common themes across entries was that nurses are central to the changes occurring in health care and that they should seize the opportunities to be in charge of the redesign of the U.S. health care system. There was another strong theme that permeated the entries: that of the knowledge necessary for nurse leaders in health care delivery. To assume leadership roles in a new delivery system, nurse leaders are advised to understand policy and finance and the roles of all team members. Furthermore, leadership must be about the organizational goals, not one’s individual goals. Self-knowledge is essential, including the understanding of how you are reflected in the eyes of others. A high level of self-confidence is essential for leadership. Other important developmental needs for nurse leaders include quantitative skills and technological expertise, including electronic and digital forms of communication.
Interprofessional education (IPE) and collaborative practice are increasingly called upon to improve these domains such as patient care, community health, health care delivery systems respective and overlapping spheres of activity with the larger goal of improving the overall health care system. Nurse leaders are moving the interprofessional collaboration agenda forward by serving in key leadership positions nationally and on local campuses. Nurse leaders, through a combination of their training, professional experiences, and personal preferences, have unique knowledge and skills for which they are enthusiastic champions. Effective leaders apply principles of good communication in their work with individuals and groups. Nurse leaders possess valuable professional knowledge and skills, and when coupled with individual talents and strengths, they offer important assets to the success of a collaborative effort. Nurse leaders should recognize how they can best capitalize on their leadership abilities and confidently apply them.
This chapter talks about mentor intelligence as a source of excellence. In order to perform successfully in a complex profession like nursing, there are beginning threshold requirements such as intellectual intelligence (IQ) and specialized knowledge and skills. Further, it is thought that working at a high level of excellence in one’s field requires emotional intelligence. However, the lack of Mentor Intelligence presents major impediments in developing one’s full potential to the highest level. The chapter provides ten tips for raising nurse’s mentor intelligence. The tips include such as cultivating the three ingredients of Mentor Intelligence, practicing nursing profession in a culture of mentorship and collegiality, sharpening nurse’s communication skills and their message, networking, becoming a mentor-leader, and being a “forever” student of mentoring, and developing the art of mentoring others. Three ingredients of Mentor Intelligence include mentoring mentality; mentoring lens; and mentoring momentum.
The Transmissible spongiform encephalopathies (TSEs) form a group of illnesses, characterized by a pathological form of the native prion protein, which results in a rapidly progressive neurodegenerative illness. They also are responsible for Gerstmann-Strâussler-Scheinker (GSS) syndrome and fatal familial insomnia (FFI), and they have been produced experimentally in several other animals. Creutzfeldt-Jakob disease (CJD) is the most common TSE in humans. Human prion diseases have three etiologies: (a) sporadic, (b) genetic, and (c) acquired. Human prion diseases are important to understand because of their underlying pathophysiology, public health implications, and clinical features that often result in misdiagnosis. This chapter reviews the historical discovery of prion diseases and the formulation of the prion hypothesis. It explores prion hypothesis and the neuropathogenesis of prion diseases. The chapter ends with a description of the diagnosis, prognosis, and experimental treatment of human prion diseases.
The increasingly more complex, diverse, and interdisciplinary facets of the health care system prompted the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) to join together and assess the current state of health care, thus issuing a “call to action” by the nursing profession. This monumental report challenges nurses to practice to the full extent of their training, transform health care and improve research and information systems. The heightened roles of the professional nurse allow nurses of all practices to more fully develop their leadership skills. The author’s, Greer Glazer, personal and professional life changed when she was notified by the RWJENF Program that she was a finalist for their leadership program. Doctor of Nursing Practice (DNP) programs are designed to prepare nurses for the highest level of leadership in practice that is innovative, evidence based, and reflects application of research.
Dementia with Lewy bodies (DLB) is a clinical syndrome characterized by progressive dementia, cognitive fluctuations, visual hallucinations (VH), and parkinsonism. In 1961, Okazaki, Lipkin, and Aronson reported two patients with dementia and parkinsonism with cortical neuronal inclusions similar to the brain-stem Lewy bodies (LB) seen in Parkinson’s disease (PD). LBs are intra-cytoplasmic neuronal inclusions containing α-synuclein and ubiquitin. There are other associated pathological features in DLB such as spongiform change neuronal loss, and Alzheimer’s disease (AD) pathology includes amyloid plaques and neurofibrillary tangles (NFTs). DLB and other entities such as PD and multiple system atrophy (MSA) have been grouped under the term synucleinopathies due to the existence of α-synuclein inclusions in the brain. The central feature required for a diagnosis of DLB is the presence of dementia: a progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function.
Steven A. Wartman, the author, provides key advice for potential and aspiring nurse leaders. He advises to let go of the guild mentality, particularly important for nurses who aspire to leadership positions that transcend nursing. Nurse’s perspectives are invaluable in bridging the gap between the technical experience of health care and its meaning in the lives of patients and their families. Nurse leaders are advised to become transformational rather than transactional leaders, and to move beyond the rewards and punishments inherent in transactional leadership styles. Transformational leadership is especially challenging, given the traditional hierarchies in the medical fields and academia. To provide the most effective and “transformational” leadership, potential nurse leaders should focus their efforts on four areas: eliminate the “guild mentality”; change restrictive policies and regulations that weaken the role of nursing; seek to become a “transformational” leader; and learn to take the ego out of the job.
This chapter describes an overview of the procedures that a neuropsychologist may apply to a range of similar referrals in the area of civil capacities. It explores the presentation of a framework developed by the American Bar Association/American Psychological Association (ABA/APA) working group on capacity issues and provides more specific guidance regarding assessment tools. Decision making is a complex cognitive process that involves multiple brain regions and brain systems. Injuries to the prefrontal cortex are common in dementia and are often linked to changes in decision-making abilities. Key differences between clinical assessments and those for capacity evaluations include knowledge of relevant legal and ethical issues, a functional assessment, and an ability to present neuropsychological data to lay readers. Research on medical consent capacity and financial capacity highlight the importance of the assessment of calculation, executive function, and verbal memory as part of any test battery.
This chapter discusses the historical background of the mentor connection and mentoring relationships in nursing, different types of support relationships and mentors. It also discusses why and when nurse need mentors and early career challenges and mentoring. The mentor connection is a developmental, empowering, nurturing relationship extending over time, in which mutual sharing, learning, and growth occur in an atmosphere of respect, collegiality, and affirmation. Clearly, mentor connections and networks were integral to the developmental experience of successful career-oriented men. Mentoring is a vital component of professional nursing and that mentors are essential for nurses’ ongoing development and leadership achievement. In organizations, mentoring relationships serve as an antidote to disrespectful attitudes and behaviors among nurses and physicians and other health care providers. Mentors mentoring activities can be broken down into two categories: career functions and psychosocial functions.
Chronic alcohol use has been related to various linked disorders when used in excess, particularly when this excessive use becomes chronic. It is important for clinicians to clarify the amount and type of alcohol being consumed and the frequency of this consumption when considering its potential role in any neuropsychological profile. The most commonly reported terms found in the literature include alcohol-induced persisting dementia (APA), alcohol-related dementia, and Korsakoff’s syndrome (KS). This chapter provides some synthesis of this literature to offer some clarity on cognitive dysfunction as it relates to alcohol and the manifestation of dementia as a result of chronic use, including discussion of the classic KS and related presentations. Alcohol dependency is commonly associated with a number of neurological impairments including deficits in abstract problem solving, visuospatial and verbal learning, memory function, perceptual-motor skills, and even motor function.
Kate Judge’s first glimpse of nursing leadership in action came the day she arrived at the University of Pennsylvania School of Nursing for an in-person interview to lead Penn Nursing’s development and alumni relations program. During her 8 years at Penn Nursing, she collaborated with a number of faculty members who were gifted in attracting philanthropy. Leadership in philanthropy combines a deep personal moral purpose and the perfect balance between impatience for immediate impact and a desire to achieve long-term outcomes. To be a nurse leader in philanthropy, one must expose oneself to other values, interests, and priorities. Nursing can assume a larger role in tomorrow’s health care delivery if it commands a larger portion of U.S. and global philanthropy. Finally, to be leaders in philanthropy, nurses need to educate themselves about the larger world and the values and issues that resonate with donors.
This chapter presents what it means to be a professional nurse, the difference between a career and an occupation, the seasons and stages of a nursing career, and the value of collegiality in a nursing career. Professional nurses are expected to expand their knowledge and expertise throughout the different stages of their careers in order to provide safe comprehensive health services to the public in accordance with contemporary best practices. The chapter highlights the key elements of professional nursing as described in Nursing’s Social Policy Statement, Code of Ethics for Nurses, Nursing: Scope & Standards of Practice, and a State Nurse Practice Act. All life and career developmental models acknowledge the central importance of support persons in the life and career journey of every human being. Professional nurses demonstrate collegiality with each other by respecting, mentoring, and advocating for nursing students and nursing colleagues.
Barry H. Smith’s opening is significant: that nursing care is at the core of humanity. He recounts his own experiences with nurses, when as a surgical resident he learned the value of team work, and developed a respect for the nurses who were so tuned in to the needs of the patients and families. Smith asserts that nurses must be the central point of any health care system, and yet many factors have converged to keep nurses in a subservient role within health care. Today, there are Nurses Aides, Licensed Practical Nurses, Registered Nurses, Nurse Practitioners, and those with doctorates in nursing, with an increasing premium being placed on advanced nursing clinical practice, as well as research. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
Disgust may seem like an odd topic to highlight in a book dedicated to enhancing patient-provider relationships, but it bears special consideration given that it is rarely openly discussed even though it is a common phenomenon. In the course of the authors’ work, clinicians are exposed to patients’ most basic human products: urine, feces, pus, blood, and vomit, to name a few. The authors encounter smells, see anatomical parts, hear bodily sounds, and touch things that people outside of health care can only imagine. Some of these things are very difficult to experience, and yet doing so is not only part of the job, but doing so graciously, with acceptance and sensitivity, is a gesture of compassion. Being in a state of mind to make that compassion happen is aided by mindfulness. This chapter provides an example of a forty five year-old woman with end-stage pancreatic cancer.
Listening is an obvious and often overlooked aspect of high-quality patient care. Given the environment in which modern health care is provided, the ability to stop, shift, and turn one’s full attention to a patient and family, to their thoughts, feelings, and needs, means having to temporarily “turn off and tune out” all manner of distractions. Being able to focus is a core aspect of mindfulness. To engage in quality listening is a commitment, made over and over again, in the service of effective patient care. Vulnerable patients who express doubt about the suitability of their treatment or question the clinician’s opinion run considerable risk of being marginalized or treated with dismissive indifference. When a patient challenges a provider’s perspective, conclusion, or diagnosis, the clinician needs to honor that challenge; have the emotional maturity and humility to use the patient’s concerns as data.
This chapter explores the importance of risk prevention in mentor relationships, about potential roadblocks for mentors and protégés, and how to manage change in the mentoring experience. Good risk prevention includes agreeing with nurse’s mentors on basic expectations about their goals and outcomes, frequency of contact, roles their mentor can play, expected performance of both partners, and how to address problems if they arise. Studies have reported various types of mentoring relationship problems such as unrealistic expectations, personal and professional mismatches, power and control issues, excessive competitiveness, “cloning”, communication, and dependence. Abuses of power in the mentor relationship occur when there are instances of manipulation, exploitation and excessive demands of loyalty and conformity by the mentor. Frequent, open, and honest communication is the foundation of healthy mentor relationships. The power and magic of mentor relationships are reflected in the achievements, joyful sharing, and professional and life connections between mentoring partners.
This chapter presents how to create a Personal Mentor Action Plan, types of mentors and where to find them, selection process of the mentor and the protégé, and how to inventory individuals and groups as potential mentors. The elements of this Action Plan are vision and goals, mentoring strategies, implementation activities, and mentoring outcomes. Potential mentors can be found at nurse’s workplace, conferences, classrooms, clinical units, meetings, and conventions. Two main types of mentor relationships will boost nurse’s career development: relationships that are “chosen” by the mentor and protégé, and relationships in which mentors and protégés are “matched” or assigned in a formalized program. “Assigned” mentors are found in on-the-job mentor programs, professional associations, specialty nursing organizations, and community volunteer programs. Currently, professional nursing and student associations are very proactive in offering formal mentor programs that address their members’ needs in various ways.
Frontotemporal dementia (FTD) is the third leading cause of dementia in large pathological series but tends to have an earlier age of onset than Alzheimer’s disease (AD) and Lewy body dementia, the most frequent and second most frequent forms of dementia. Semantic dementia (SD) includes impairment in the understanding of the meanings of words and difficulty in identifying objects. Semantic primary progressive aphasia, also known as SD, includes difficulties with naming and single-word comprehension although grammar and fluency are often spared. SD is a disorder that involves loss of semantic memory, anomia, receptive aphasia, and an actual loss of word meaning. The chapter presents some assessment tools that are those conducted by a psychologist or a neuropsychologist. Such an evaluation should include a clinical interview and neuropsychological examination. SD has been associated with ubiquitin-positive, TAR-DNA-binding protein-43 (TDP-43)-positive, tau-negative inclusions.
The range of emotions experienced by clinicians spans the spectrum of human emotions in general, but certain emotions are particularly challenging for those working in health care settings. Anxiety can be an almost constant companion for the first year or two of practice, until time and experience help them begin to feel more comfortable in their roles. Through consistently witnessing the suffering of others, clinicians can easily absorb their patients’ sadness, frustration, and even despair. Horror, grief, shock, and outrage are normal responses that many clinicians experience when faced with patients whose suffering comes as the result of violent or traumatic events. Tired and fatigued, some clinicians hope to call upon the psychiatry service to contend with the patients who dramatically display suffering. This can occur in situations where the patient’s emotions are quite understandable, and are no reflection of psychopathology. Mindfulness provides a framework for mentally processing distress-provoking situations.
This chapter discusses how to find and keep mentors, compatibilities that contribute to the mentoring “match”, ground rules for productive mentoring, and transitions in the mentor-protégé relationship. Nurses find that they benefit from both expert and peer mentors, particularly at transitional points throughout their career. Openness and a curiosity to learn are crucial qualities in a mentor relationship. In the early stages of the relationship, the mentoring partners should discuss and mutually agree on: goals and expectations, time management, work approaches and boundaries, and feedback opportunities. From the beginning of the mentor relationship through each evolving phase, it is essential to engage in ongoing review and evaluation of the protégé’s changing needs, career goals, personal expectations, and key outcomes. Review and evaluation help both mentor and protégé to gain insight and confidence to move forward with new challenges and new goals. Reciprocal rewards are always part of mentoring outcomes.
Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.
Vascular dementia (VaD) is an umbrella term representing a clinical grouping with inherent heterogeneity in its clinical manifestations reflecting a variability in its underlying etiology. This chapter discusses specific presentations that can fall under the VaD heading. It includes discussion of multi-infarct dementia (MID) and dementia associated with lacunar states (LSs), as well as Binswanger’s disease (BD), which remains embroiled in controversy. The chapter discusses cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and moyomoya disease due to their clinical overlap. The etiology of MID is in many ways the same as the etiology of cerebrovascular disease (CVD) in general and even late-life dementia. The term MID itself is used to describe a disorder characterized by a stepwise deterioration of cognitive functioning associated with strokes or accumulated transient ischemic attacks (TIAs).