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.

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

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

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

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

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

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

This chapter presents two evidence-based practice (EBP) scenarios that illustrate how implementation of EBP requires an interprofessional collaborative team approach and a well-designed implementation plan. Nurses are at the heart of implementing EBP, and when they do not have team support, collaboration, and a well-thought-out implementation plan, success of an EBP project is unlikely. The chapter provides a review of fundamental concepts and strategies that must be considered with any model when implementing EBP projects. While not detracting from EBP models, the chapter provides suggestions and reminders for selecting key implementation strategies. EBP is becoming the standard for delivery of the best and most up-to-date patient-centered care. Undoubtedly, EBP implementation strategies are becoming a necessary component of the nurse's repertoire for the delivery of optimal care. The chapter outlines useful approaches to EBP implementation spanning from the inception of an EBP idea to the dissemination of the final EBP product.

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.