Toward Healthy Aging : Human Needs and Nursing Response

by Ebersole, Hess & Luggen

• ISBN13: 9780323020121
• ISBN10: 0323020127
• Edition: 6th
• Format: Hardcover
• Copyright: 2003-10-22
• Publisher: Mosby

Summary

Toward Healthy Aging is a definitive, comprehensive source for health promotion and health maintenance in gerontologic nursing education. Noted for its use of Maslow's hierarchy of needs, this resource and its author team have been praised for the text's wellness-based and holistic approach; comprehensive coverage of common, as well as not-so-common, conditions in the older adult; accuracy of content; and pedagogic aids that promote student understanding. This popular resource provides a solid understanding of how to effectively provide holistic care, promote healthy lives, and address end-of-life issues and concerns. Instructor resources are available; please contact your Elsevier sales representative for details. Focus on health and wellness establishes a positive perspective to aging. Unique! Disease processes are discussed in the context of healthy adaptation, nursing support, and responsibilities to help the reader gain an understanding of a client's experience. Careful attention to age, cultural, and gender differences are integrated throughout to help nurses understand these important considerations in caring for older adults. Each chapter provides a consistent organization including objectives, case studies, research, and study questions/activities to make information easy to find and use. Assessment guidelines are incorporated throughout as tables, boxes, and forms to provide useful tools for practice. Case studies at the end of each chapter provide realistic situations to expand knowledge and understanding. Appendices and resource lists assist the reader in further exploration of material. Up-to-date content on AIDS provides the reader with important information related to this growing concern among older adults. Correlates with federal guidelines or Healthy People 2010 to help students integrate knowledge about healthy aging considerations. Unique! Wellness Diagnosis pyramids, based on Maslow's hierarchy of needs, help readers determine which diagnoses to consider when planning care for the older adult. Places greater emphasis on the needs of caregivers working with older adults in the home and community settings. Expands content on pharmacologic and nonpharmacologic pain management. Expands content on end-of-life issues and concerns for both the older adult and family/caregiver. The previous edition of Toward Healthy Aging won a national award from the Robert Wood Johnson Foundation for its coverage of this important topic. Incorporates new healthy aging strategies to maximize the healthiest behaviors of clients with dementia and their caregivers.

Author Biography

Ann Schmidt Luggen teaches in the graduate program at Northern Kentucky University.

Table of Contents

PART I FOUNDATIONS OF HEALTHY AGING
Geriatric Nursing and an Aging Society	1	(26)
The Study of Aging	1	(1)
Gerontology	2	(1)
The Biomedicalization of Aging	2	(1)
Organizations Devoted to Gerontologic Research and Practice	3	(1)
Development of Geriatric Nursing	3	(5)
Gerontic Nurse Pioneers and Leaders	3	(3)
Geriatric Nursing Education	6	(1)
Geriatric Nursing Roles	7	(1)
Aging Today	8	(8)
Demographics of Aging	8	(4)
Chronologic Age	12	(2)
Attitudes toward Aging	14	(1)
Research and Aging	14	(1)
Nursing Research	15	(1)
The Politics of Aging	15	(1)
The Business of Aging	16	(1)
Geriatric Nursing and Aging: The Future	16	(11)
The Nursing Shortage	19	(1)
Nurse Leaders and Followers	20	(7)
Theories of Aging	27	(29)
Early Theories of Aging	27	(1)
Life Span Theory Development	28	(1)
Anthropology and Ethnography of Aging	29	(1)
Evolutionary Basis for Aging	30	(1)
Perspectives on Aging	30	(1)
Biologic Theories of Aging	30	(9)
Stochastic Theories	31	(2)
Nonsochastic Theories	33	(6)
Psychologic Aspects of Aging	39	(6)
Morality	39	(1)
Competence	40	(1)
Self-View	40	(1)
Psychologic Tasks of Aging	40	(1)
Developmental Tasks and Status	40	(4)
Personality Styles and Phases	44	(1)
Psychosocial Theories of Aging	45	(1)
Disengagement	45	(1)
Activity	45	(1)
Continuity	45	(1)
Sociologic Aging	46	(10)
Social Gerontology	46	(1)
Life Course	46	(1)
Social Supports	47	(1)
Reciprocity	47	(1)
Longevity	47	(9)
Health and Wellness	56	(23)
Health	56	(5)
Health Continuum	61	(1)
Dimensions of Wellness	62	(10)
Self-Responsibility	62	(2)
Nutritional Awareness	64	(1)
Physical Fitness	65	(3)
Stress Management	68	(2)
Additional Methods of Stress Reduction	70	(1)
Environmental Sensitivity	70	(2)
Chronicity and Wellness	72	(7)
Chronicity	72	(1)
Wellness in Chronic Illness	72	(1)
Gender and Wellness	73	(6)
Age-Related Changes	79	(36)
Physiologic Questions	79	(17)
Structure and Posture	81	(1)
Skin, Hair, and Nails	82	(1)
Photoaging	83	(1)
Facial Changes	83	(1)
Loss of Tissue Elasticity	83	(1)
Body Composition	83	(1)
Cardiovascular Changes	84	(2)
Peripheral Vascular Changes	86	(1)
Respiratory Changes	87	(1)
Upper Airway	87	(2)
Renal Changes	89	(1)
Endocrine Changes	89	(1)
Gastrointestinal Changes	90	(2)
Nervous System Changes	92	(1)
Sensory Changes	92	(1)
Eye and Vision Changes	93	(1)
Auditory Changes	94	(2)
Immunologic Changes	96	(1)
Biochemical and Genetic Changes	96	(1)
Health Assessment	96	(3)
Assessment Tools	99	(3)
Physical Assessment	99	(1)
Functional Assessment	100	(1)
Mental Assessment	100	(1)
Integrated Assessments	101	(1)
Recording of Data	101	(1)
Nursing Diagnosis and the Aged	102	(13)
Appendix 4-A Normal Physical Assessment Findings in the Elderly	109	(3)
Appendix 4-B Geriatric Assessment Instrument to Be Used in Primary Care	112	(1)
Appendix 4-C Katz Index, Modified Barthel Index, and Functional Performance Tests	113	(2)
Laboratory Values and Diagnostics	115	(21)
Hematology	116	(6)
Bone Marrow	116	(1)
Red Blood Cells	116	(1)
Hemoglobin	116	(1)
Hematocrit	116	(5)
Erythrocyte Sedimentation Rate	121	(1)
White Blood Cells	121	(1)
Serum Chemistry	122	(1)
Serum Iron	122	(1)
Vitamin B12	122	(1)
Folic Acid	122	(1)
Endocrine	122	(1)
Blood Chemistry	123	(3)
Glucose	123	(1)
Creatine Kinase	124	(1)
Troponin	124	(1)
Alkaline Phosphatase	124	(1)
Alanine Aminotransferase/Serum Glutamic Pyruvic Transaminase	124	(1)
Aspartate Aminotransferase	124	(1)
Serum Albumin	124	(1)
Cholesterol	125	(1)
Triglycerides	125	(1)
Calcium	125	(1)
Uric Acid	126	(1)
Prostate-Specific Antigen	126	(1)
Renal Tests	126	(2)
Urine	126	(1)
Urinalysis	126	(1)
Creatinine Clearance	127	(1)
Bacteriuria	127	(1)
Electrolytes	128	(2)
Dehydration	128	(1)
Potassium	128	(1)
Sodium/Hyponatremia	128	(2)
Hypernatremia	130	(1)
Acid-Base Metabolism	130	(1)
Long-Term Care	130	(1)
Specimen Collection	131	(5)
Phlebotomy	131	(1)
Clean-Catch Urine Specimens	132	(4)
PART II BASIC BIOLOGIC NEEDS
Managing Basic Physiologic Needs	136	(39)
Nutritional Needs	137	(16)
Food Guide Pyramid	137	(2)
Recommended Dietary Allowance	139	(1)
Factors Affecting Fulfillment of Nutritional Needs	140	(3)
Problems in Nutrition	143	(6)
Ethics of Nutrition	149	(2)
Assessment	151	(2)
Intervention	153	(1)
Elimination	153	(3)
Bowel Function	154	(2)
Rest and Sleep	156	(7)
Biorhythm and Sleep	156	(1)
Normal Sleep Pattern	157	(3)
Assessment	160	(1)
Intervention	160	(3)
Evaluation	163	(1)
Activity	163	(12)
Assessment	164	(2)
Exercise Programs	166	(1)
Senior Games	166	(3)
Different Forms of Exercise	169	(1)
Special Needs of Elderly People	169	(1)
Safety Considerations	169	(6)
Biologic Maintenance Needs	175	(30)
Dental Health	175	(9)
Changes in the Buccal Cavity during the Aging Process	176	(1)
Common Dental Problems	177	(2)
Assessment	179	(1)
Interventions	179	(2)
Assisting Dependant Elders	181	(1)
Homebound	182	(1)
Care of the Dentures	182	(2)
Dental Implants	184	(1)
Feet	184	(8)
Foot Problems in Old Age	185	(2)
Care of the Feet	187	(1)
Assessment	188	(1)
Interventions	189	(3)
Integument	192	(13)
Pigmentation Changes	195	(1)
Nerves	195	(1)
Glands	195	(1)
Hair	196	(1)
Nails	196	(1)
Photoaging	196	(1)
Skin Problems	196	(3)
Keratoses	199	(6)
Common Chronic Problems	205	(74)
Chronicity	205	(2)
Wellness in Chronic Illness	207	(1)
Chronic Illness and Aging	208	(3)
Scope of the Problem	208	(1)
Chronic Illness Trajectory	209	(1)
Special Considerations	210	(1)
Assessment	211	(2)
Activities of Daily Living and Instrumental Activities of Daily Living: ADLs and IADLs	212	(1)
Interventions	213	(3)
Caring	213	(1)
Small-Group Approaches to Chronic Illness	214	(1)
Group Support by Telephone	214	(1)
Adaptive Devices	214	(2)
Prevention of Iatrogenic Disturbances	216	(1)
Telephone Follow-up after Discharge	216	(1)
Rehabilitation and Restorative Care	217	(2)
Considerations in Planning Rehabilitation Care	217	(2)
Common Chronic Disorders	219	(42)
Diabetes Mellitus	220	(4)
Stroke and its Consequences	224	(2)
Pressure Sores (Pressure Ulcers)	226	(2)
Polymyalgia Rheumatica and Giant Cell Arteritis	228	(4)
Incontinence	232	(7)
Diverticulosis	239	(4)
Coronary Disease	243	(3)
Congestive Heart Failure	246	(4)
Vascular Insufficiency	250	(2)
Pernicious Anemia	252	(3)
Chronic Obstructive Pulmonary Disease	255	(3)
Asthma	258	(1)
Tuberculosis	259	(2)
Health Beliefs and Adherence in Chronic Illness	261	(1)
Compliance	261	(1)
Chronic Problems and Long-Term Care	262	(1)
Chronic Functional Disability and Home Care	262	(17)
Effects of Chronic Illness on the Family	263	(1)
Effects of Chronic Illness on the Individual	263	(8)
Appendix 8-A Barthel Index	271	(1)
Appendix 8-B Braden Scale for Predicting Pressure Sore Risk	272	(2)
Appendix 8-C Activities of Daily Living and Instrumental Activities of Daily Living	274	(3)
Appendix 8-D Minimum Data Set (MDS) Version 2.0 (Condensed) for Nursing Home Resident Assessment and Care Screening	277	(2)
Pain and Comfort	279	(27)
Acute and Chronic Pain	281	(1)
Pain in the Aged	281	(3)
Pain Control	284	(4)
Pharmacologic Pain Control	284	(2)
Nonpharmacologic Pain Control	286	(2)
Placebo	288	(1)
Pain Clinics	289	(1)
Nurse's Role	290	(16)
Assessment	290	(6)
Intervention	296	(2)
Evaluation	298	(7)
Appendix 9-A Pain Control Plan	305	(1)
Geropharmacology	306	(31)
Trends in Health Care that Affect Medications in Elders	307	(1)
Pharmacokinetics	307	(4)
Absorption	307	(1)
Metabolism	308	(2)
Distribution	310	(1)
Excretion	310	(1)
Pharmacodynamics	311	(1)
Problems with Drug Therapy and their Prevention	312	(6)
Adverse Drug Reactions	312	(1)
Drug-Drug Interactions	313	(1)
Natural Product-Drug Interactions	313	(3)
Food-Drug Interactions	316	(1)
Drug Allergy	316	(1)
Drugs and Sexuality	317	(1)
Nursing Role and Interventions	318	(1)
Monitoring	318	(1)
Advocacy Role	318	(1)
Patterns of Drug Use	318	(12)
Polypharmacy	318	(2)
Self-Prescribing of Medications: Prescription, Over-the-Counter, and Herbal Drugs	320	(2)
Herbal Medicines	322	(1)
Medications Prescribed for Behavioral and Psychiatric Concerns	322	(1)
Noncompliance/Nonadherence	322	(1)
Applying Theory to Practice	323	(1)
Considering Provider Behavior: Guidelines for Safe Medication Practices	324	(4)
Patient Education: A Nursing Role	328	(1)
Self-Evaluation Questions	329	(1)
Teaching Safe Practices	329	(1)
Drug Use Assessment: The Interview	330	(7)
Outcomes	330	(7)
Herbs and Supplements	337	(10)
Uses	337	(1)
Herbs	337	(1)
Teas	338	(1)
Commonly Used Herbs and Teas	338	(1)
Herbal Interactions with Medications	339	(1)
Misuse	339	(2)
The Nurse's Role	341	(1)
Assessment	341	(1)
Diagnosis	341	(1)
Planning	341	(1)
Intervention	341	(1)
Evaluation	342	(1)
Education	342	(1)
Selected Conditions	342	(5)
Use by Transplant Patients	342	(1)
Hypertension	343	(1)
Human Immunodeficiency Virus-Related Symptoms	343	(1)
Gastrointestinal Disorders	343	(1)
Cancer	343	(1)
Alzheimer's Disease	343	(1)
Perioperative Assessment	343	(4)
Sensory Function	347	(31)
The Sensory Apparatus	347	(4)
Appreciation of Sensory Changes	348	(1)
Alteration in Sensory Experience	348	(3)
Healthy People 2010	351	(1)
Vision	351	(9)
Presbyopia	352	(1)
Dry Eye	352	(1)
Glaucoma	352	(1)
Cataracts	353	(3)
Diabetic Retinopathy	356	(1)
Macular Degeneration	356	(1)
Assessment of Vision	357	(1)
Caring for the Elder with Visual Impairment	357	(1)
Orientation Strategies for the Nonsighted	358	(2)
Hearing and Hearing Impairment in the Aged	360	(10)
Presbycusis	361	(1)
Prelingual Deafness	361	(1)
Cerumen Impaction	361	(1)
Tinnitus	362	(1)
The Hospitalized Hearing-Impaired Person	363	(7)
Taste and Smell	370	(2)
Taste	370	(1)
Olfaction	371	(1)
Perceptual Organization	372	(6)
Disorientation	372	(2)
Nursing to Integrate Sensory Stimuli	374	(4)
Mobility	378	(39)
Disorders Affecting Mobility	379	(2)
Falls	380	(1)
Falls: Causes and Consequences	381	(20)
Factors Contributing to Falls	381	(4)
Risk of Falling	385	(1)
Gait Disorders	386	(2)
Osteoporosis	388	(4)
Rheumatic Diseases of Older Adults	392	(7)
General Interventions to Manage Gait and Balance Disorders	399	(2)
Functional Restoration	401	(1)
Restraints	401	(4)
Physical and Chemical Restraints	401	(2)
Environmental Restraints	403	(2)
Mobility Aids	405	(12)
Assistive Devices	405	(2)
Transportation	407	(1)
Automobiles and Older People	407	(7)
Appendix 13-A Osteoporosis Functional Disability Questionnaire	414	(2)
Appendix 13-B Tinetti Balance and Gait Evaluation	416	(1)
PART III SAFETY AND SECURITY NEEDS
Environmental Safety and Security	417	(14)
Feeling Secure as One Ages	417	(1)
Influences of Changing Health and Disability on Safety and Security	418	(5)
Physical Vulnerability	418	(5)
Effects of Changing Life Situations	423	(1)
Auto Safety	423	(1)
Neighborhood Security	423	(1)
Crimes against the Elderly	424	(1)
Risks and Vulnerability	424	(1)
Fraudulent Schemes against Elders	424	(1)
Fire Safety for Elders	425	(2)
Risk Factors for Elders	425	(2)
Risk for Suicide and Self-Neglect	427	(4)
Economic, Health Care, and Legal Issues	431	(19)
Legal and Economic Needs and Concerns of Older Adults	433	(1)
Health and Planning for Care	433	(5)
Historical Background	433	(1)
Social Security	433	(2)
Medicare	435	(3)
Long-Term Care	438	(3)
Long-Term Care Insurance	440	(1)
Rights in Long-Term Care	440	(1)
Housing for Older Adults	441	(2)
Where Older Adults Live	441	(1)
Financial Concerns about Housing	442	(1)
Advocacy	443	(1)
Powers of Attorney	443	(1)
Guardians and Conservators	443	(1)
Consent	444	(1)
Advance Directives	444	(1)
Elder Abuse	444	(6)
Physical Abuse	445	(1)
Sexual Abuse	445	(1)
Emotional and Psychologic Abuse	445	(1)
Neglect	445	(1)
Financial Exploitation	445	(1)
Self-Neglect	445	(1)
Nursing Intervention	445	(5)
Frailty, Vulnerability, Neglect, and Abuse	450	(16)
Hardiness	451	(1)
Vulnerability	451	(2)
Physical Vulnerability	451	(1)
Economic Vulnerability	452	(1)
Ethnic Minorities and their Vulnerability	452	(1)
Vulnerability to Fraud	452	(1)
Spiritual Vulnerability	453	(1)
Frailty	453	(2)
Mental Frailty	453	(1)
Failure to Thrive	454	(1)
Elder Mistreatment	455	(1)
Neglect	455	(1)
Self-Neglect	456	(1)
Undue Influence	456	(1)
Abuse	456	(10)
Elder Violence in Domestic Settings	457	(2)
Principles of Working with Frail and Vulnerable Elders	459	(1)
Frail and Vulnerable Aged and their Future	460	(1)
Telecommunication Health Care Management	461	(5)
PART IV THE NEED TO BELONG
Intimacy, Sexuality, and Aging	466	(24)
Touch	466	(3)
Intimacy Levels of Touch	467	(1)
Touch Deprivation	468	(1)
Therapeutic Touch	469	(1)
Sexuality	469	(15)
Acceptance and Companionship	470	(1)
Femininity and Masculinity	470	(1)
Sexual Health	471	(1)
Age Variables	472	(3)
Alternative Sexual Lifestyles	475	(2)
AIDS and the Elderly	477	(1)
Sexual Dysfunction	478	(3)
Chronic Conditions and Sexuality	481	(2)
Sex in the Nursing Home	483	(1)
Nursing Roles and Functions	484	(6)
Assessment	484	(1)
Interventions	484	(1)
Evaluation	484	(6)
Relationships, Roles, and Transitions	490	(28)
Relationships	491	(1)
Friendships	491	(1)
Mentoring Relationships	491	(1)
Families	491	(5)
Blended Families and the Elderly	492	(1)
Couple Relationships	492	(1)
Lesbians, Gays, Bisexual, and Transgender Couples	492	(1)
Parental Relationship	493	(1)
Grandparenting	493	(2)
Great Grandparenting	495	(1)
Siblings	495	(1)
Other Kin	495	(1)
Caregiving Roles	496	(6)
Family Caregiving	496	(1)
Caring for Parents	497	(1)
Grandparents Raising Grandchildren	497	(1)
Spousal Caregiving	498	(1)
Role Reversal in Spousal Caregiving	499	(1)
Long-Distance Caregiving	499	(1)
Role of Nonfamily Caregivers	499	(1)
Role of Nursing Professionals in Providing Support for Caregivers	499	(3)
Transitions	502	(1)
Gender Considerations in Role Transitions	503	(1)
Retirement	503	(4)
Labor Force Participation	503	(1)
Retirement and the Work Role Transition	504	(1)
Retirement Planning	504	(2)
Early Retirement	506	(1)
Nurse's Role in Assisting in Retirement Preparation	506	(1)
Satisfaction in Retirement	507	(1)
Opportunities for New Development	507	(1)
Volunteerism	507	(1)
Health Care Volunteers	508	(1)
Peer Counseling	508	(1)
Volunteer Training and Roles	508	(1)
Widows and Widowers	508	(10)
Widowhood	509	(1)
Transitions in Widowhood	509	(1)
Widowers	510	(1)
Nurse's Role with Widows and Widowers	511	(1)
Divorce	511	(1)
Transition from Health to Illness	512	(1)
Roles of Client and Nurses	512	(6)
PART V SELF-ESTEEM
Gender and Culture	518	(32)
Differences Related to Birth Circumstance	518	(15)
Cohorts	518	(1)
Gender	519	(2)
Population Diversity	521	(4)
Culture	525	(1)
Assimilation and Adaptation	526	(1)
Cultural Competence and Sensitivity	527	(1)
Cultural Groups	528	(5)
Multicultural Nursing Perspectives	533	(10)
Cultural and Health Belief Systems	534	(1)
Culture and Health Practices	535	(3)
Caring for the Minority Elderly	538	(4)
Human Need Hierarchy	542	(1)
Integrating Concepts	543	(7)
Appendix 19-A Cultural Status Examinations	549	(1)
Rural Aging	550	(17)
Aging in Rural America	550	(2)
Rural Concepts	552	(4)
Definitions	552	(1)
Characteristics of Rural Older Adults	552	(2)
Health Status	554	(2)
Cultural Characteristics	556	(1)
Spirituality and Faith	556	(1)
Health Services	557	(2)
Rural Hospitals	557	(1)
Home Care	558	(1)
Nursing Homes	558	(1)
Informal Care	559	(1)
Rural Nursing	559	(8)
Key Concepts of Rural Nursing	560	(1)
Current Changes in Rural Nursing	561	(6)
Cognition	567	(33)
Cognitive Function	567	(18)
Adult Cognition	567	(1)
The Aging Brain	568	(1)
Learning in Later Life	569	(1)
Cognitive Impairment	570	(3)
Confusion	573	(3)
Irreversible Dementia	576	(9)
Interventions: Caring for the Person with Dementia	585	(9)
Basic Nutrition	586	(1)
Dealing with Agitation	586	(1)
Coping with Problem Behaviors	587	(1)
Improving Communication	587	(1)
Preventing Catastrophic Reactions	587	(2)
Reality Orientation	589	(1)
Validation Theory	590	(1)
Healthy Aging in Dementia: Environmental Alterations	590	(1)
Memory Enhancement	591	(1)
Support Groups	591	(1)
Caring for the Developmentally Disabled with Mental Retardation	591	(1)
Families of Patients with Dementia	592	(2)
Legal Issues in Geriatric Psychiatry	594	(6)
Establishing Competence	594	(1)
End-of-Life Decisions and Physician-Assisted Suicide	595	(5)
Stress, Crises, and Health in Aging	600	(16)
Stress	600	(4)
Acute Stress	600	(1)
Proximal Stressors	601	(1)
Distal Stressors	601	(1)
Chronic Stressors	601	(1)
Stressors Experienced in the Process of Aging	601	(2)
Assessment of Stress Levels	603	(1)
Stress Management	603	(1)
Crises	604	(2)
Posttraumatic Stress Disorder	604	(1)
Holocaust Survivors	605	(1)
``Acts of God''	605	(1)
Crisis Assessment	605	(1)
Emotions and Illness	606	(1)
Psychoneuroimmunology	606	(1)
Dependency and Loss of Control	606	(1)
Coping	607	(4)
Personal and Contextual Determinants of Coping	609	(1)
Hardiness and Buffers	609	(1)
Establishing Control	609	(2)
Wellness and Growth	611	(5)
Mental Wellness and Disturbances	616	(39)
Mental Health in Old Age	616	(6)
Mental Health Services for the Elderly	617	(2)
Demographics	619	(1)
Psychologic Assessment of Elders	619	(1)
Defenses	619	(3)
Psychiatric Disorders of Aging	622	(17)
Adjustment Disorders	622	(1)
Anxiety Reactions	623	(1)
Posttraumatic Stress Disorder	624	(1)
Obsessive-Compulsive Disorders	624	(1)
Substance Abuse and Addictions	625	(2)
Suspicion and Paranoia	627	(1)
Delusions	628	(1)
Hallucinations	628	(1)
Schizophrenia	629	(1)
Bipolar Disorder	629	(1)
Depression	630	(4)
Suicide	634	(5)
Therapeutic Strategies to Promote Mental Health	639	(6)
Community-Based Psychiatric Care	639	(1)
Psychotherapy	639	(6)
Nontraditional Therapy and Counseling	645	(10)
Peer Counseling	645	(1)
Self-Help Programs	645	(1)
Mobile Clinics	646	(6)
Appendix 23-A Depression Rating Scales	652	(3)
PART VI SELF-ACTUALIZATION
End-of-Life Issues	655	(46)
Loss, Grief, and Bereavement	655	(1)
Conceptual Underpinnings of Grief	656	(9)
Modernistic or Romantistic Approaches	657	(1)
Postmodern Era	657	(1)
Types of Grief	657	(2)
Grief Work	659	(1)
Grief Assessment	659	(2)
Interventions	661	(1)
Evaluations	662	(3)
Process of Dying	665	(8)
Nature of Dying	665	(1)
Dying Process	665	(2)
Nursing the Dying	667	(1)
Needs of the Dying	668	(3)
Spirituality and Hope	671	(1)
Dying and Family	672	(1)
Grieving and the Health Professional	673	(5)
Assessment	674	(1)
Intervention	675	(1)
Hospice: An Alternative	676	(2)
Current Issues in Death and Dying	678	(23)
Palliative Care	678	(1)
Advance Directives	679	(5)
Planning for the Care of Survivors	684	(6)
Appendix 24-A The Medical Directive	690	(5)
Appendix 24-B Durable Power of Attorney	695	(4)
Appendix 24-C Living Will Declaration	699	(1)
Appendix 24-D Definitions and Equivalent Language Examples for Key Issues	700	(1)
Self-Actualization, Spirituality, and Transcendence	701	(40)
Self-Actualization	702	(5)
Characteristics of the Self-Actualized	703	(1)
Self-Renewal	704	(1)
Learning and Growing in Later Life	705	(1)
Education for Elders with Special Needs	706	(1)
Peer Teaching and Learning	707	(1)
Collective Actualization	707	(1)
Politics and Power	708	(1)
Creativity	708	(4)
Creative Arts for the Elderly	709	(1)
Creative Arts and Theater	710	(2)
Recreation	712	(2)
Leisure	712	(1)
Natural World	713	(1)
Bringing Young and Old Together	714	(1)
Nursing and Self-Actualization	714	(1)
Spirituality	714	(6)
Study of Spirituality and Aging	715	(1)
Religion	716	(3)
Creative Health Care	719	(1)
Nursing Assessment and Intervention to Encourage Spiritual Well-Being	720	(1)
Transcendence	720	(10)
Gerotranscendence	723	(1)
Time Transcendence	723	(1)
Sexuality as a Transcendent Mechanism	724	(1)
Altered Mind States	724	(4)
Hope as a Transcendent Mechanism	728	(1)
Transcendence in Illness	729	(1)
Suicide as Transcendence	729	(1)
Nursing Interventions	730	(1)
Legacies	730	(4)
Autobiographies and Life Histories	730	(3)
Living Legacies	733	(1)
Self-Actualization, Transcendence, Legacies, and Nursing	734	(7)
Name Index	741	(19)
Subject Index	760