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Fundamentals of Nursing

TENTH EDITION

Patricia A. Po er, RN, MSN, PhD,

FAAN
Formerly, Director of Research, Patient Care Services, Barnes-Jewish
Hospital, St. Louis, Missouri

Anne Griffin Perry, RN, MSN, EdD,

FAAN
Professor Emerita, School of Nursing, Southern Illinois University
Edwardsville, Edwardsville, Illinois

Patricia A. Stockert, RN, BSN, MS,

PhD
Formerly, President, College of Nursing, Saint Francis Medical Center
College of Nursing, Peoria, Illinois
Amy M. Hall, RN, BSN, MS, PhD,
CNE
Professor and Dean, School of Nursing, Franciscan Missionaries of Our
Lady University, Baton Rouge, Louisiana
Table of Contents

Instructions for online access

Cover image

Title page

Copyright

Contributors

Reviewers

Dedication

Preface to the Instructor

Acknowledgments
Unit 1. Nursing and the Health Care
Environment

1. Nursing Today

Nursing as a Profession
 Historical Influences

Contemporary Influences

Trends in Nursing

Professional Registered Nurse Education

Nursing Practice

Professional Nursing Organizations

2. The Health Care Delivery System

Traditional Level of Health Care

Integrated Health Care Delivery

Issues in Health Care Delivery for Nurses

The Future of Health Care

3. Community-Based Nursing Practice

Community-Based Health Care

Community-oriented nursing

Community-based nursing

Community Assessment

Changing patients’ health

4. Theoretical Foundations of Nursing Practice

Theory
 Shared Theories

Select Nursing Theories

Link between Theory and Knowledge Development in Nursing

5. Evidence-Based Practice

The Need for Evidence-Based Practice

Nursing Research

Research Process

Performance Improvement

The Relationship Between EBP, Research, and Performance

Improvement

Unit 2. Caring Throughout the Life Span

6. Health and Wellness

Healthy People

Definition of Health

Models of Health and Illness

Variables Influencing Health and Health Beliefs and Practices

Health Promotion, Wellness, and Illness Prevention

Risk Factors

Risk-Factor Identification and Changing Health Behaviors

 Illness

Caring for Yourself

7. Caring in Nursing Practice

Theoretical Views on Caring

Patients’ Perceptions of Caring

Ethic of Care

Caring in Nursing Practice

The Challenge of Caring

8. Caring for Patients With Chronic Illness

The Prevalence and Costs of Chronic Disease

Multifactorial Nature of Chronic Disease

Physical Effects of Chronic Illness

Psychosocial Needs of Patients with Chronic Illness

Growth AND Development Considerations

Family Caregivers

The Chronic Care Model

Implications for Nursing

Health Promotion and Disease Prevention

Public Policy
9. Cultural Competence

World View

Health Disparities

Racial, Ethnic, and Cultural Identity

Disease and Illness

A Model of Cultural Competence

Cultural Awareness and Knowledge

Cultural Skill

Cultural Encounter

Cultural Desire

10. Family Dynamics

The Family

Family Forms and Current Trends

Family Nursing

Family-Centered Care and the Nursing Process

11. Developmental Theories

Developmental Theories

12. Conception Through Adolescence

Stages of Growth and Development

 Selecting a Developmental Framework for Nursing

Intrauterine Life

Transition from Intrauterine to Extrauterine Life

Newborn

Infant

Toddler

Preschoolers

School-Age Children and Adolescents

School-Age Children

Adolescents

13. Young and Middle Adults

Young Adults

Middle Adults

14. Older Adults

Variability Among Older Adults

Myths and Stereotypes

Nurses’ Attitudes Toward Older Adults

Developmental Tasks for Older Adults

Community-Based and Institutional Health Care Services

 Assessing the Needs of Older Adults

Addressing the Health Concerns of Older Adults

Older Adults and the Acute Care Setting

Older Adults and Restorative Care

Unit 3. Critical Thinking in Nursing Practice

15. Critical Thinking in Nursing Practice

Clinical Judgment in Nursing Practice

Critical Thinking Defined

Levels of Critical Thinking in Nursing

Critical Thinking Competencies

Nursing Process Competency

A Critical Thinking Model for Clinical Decision Making

Developing Critical Thinking Skills

Managing Stress

Critical Thinking Synthesis

16. Nursing Assessment

Critical Thinking in Assessment

The Nurse-Patient Relationship in Assessment

The Patient-Centered Interview

 Nursing Health History

The Assessment Process

17. Nursing Diagnosis

Types of Diagnoses

Terminologies for Nursing Diagnoses

Critical Thinking and the Nursing Diagnostic Process

Use of Nursing Diagnosis in Practice

Sources of Diagnostic Error

Documentation and Informatics

Nursing Diagnoses Application to Care Planning

18. Planning Nursing Care

Establishing Priorities

Critical Thinking in Setting Goals and Expected Outcomes

Critical Thinking in Planning Nursing Care

Systems for Planning Nursing Care

Consulting with Health Care Professionals

19. Implementing Nursing Care

Standard Nursing Interventions

Critical Thinking in Implementation

 Implementation Process

Direct Care

Indirect Care

Achieving Patient Goals

20. Evaluation

Standards for Evaluation

Critical Thinking in Evaluation

Collaborate and Evaluate Effectiveness of Interventions

Document Outcomes

Evaluation of Health Care

21. Managing Patient Care

Building a Nursing Team

Leadership Skills for Nursing Students

Unit 4. Professional Standards in Nursing

Practice

22. Ethics and Values

Basic Terms in Health Ethics

Professional Nursing Code of Ethics

Values
 Approaches to Ethics

Nursing Point of View

Issues in Health Care Ethics

23. Legal Implications in Nursing Practice

Legal Limits of Nursing

Federal Statutes Impacting Nursing Practice

State Statutes Impacting Nursing Practice

Legal Implications and Issues Associated with Nursing Practice

24. Communication

Communication and Nursing Practice

Elements of the Communication Process

Forms of Communication

Professional Nursing Relationships

Elements of Professional Communication

Nursing Process

25. Patient Education

Standards for Patient Education

Purposes of Patient Education

Teaching and Learning

 Domains of Learning

Basic Learning Principles

Nursing Process

26. Informatics and Documentation

Purposes of the Health Care Record

Interprofessional Communication Within the Health Record

Standards and Guidelines for Quality Nursing Documentation

Methods of Documentation

Common Record-Keeping Forms Within The Electronic Health

Record

Documenting Communication With Providers and Unique

Events

Acuity Rating Systems

Documentation in the Long-Term Health Care Setting

Documentation in the Home Health Care Setting

Case Management and use of Critical Pathways

Informatics and Information Management in Health Care

Unit 5. Foundations for Nursing Practice

27. Patient Safety and Quality

Scientific Knowledge Base

 Nursing Knowledge Base

Critical Thinking

Nursing Process

28. Infection Prevention and Control

Scientific Knowledge Base

Nursing Knowledge Base

Nursing Process

29. Vital Signs

Guidelines for Measuring Vital Signs

Body Temperature

Nursing Process

Pulse

Nursing Process

Respiration

Nursing Process

Blood Pressure

Nursing Process

30. Health Assessment and Physical Examination

Purposes of the Physical Examination

 Preparation for Examination

Organization of the Examination

Techniques of Physical Assessment

General Survey

Skin, Hair, and Nails

Head and Neck

Thorax and Lungs

Heart

Vascular System

Breasts

Abdomen

Female Genitalia and Reproductive Tract

Male Genitalia

Rectum and Anus

Musculoskeletal System

Neurological System

After the Examination

31. Medication Administration

Scientific Knowledge Base

Nursing Knowledge Base

 Critical Thinking

Nursing Process

Medication Administration

32. Complementary Therapies and Integrative Health

Complementary and Integrative Approaches to Health

Nursing-Accessible Therapies

Training-Specific Therapies

The Integrative Nursing Role

Unit 6. Psychosocial Basis for Nursing Practice

33. Self-Concept

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

34. Sexuality

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking
 Nursing Process

35. Spiritual Health

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

36. Loss and Grief

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

37. Stress and Coping

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

Unit 7. Physiological Basis for Nursing Practice

38. Activity and Exercise

 Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

39. Immobility

Scientific Knowledge Base

Nursing Knowledge Base

Nursing Process

40. Hygiene

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

41. Oxygenation

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process
42. Fluid, Electrolyte, and Acid-Base Balance

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

43. Sleep

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

44. Pain Management

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

45. Nutrition

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking
 Nursing Process

46. Urinary Elimination

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

47. Bowel Elimination

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

48. Skin Integrity and Wound Care

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Nursing Process

49. Sensory Alterations

Scientific Knowledge Base

 Nursing Knowledge Base

Critical Thinking

Nursing Process

50. Perioperative Nursing Care

Scientific Knowledge Base

Nursing Knowledge Base

Critical Thinking

Preoperative Surgical Phase

Transport to the Operating Room

Preanesthesia Care Unit

Intraoperative Surgical Phase

Nursing Roles During Surgery

Nursing Process

Postoperative Surgical Phase

Immediate Postoperative Recovery (Phase I)

Recovery in Ambulatory Surgery (Phase II)

Recovery of Inpatients: Postoperative Recovery and

Convalescence

Nursing Process

Glossary
Index

Special Features
Copyright
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Contributors
Kimberly Diane Baxter, DNP, APRN, FNP-BC, Associate Dean of
Undergraduate Programs, Orvis School of Nursing, University of
Nevada, Reno, Reno, Nevada

Sharon Ferguson Beasley, PhD, MSN, RN, CNE, Director,

Executive, Accreditation Commission for Education in Nursing
(ACEN), Atlanta, Georgia

Carolyn J. Wright Boon, MSN, BSN, Assistant Professor,

Nursing, Saint Francis Medical Center College of Nursing, Peoria,
Illinois

Jessica L. Bower, DNP, MSN, RN, Simulation Lab Coordinator,

Nursing Department, Pennsylvania College of Technology,
Williamsport, Pennsylvania

Karen Bri , DNP, RN-BC, CNE, Associate Professor, Nursing,

MCPHS University, Manchester, New Hampshire

Janice C. Colwell, RN, MS, CWOCN, FAAN, Advanced Practice

Nurse, Surgery, University of Chicago Medicine, Chicago, Illinois

Sarah Delgado, MSN, RN, ACNP, Clinical Practice Specialist,

Practice Excellence, American Association of Critical-Care Nurses,
Aliso Viejo, California

Bronwyn Doyle, PhD, RN, CNE, Associate Dean of

Undergraduate Nursing, School of Nursing, Franciscan Missionaries
of Our Lady University, Baton Rouge, Louisiana

Alice E. Dupler, MSN, JD, RN, CNP, Esq, Professor, Nursing,

School of Health Professions, University of Providence, Great Falls,
Montana

Jane Fellows, MSN, CWOCN-AP, Wound/Ostomy CNS,

Advanced Clinical Practice, Duke University Health System,
Durham, North Carolina

Linda Felver, PhD, RN, Associate Professor, School of Nursing,

Oregon Health & Science University, Portland, Oregon

Susan Fe er, BA, BSN, MSN, MBA, PhD

Professor Emeritus, College of Health and Human Services,
University of New Hampshire, Durham, New Hampshire;
Director of Research, Patient Care Services, Southern New
Hampshire Medical Center, Nashua, New Hampshire

Victoria N. Folse, PhD, APRN, PMHCNS-BC, LCPC, Director

and Professor; Caroline F. Rupert Endowed Chair of Nursing, School
of Nursing, Illinois Wesleyan University, Bloomington, Illinois

Kay Gaehle, PhD, MSN, Associate Professor, Department of

Primary Care and Health Systems Nursing, Southern Illinois
University Edwardsville, Edwardsville, Illinois

Lorri A. Graham, DNP-L, RN, Visiting Professor, Nursing,

Chamberlain University, Downers Grove, Illinois

Carla Armstead Harmon, PhD (Curriculum & Instruction), MSN,

BSN, Associate Professor, School of Nursing, Franciscan
Missionaries of Our Lady University, Baton Rouge, Louisiana

Susan Hendricks, EdD, MSN, RN, CNE, Professor and Dean,

School of Nursing, Indiana University Kokomo, Kokomo, Indiana

Maureen Hermann, BSN, MSN, DNP, RN, Associate Professor,

Nursing, Saint Francis Medical Center College of Nursing, Peoria,
Illinois
Tara Hulsey, BSN, MSN, PhD, Vice President and Dean, Nursing,
West Virginia University, Morgantown, West Virginia

Lenetra Jefferson, PhD, MSN, BSN, LMT

Nurse Educator, JeffCare, Jefferson Parish Human Services
Authority, Metairie, Louisiana;
Contributing Faculty, School of Nursing, Walden University,
Minneapolis, Minnesota;
Adjunct Faculty, School of Nursing, Troy University, Troy, Alabama

Noël Marie Kerr, PhD, Associate Professor, School of Nursing,

Illinois Wesleyan University, Bloomington, Illinois

Shari Kist, PhD, RN, CNE, Project Supervisor, Missouri Quality

Initiate for Nursing Homes, Sinclair School of Nursing, University of
Missouri-Columbia, Columbia, Missouri

Mary Koithan, PhD, MSN, BSN, Associate Dean and Anne

Furrow Professor, Student and Community Engagement, College of
Nursing, University of Arizona, Tucson, Arizona

Emily McClung, MSN, RN, PhD, Nursing Instructor, Hiram

College, Hiram, Ohio

Angela McConachie, FNP, DNP, Associate Professor, Faculty,

Goldfarb School of Nursing at Barnes Jewish College, St. Louis,
Missouri

Emily McKenna, APN, CNS, Illinois Neurological Institute, INI

Neurology, OSF St. Francis Medical Center, Peoria, Illinois

Theresa Miller, PhD, MSN, MHA, RN, Associate Professor,

Nursing, Saint Francis Medical Center College of Nursing, Peoria,
Illinois

Wendy Ostendorf, RN, MS, EdD, CNE, Contributing Faculty,

Master of Science in Nursing, Walden University, Minneapolis,
Minnesota
Jill Parsons, PhD, RN, Associate Professor, Nursing, MacMurray
College, Jacksonville, Illinois

Lyne e Savage, BS, BSN, MS, PhD, Associate Professor, Joint

Appointment, School of Health Professions, University of
Providence, Great Falls, Montana

Angela Renee Starkweather, PhD, ACNP-BC, FAAN, Professor

and Associate Dean for Academic Affairs, School of Nursing,
University of Connecticut, Storrs, Connecticut

Shellye A. Vardaman, PhD, Professor, School of Nursing, Troy

University, Troy, Alabama

CONTRIBUTORS TO PREVIOUS EDITIONS

Michelle Aebersold, PhD, RN

Jeane e Adams, PhD, MSN, APRN, CRNI

Paule e M. Archer, RN, EdD

Myra A. Aud, PhD, RN

Katherine N. Ayzengart, MSN, RN

Marjorie Baier, PhD, RN

Sylvia K. Baird, RN, BSN, MM

Karen Balakas, PhD, RN, CNE

Brenda Ba le, RN, BSN, MBA

Lois Bentler-Lampe, RN, MS

Janice Boundy, RN, PhD

Anna Brock, PhD, MSN, MEd, BSN

Sheryl Buckner, RN-BC, MS, CNE

Jeri Burger, PhD, RN

Linda Cason, MSN, RN-BC, NE-BC, CNRN

Pamela L. Cherry, RN, BSN, MSN, DNSc

Rhonda W. Comrie, PhD, RN, CNE, AE-C

Maureen F. Cooney, DNP, FNP-BC

Eileen Costantinou, MSN, RN

Cheryl A. Crowe, RN, MS

Ruth M. Curchoe, RN, MSN, CIC

Marine a DeMoss, RN, MSN

Christine R. Durbin, PhD, JD, RN

Margaret Ecker, RN, MS

Martha Keene Elkin, RN, MS, IBCLC

Antoine e Falker, DNP, RN, CMSRN, CBN, GCNS-BC

Leah W. Frederick, MS, RN CIC

Mimi Hirshberg, RN, MSN

Steve Kilkus, RN, MSN

Judith Ann Kilpatrick, RN, DNSc

Lori Klingman, MSN, RN

Karen Korem, RN-BC, MA

Gayle L. Kruse, RN, ACHPN, GCNS-BC

Anahid Kulwicki, RN, DNS, FAAN

Kristine M. L’Ecuyer, RN, MSN, CCNS

Jerrilee LaMar, PhD, RN, CNE

Joyce Larson, PhD, MS, RN

Kathryn Lever, MSN, WHNP-BC

Ruth Ludwick, BSN, MSN, PhD, RNC

Anne e G. Lueckeno e, MS, RN, BC, GNP GCNS

Frank Lyerla, PhD, RN

Deborah Marshall, MSN

Barbara Maxwell, RN, BSN, MS, MSN, CNS

Erin H. McCalley, RN, BSN, MS, CCRN, CCNS

Judith A. McCutchan, RN, ASN, BSN, MSN, PhD

Elaine K. Neel, RN, BSN, MSN

Patricia A. O’Connor, RN, MSN, CNE

Dula Pacquiao, BSN, MA, EdD

Nancy C. Panthofer, RN, MSN

Elaine U. Polan, RNC, BSN, MS

Beverly J. Reynolds, RN, EdD, CNE

Kristine Rose, BSN, MSN

Patsy L. Ruchala, DNSc, RN

Debbie Sanazaro, RN, MSN, GNP

Marilyn Schallom, RN, MSN, CCRN, CCNS

Carrie Sona, RN, MSN, CCRN, ACNS, CCNS

Ma hew R. Sorenson, PhD, APN, ANP-C

Marshelle Thobaben, RN, MS, PHN, APNP, FNP

Donna L. Thompson, MSN, CRNP, FNP-BC, CCCN-AP

Jelena Todic, MSW, LCSW

Ann B. Tritak, EdD, MA, BSN, RN

Janis Waite, RN, MSN, EdD

Mary Ann Wehmer, RN, MSN, CNOR

Pamela Becker Weili , RN, MSN(R), BC, ANP, M-SCNS

Joan Domigan Wen , BSN, MSN

Katherine West, BSN, MSEd,CIC

Terry L. Wood, PhD, RN, CNE

Rita Wunderlich, PhD, RN

Valerie Yancey, PhD, RN

 Reviewers

Dr. Colleen Andreoni, DNP, MSN APRN FNP-

BC, ANP-BC, ENP-C
Clinical Adjunct Faculty, Marcella Niehoff School of Nursing, Loyola
University Chicago, Maywood, Illinois
Nurse Practitioner, Med Express Urgent Care, Naperville, Illinois;
Nurse Practitioner, Emergency Department, Presence St. Joseph’s
Hospital, Elgin, Illinois

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