Essential Clinical Skills-Enrolled

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2021)_(0170454088)_(Cengage Learning
Australia) Joanne Tollefson
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 5 TH E D I T I O N

Essential Clinical Skills

ENROLLED NURSES

JOANNE TOLLEFSON | GAYLE WATSON

EUGENIE JELLY | KAREN TAMBREE

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
Essential Clinical Skills: Enrolled Nurses © 2022 Cengage Learning Australia Pty Limited
5th Edition
Joanne Tollefson Copyright Notice
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 iii

CONTENTS

Guide to the text v 3.10 Assisting the patient with colostomy care 99
Guide to the online resources viii 3.11 Patient comfort – pain management
Introduction x (non-pharmacological interventions –
New to this edition xi heat and cold) 103
About the authors xiv 3.12 Positioning of a dependent patient 107
Acknowledgements xv 3.13 Preventing and managing pressure injuries 111
3.14 Active and passive exercises 115
PART 1 3.15 Deep breathing and coughing, and use
HAND HYGIENE 1 of incentive spirometer 121
1.1 Hand hygiene 2
PART 4

PART 2 ASEPSIS AND WOUND CARE 125

4.1 Aseptic technique – establishing a general or
ASSESSMENT 6
critical aseptic field 126
2.1 Head-to-toe assessment 7
4.2 Simple dry dressing using a general
2.2 Risk assessment and risk management 12 aseptic field 132
2.3 Temperature, pulse and respiration (TPR) 4.3 Wound irrigation 138
measurement 18
4.4 Wound swab 143
2.4 Blood pressure measurement 23
4.5 Packing a wound – ‘wet-to-moist’ dressing 147
2.5 Pulse oximetry 28
4.6 Negative pressure wound therapy (NPWT)
2.6 Blood glucose measurement 31 dressing 152
2.7 Neurological observation 35 4.7 Suture and staple removal 157
2.8 Neurovascular observation 40 4.8 Drain removal and shortening 162
2.9 Pain assessment 44 4.9 Gowning and gloving (open and closed) 168
2.10 12-lead ECG recording 49 4.10 Surgical scrub (surgical hand wash) 173
4.11 Chest drains and underwater seal drainage
PART 3 (UWSD) management 177
ACTIVITIES OF DAILY LIVING 53
3.1 Professional workplace skills – including PART 5
time management, rounding and personal MEDICATION 182
stress management 54
5.1 Medication administration – oral, sublingual,
3.2 Bedmaking 60 buccal, topical and rectal 183
3.3 Assisting the patient to ambulate 64 5.2 Medication administration – eye drops or
3.4 Assisting the patient with ointment, and eye care 192
eating and drinking 68 5.3 Medication administration – injections 196
3.5 Assisting the patient to maintain personal 5.4 Medication therapy – inhaled medication
hygiene and grooming needs – sponge (metered-dose inhalers and nebulisers) 205
(bed bath) with oral hygiene, hair wash
5.5 Medication administration – via an
in bed, eye and nasal care 72
enteral tube 209
3.6 Assisting the patient to maintain personal
hygiene and grooming – assisted shower
(chair or trolley), undressing/dressing, PART 6
shaving, hair and nail care 79 INTRAVENOUS CARE 214
3.7 Assisting the patient with elimination – 6.1 Venepuncture 215
urinary and bowel elimination 86 6.2 Peripheral intravenous cannula (PIVC) –
3.8 Urine specimen collection and urinalysis 91 assisting with establishment 220
3.9 Faeces assessment and specimen collection 95

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
iv Contents

6.3 Peripheral intravenous cannula (PIVC) 8.7 Catheter care (including hourly urine
and therapy (PIVT) management 224 measurement) 324
6.4 Removal of a peripheral intravenous 8.8 Suctioning of oral cavity 329
cannula (PIVC) 231 8.9 Tracheostomy care 333
6.5 Intravenous medication administration – 8.10 Assist a patient to use CPAP in the
adding medication to PIVC fluid bag 235 general ward or community 338
6.6 Intravenous medication administration – 8.11 Nasogastric tube insertion 342
adding medication to a burette 240 8.12 Enteral feeding (nasogastric and
6.7 Intravenous medication administration – gastrostomy tube) 347
injection (bolus) 245 8.13 Infection control – standard and
6.8 Central venous access device (CVAD) transmission-based precautions 353
dressing 250 8.14 Care of the unconscious patient 360
6.9 Blood transfusion management 254 8.15 Palliative care and end-of-life care 365

PART 7 PART 9

DOCUMENTATION 260 MENTAL HEALTH CARE 371

7.1 Documentation 261 9.1 Mental state examination 372
7.2 Nursing care plans 265 9.2 Establishing a ‘therapeutic relationship’
7.3 Clinical handover – change of shift 269 in the mental health setting 377
7.4 Admission, discharge and patient transfer 273 9.3 Management of a client with challenging
7.5 Health teaching 279 behaviour (aggressive or violent) 382
7.6 Nursing informatics 284 9.4 Assist with the management of a client in
seclusion 388
PART 8
9.5 Electroconvulsive therapy (ECT) –
client care pre- and post-treatment 393
SPECIFIC NURSING CARE 288
8.1 Oxygen therapy (includes peak flow meter) 289
Appendix 398
8.2 Preoperative care 296
Index 407
8.3 Recovery room care and handover 302
8.4 Postoperative care 308
8.5 Nasogastric tube – gastric drainage 314
8.6 Catheterisation (urinary) 318

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
 v

Guide to the text
As you read this text you will find a number of features in every
chapter to enhance your study of essential clinical skills and help
you understand how the theory is applied in the real world.

PART OPENING FEATURES

2
Chapter list outlines
the chapters contained
in each part for easy
PART
reference.

ASSESSMENT

2.1 HEAD-TO-TOE ASSESSMENT

2.2 RISK ASSESSMENT AND RISK MANAGEMENT
2.3 TEMPERATURE, PULSE AND RESPIRATION (TPR) MEASUREMENT
2.4 BLOOD PRESSURE MEASUREMENT
2.5 PULSE OXIMETRY
2.6 BLOOD GLUCOSE MEASUREMENT
2.7 NEUROLOGICAL OBSERVATION
2.8 NEUROVASCULAR OBSERVATION
2.9 PAIN ASSESSMENT
2.10 12-LEAD ECG RECORDING

Note: These notes are summaries of the most important points in the assessments/procedures and are not exhaustive on the subject.
References of the materials used to compile the information have been supplied. The student is expected to have learnt the material
surrounding each skill as presented in the references. No single reference is complete on each subject.

CHAPTER OPENING FEATURES 7

2.1
Identify Indications
sections identify the
CHAPTER
clinical reasons to
perform the skill outlined
in the chapter.
6
HEAD-TO-TOE ASSESSMENT

BK-CLA-TOLLEFSON_5E-210155-Part_02.indd 6 26/07/21 2:47 PM

IDENTIFY INDICATIONS
The indication to perform a head-to-toe assessment is
usually contact with a healthcare facility or with healthcare
workers in the community. If the patient presents to a
healthcare facility, there is concern about their health and
they should be assessed accordingly. The patient may be
presenting to the healthcare facility for admission, and the
admission procedure of most facilities includes a thorough
assessment. The purpose of a health history is to formulate
a database incorporating historical and current data,
and to provide an opportunity for the nurse to develop a
trusting relationship with the patient. The interview provides
information on the patient’s perception of their health
concerns and learning needs. The head-to-toe assessment
should also be conducted any time the patient’s condition
changes. This allows the nursing staff to report accurately
and adequately to the doctor. Such an assessment provides
data on which nursing interventions are based and is a
key nursing action. The collection and organisation of
information about the patient assists the nurse to identify
existing or potential healthcare problems and to make
decisions based on accurate information to help the patient
return to a better state of health.
A briefer head-to-toe assessment should also be
conducted when completing other routine assessments,
such as vital signs, to gain an overall assessment of the
patient’s status or to gain further information when these
might vary from previous readings (North, 2017). The nurse
should also complete a brief head-to-toe assessment as part
of the shift handover, or soon after the commencement of
their shift (Haugh, 2015).

Copyright 2022 Cengage Learning. All Rights
GATHER EQUIPMENT
Gather equipment prior to starting the • weighing scales
procedure to maximise efficiency, reduce • height stick
apprehension on the patient’s part and • relevant facility forms.
Reserved. May not be copied, scanned, or duplicated, inTowhole
increase confidence in the nurse. The prepareor theinenvironment,
part. WCN ensure that the ambient
02-300
following equipment is required for head-to-toe assessment: temperature is comfortable and without draughts, there
• sphygmomanometer, stethoscope and blood pressure is sufficient light for the nurse to be able to examine the
(BP) cuff of appropriate size patient, the area is made private and there is provision for
 tucked into the dressing towel at the top of the
admission procedure
individualised care plans,of most facilities
work lists,includes
documenting a thorough of return
but aretoapplied
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in a different
contents inside the pack. These forceps (setting-up
assessment.
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health history is to formulate
and documenting A briefer head-to-toe
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virtual visits, also be a sense
forceps) are carefully picked up (at the ends that will
a database
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other items on the aseptic field. They are then placed
information on the patient’s perception of their health might vary from previous readings (North, 2017). The nurse
in the lower right-hand (or left-hand) area of the
concerns and learning needs. The head-to-toe assessment should also complete a brief head-to-toe assessment as part
sterile CASE
FEATURESfield, STUDY
where they can be accessed.
should also beWITHIN conductedCHAPTERS any time the patient’s condition of the shift handover, or soon after the commencement of
Unpack the remaining items in the pack using the
changes.
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a new employee the nursing staff to report accurately their
4. On shift
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Gather equipment sections list and explain each item of equipment
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fileof(Cedricneed to perform the clinical skill.
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edge of the field carewhere
planning they andcan patient
easily digital records. FIGURE 4.1.1
be picked Pouring fluid from
As part of your orientation you
up, but within the 5 cm border. Arrange the tray in the are given a personal staff ID information online related to the following changes.
GATHER
code in order EQUIPMENT
to access patient
middle section (where swabs and other equipment/ and hospital information. • Diet/fluids:
Perform hand hygiene patient can 2commence
.1: H E A d -Tclear
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E A S Sthis
ESSMENT 9
1. Why is it essential that you
materials can later be prepared) and other materials to do not share your staff ID evening
After
• all additional
weighing scales items have been placed on the
the backaccess third of andGather
the
equipment
thatfield.
you log priorentering
out after
Maintain
to starting
this format
the
relevant
after • Mobility: To sit out of bed twice daily; commence
procedure to maximise efficiency, reduce aseptic
• height field, perform
stick hand hygiene using ABHR
adding patient
and information?
arranging extra items.functioning by assessing to is ambulation after assessment by physiotherapist.
■■ Assess the musculoskeletal remove
an microorganisms
ongoing
•5. relevant process that and prevent to
continues cross-
provide data
2. What is theapprehension
potential outcome on theofpatient’s
not followingpart and When onfacility
placement forms.in a tertiary hospital, review the
motor function – for instance, raising limbs against contamination.
until the patient is discharged.

C H A P T E R 2 .1
increase confidence in the nurse.
loginThe To prepare patient
the environment, ensure that theand ambient
Add the necessary
workplace
gravity sterile
procedures
and resistance,
for supplies
and assessingusing
keeping your
strength a of and
details electronic record system available identify
following
workplaceequipmentsystems is required
secure? for head-to-toe assessment: temperature
how changes is comfortable
such as these and without
could bedraughts, there
successfully
non-touch
• handgrips techniquebilaterally.stethoscope
Assess range ofblood
movement Manipulating
Perform
is sufficient hand thehygiene
items using a non-touch
3. sphygmomanometer,
What is your responsibility if you are andunsure pressure
about how updated.light for the nurse to be able to examine the
(see
All packages Skill
(BP)
to
are
usecuff
3.14).
opened A
theoffacility
Falls
appropriate Risk
while
software?
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standing
size back must
from also
the technique
Maintain the 5 Moments
patient, the area is made private for and
Hand Hygiene
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is provision
be
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aseptic
• pulse oximeter out by
field using
to avoid the relevant
contaminants Falls Risk
falling perform
Rearranging hand
privacy anditems warmth.hygiene
on the aseptic field is done with and
after touching the patient
from•the Management
packaging tool
material(see Skill
onto 2.2).
the field (i.e. do not the patient’s
sterile forceps and surrounds.
included in commercial prepared packs.
Note:thermometer,
These notes arepenlight
summariestorch of theand
mostwatch
important points in the assessments/procedures, are not exhaustive on the subject. The naming of
open Assess skin
■■ packaging
documents or chartsintegrity
over maythe
differ according
sterile field).
from state to organisational
to state, These
and facility to facility. In all possiblecan be different
situations colours
the guidelines and the
of the ACSQHC aremost easily
used when describing
■■ Peelingpolicy.
national This
pouches.
charts may
Grasp
or documents encompass
the opposite
(e.g. the ACSQHCpressureedgesinjury
Observation therisk
of and two Chart
Response is named theof Adult Observationare andthe Response Chart in WA, and the
Rapid Detection andtattooing,
Response Observation Chart in SA). References CLEAN,
accessible
of the materials REPLACE
used to compile the informationOR
the forceps
haveDISPOSE
been supplied. TheOF
setting-up forceps
student is
PERFORMING
sidesassessment,
Challenge of the wrapper
theory HEAD-TO-TOE
and
you body
carefully
have piercing,
learnt peel
by infections
down,
considering fullythe NEW Give
(often Criticala clear
thinking
yellow). Theexplanation
boxes,
expected to have learned the material surrounding each skill as presented in the references. No single reference is complete on the subject. discussion.
the setting-up perhaps of
forcepsthe
in a procedure
group
and a second and
and other skin problems.
exposing the item (gauze squares, instruments, The relevant pressure setEQUIPMENT
establish therapeutic communication
of forceps are carefully picked up, ensuring that
ASSESSMENT
injury assessment
catheters, etc.). Without scalereaching
(e.g. Braden, acrossNorton,or nothing else isprocedure
touched by thegainnurse’s hands respect
or consent.
fingers.
Discuss
Cleaning theand replacing andequipment the shows
patient’s for
Waterlow
touching theor Glamorgan
aseptic field, drop Scale) theas item
per hospital
(or lift
CRITICAL THINKING The forceps
Giving
other a
staffare
clear then used
explanation
members, to
increases manipulate
is required
efficiency the
to items
gain
in the on
legal
unit
Hand
outpolicy hygiene
with should
the setting-up (see Skillonto
be usedforceps) 3.13 forthefurther
aseptic theand field.
consent If and
the forceps
develops to address
good arepolicy
used for
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requirements.
and work wet, keep
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thehygiene
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before injury
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the assessment).
within
patient the thealsotip assist
of thethe forceps lower than yourwith wristthe to prevent
Growth and Development patient to cooperate procedure,
5■ cm
or
■ Assess
the bowel
border.
patient’s Itemsfunction
are dropped
surrounds by
and questioning
from
prior toabout
any the patient
15 cm
procedure
1. Access the intranet at your work placement and review theliquids allay from
relevant running
documents
anxiety and down
relating
assist the
toinSkills forceps bya gravity
7.2 to 7.4.
establishing therapeutic and
so about
that the
involving the
patientfrequency
packaging contact and to regularity
material reduceand the your
How do you think these forms/paperwork may vary within the
ofpossibility
their bowel
hand do thenDOCUMENT
back to the tips AND
to
following types of facilities:
relationship. make REPORT
the forceps RELEVANT
unsterile.
not
of actions
touch and usual type
the aseptic
cross-contamination. field.
Handof stool
hygiene (e.g. is Bristol
the most Stool
■■ public hospital
Chart)method
Opening
■■ effective (see Skill of3.9).
solution/ampoules. infection Add liquids
control as itlast; ensure
removes
INFORMATION
These setting-up
The forcepsof
initial action are later used for
introducing cleansing
yourself to the
■■ private hospital and dryingand
patient of the key site
gaining their and then discarded.
consent will help the patient
■ Weight
there
transient
■ and height
is aorganisms
container are the
available
from measuredfor the
hands tofluid
of establish
the on the
nurse. the Documentation can be extensive. Facilities usually
■■ aged care facility to feel relaxed during the assessment. The more
have specific forms for the required information. If
bodyfield
aseptic massbefore index you
■■ community nursing?
(BMI). openAskit, about
and the readpatient’s
the label Perform the required procedure
to regular
ensure you dietary have intake. A malnutrition
the correct solution.screening Open no forms exist, document the data that you have
2. Consider how you would adapt a patient teaching session for Perform the required
a child aged 5 compared procedure
to an adult using
agedthe 30. principles
thetool may be used and
ampoule/sachet reviewedTwist
of solution. for at-risk
off the patients. of gathered in a systematic manner. Use the observation
3. Explain why nursing care plans should be individualised to each patient’s personal needs and their stage parts
the aseptic technique. Ensure all key of growthandand key
■ Assess the
■ampoule top genitourinary
and dispose offunctioning it in the rubbish by bag and assessment format described earlier or a systems
development. sites are protected. Sterile items should only be used
or questioning
tear back thethe patient
sachet at theabout markedurinary point activity
and and once, format to record the information. All vital signs
and then disposed of in the rubbish bag. Only
fold reproductive
back the flap. and sexual activity. Obtain a clean and other relevant data should also be recorded on
sterile items should come in contact with the key site.
■■ Seecatch FIGURE 4.1.1. Hold
specimen forthe urinalysis Skill 3.8). the observation and response chart (ORC). Respond
Chapter linkages refer you back (see
ampoule/sachetto important If there
directly Nurses must assess their patients for risk and
over aretheurinary
tray and
BK-CLA-TOLLEFSON_5E-210155-Part_02.indd symptoms,
7 about 10 these
cm up must be reported at
to prevent appropriately to the total score when recording the 26/07/21 2:47 PM
foundational skills and highlight the connection choose to use a critical aseptic field as opposed to a
once.
accidentally touching the aseptic field, and observations on this chart. The Australian Commission
between similar tasks, procedures and skills. general aseptic field if there is an increased chance
pour Following
slowly to completion
prevent splashes, of the head-to-toe
since moisture physical of on Safety and Quality in Health Care (ACSQHC, 2019)
infection. If a critical aseptic field is required, don
assessment, the patient
will contaminate the field by facilitatingshould be reassured and asked states that using the ORC correctly promotes accurate
surgical gloves using open gloving as per Skill 4.9.
to relay
microorganismany further information
movement through they think
the would
sterile be and timely recognition of deterioration in a patient’s
BK-CLA-TOLLEFSON_5E-210155-Part_07.indd 285 Refer to Skill 4.2 for further description of basic 26/07/21 4:02 PM
of assistance
drapes. Ensure in caring
you dofor notthem.contaminate the health status, plus prompt action. Any implemented
wound dressing technique. This basic dressing
solution when pouring. actions should also be documented on the chart in
technique (standard aseptic technique) and general
Ongoing
Analyse physical
in-depth Case assessment
studies that present issues the relevant section. Any other concerns not already
aseptic field can be adapted for more complex
in context, encouraging
Assessment of the patient you to integrate
does not stop when and apply the identified as needing to be reported can be reported to
wounds and procedures (e.g. Skills 4.3, 4.5 and 4.6) that
head-to-toe
the conceptsassessmentdiscussed and in the interview
chapterare to the complete. It require the RN or shift coordinator.
critical aseptic fields and a surgical aseptic
workplace.

CASE STUDY
1. Using a nursing history and assessment form from procedure. She is athletic and plays team netball, is
your facility,
BK-CLA-TOLLEFSON_5E-210155-Part_04.indd 129complete a basic assessment on a family generally fit and well, and does not have any significant 26/07/21 4:51 PM
member. Practise the required assessment skills, and medical history She has been fasting. Her observations
collect information about their health history. Follow are within the normal adult range. Besides completing
the processes of professional and effective patient her vital signs, what other head-to-toe assessments will
communication when completing this procedure. you perform?
2. Evelyn Deer is a 31-year-old woman admitted to your day
surgery ward this morning for a right knee arthroscopy
Note: These notes are summaries of the most important points in the assessments/procedures, and are not exhaustive on the subject. The naming of
documents or charts may differ from state to state, and facility to facility. In all possible situations the guidelines of the ACSQHC are used when describing
national charts or documents (e.g. the ACSQHC observation and Response Chart is named the Adult observation and Response Chart in WA, and the
Rapid detection and Response observation Chart in SA). References of the materials used to compile the information have been supplied. The student is
expected to have learned the material surrounding each skill as presented in the references. No single reference is complete on the subject.

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
 G U I D E TO T H E TE X T vii

END-OF-CHAPTER FEATURES

At the end of each chapter you will find several tools to help you to review, practise and extend your knowledge
of the key learning outcomes.
Extend your understanding through the suggested recommended readings relevant to each chapter.
At the end of each chapter you’ll find an essential skills competency table for you to review, practise and
record your growing competency for each clinical skill. 2 .7: N E u R o l o g I C A l o B S E R VAT I o N 39

ESSENTIAL SKILLS COMPETENCY

CHAP TER 2 .7
Neurological Observation
Demonstrates the ability to effectively assess the neurological status of the patient

Criteria for skill performance Y D

(Requires
(Numbers indicate Enrolled Nurse Standards for Practice, 2016) (Satisfactory)
• The key performance development)

criteria for an entire 1. Identifies indication (8.3, 8.4)

2. Gathers equipment (1.2, 1.6, 4.4, 6.4, 8.4, 9.4):
skill are listed, ■■ sphygmomanometer, BP cuff and stethoscope

not just a task or ■■ thermometer, watch with a second hand

■■ pulse oximeter
procedure, and ■■ penlight torch
■■ pen
the relevant NMBA ■■ neurological observation sheet (e.g. Glasgow Coma Scale)

National Competency 3. Performs hand hygiene (1.2, 1.4, 1.8, 3.9, 6.4, 9.4)

Standards are 4. Evidence of therapeutic communication with the patient; gives explanation of procedure,
gains patient consent (2.1, 2.3, 2.4, 2.5, 6.3)
included. 5. Demonstrates problem-solving abilities; e.g. modifies questions with regard to age,
culture and existing physical conditions, can describe warning postures
(4.1, 4.2, 8.3, 8.4, 9.4)
6. Assesses level of consciousness (1.2, 1.4, 3.2, 4.1, 4.2, 6.6, 7.1, 8.4, 9.4)
7. Assesses orientation of the patient (1.2, 1.4, 3.2, 4.1, 4.2, 6.6, 7.1, 8.4, 9.4)
8. Assesses motor response (1.2, 1.4, 3.2, 4.1, 4.2, 6.6, 7.1, 8.4, 9.4)

• There is space for 9. Assesses pupillary activity (1.2, 1.4, 3.2, 4.1, 4.2, 4.4, 6.4, 6.6, 7.1, 8.4, 9.4)

students and clinical 10. Assesses muscle strength and tone (1.2, 1.4, 3.2, 4.1, 4.2, 6.3, 6.6, 7.1, 8.4, 9.4)

facilitators to record 11. Assesses vital signs (1.2, 1.4, 3.2, 4.1, 4.2, 4.4, 6.4, 6.6, 7.1, 8.4, 9.4)
12. Performs hand hygiene (1.2, 1.4, 1.8, 3.9, 6.4, 9.4)
your performance
13. Cleans, replaces and disposes of equipment appropriately (1.2, 1.4, 3.9, 6.5, 9.4)
and progress.
14. Documents relevant information (1.2, 1.3, 1.8, 3.2, 5.3, 6.6, 7.1, 7.2, 7.3, 7.4, 7.5)
15. Demonstrates ability to link theory to practice (8.3, 8.4, 8.5, 9.4)

• Signature section for Student:

students and clinical Clinical facilitator: Date:
facilitators to record
assessment.

BK-CLA-TOLLEFSON_5E-210155-Part_02.indd 39 26/07/21 2:48 PM

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viii

Guide to the online resources

FOR THE INSTRUCTOR

Cengage is pleased to provide you with a selection of resources

that will help you to prepare your lectures and assessments,
when you choose this textbook for your course.
Log in or request an account to access instructor resources at
au.cengage.com/instructor/account for Australia or
nz.cengage.com/instructor/account for New Zealand.

COMPETENCY MAPPING GRID

The Mapping grid is a simple grid that shows how the content of this book relates to the units of competency
needed to complete the HLT54121 Diploma of Nursing.

INSTRUCTOR RESOURCES PACK

Premium resources that provide additional instructor support

are available for this text, including
Sample lesson plans
Sample care plans
Case studies plus case archive database
Downloadable logbook
Artwork from text

These resources save you time and are a convenient way to add
more depth to your classes, covering additional content and with an
exclusive selection of engaging features aligned with the text.
The Instructor Resource Pack is included for institutional adoptions
of this text when certain conditions are met.
The pack is available to purchase for course-level adoptions
of the text or as a standalone resource.
Contact your Cengage learning consultant for more information.

SAMPLE LESSON PLANS

Sample lesson plans provide a practical tool for your students to review and create sample lesson plans for a
classroom.

CASE STUDIES PLUS CASE ARCHIVE DATABASE

Case studies plus case archive database contains case studies that link the theory to real-world situations and
can be utilised in both the classroom and online student activities. Comprehensive solutions to each case study
question have been supplied for your use.

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 G U I D E TO T H E ON L I NE R ESO U R C ES ix

SAMPLE CARE PLANS

Sample care plans provide a practical tool for your students to review and create care plans as they would in
the workplace.

DOWNLOADABLE LOGBOOK
The downloadable logbook is designed to record a students evidence of experience. The word format enables
instructors to edit and customise to your institutions requirements.

ARTWORK FROM THE TEXT

Add the digital files of graphs, tables, pictures and flow charts into your learning management system, use
them in student handouts, or copy them into your lecture presentations.

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x
INTRODUCTION
The Nursing and Midwifery Board of Australia (NMBA)
(2016) Standards for Practice – Enrolled Nurses (see
the Appendix) were developed to guide workplace
performance and are the minimum requirements for
registration as a nurse. Nursing ‘Industry Reference
Committees’ have also liaised with the Australian
Nursing and Midwifery Accreditation Council and
used these standards to develop the Diploma of
Nursing qualification for use by the vocational
education and training sector in enrolled nursing
course content and for assessment of student
performance. The Diploma of Nursing qualification
has embedded these industry benchmarks. Students
and qualified enrolled nurses can achieve competence
in these required standards through the consistent
application of knowledge, skills and attitudes required
Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
to operate effectively within the workplace (NCVER,
n.d.). The nurse should also be able to transfer
skills and knowledge gained to new situations and
environments.
Essential Clinical Skills for Enrolled Nurses outlines
and explains the practical actions for completing skills
that contribute to the development of satisfactory
performance, underlying knowledge and required
clinical competence as an enrolled nurse (EN). Each
chapter contains descriptions of nursing skills and
underlying knowledge required within core units
of the Diploma of Nursing course, and some of the
elective units. Many of the skills are also required
within some units of the Advanced Diploma of
Nursing course.

NEW TO THIS EDITION
All the skills in this edition have been extensively
reviewed and edited, not only to reflect current
industry standards of practice, but also national
standards and recommendations from government
bodies such as the Australian Commission on Safety
and Quality in Health Care and the National Health
and Medical Research Council.
All skills within this text, along with the attached
skills grids, have been revised and updated according
to current industry standards. More images have
also been included. We have recognised the impact
of COVID-19 on the nursing workplace, and the
consequent impact on infection control. A greater
focus has been placed on donning and doffing
throughout this text to support student development
of these key skills when performing other procedures
and improve their infection control practices.
Critical Thinking and Lifespan boxes have been
included throughout the text to expand student
skills and understanding of different care situations.
The lifespan development helps students recognise
the different situations between paediatric and adult
patients.
Over 50% of the case studies are new or updated.
The case studies are designed to reinforce the students’
underlying knowledge of the relevant skill and the
ability to apply this to a clinical situation. Further
online resources are also available on the book’s
companion website.
Clinical skills assessment
Clinical skills performance is only one aspect of the
overall competency of an individual nurse. Assessment
in the VET sector (Department of Training and
Workforce Development, 2016) describes competence
as being able to consistently apply knowledge
and skills to required workplace standards. When
implementing relevant skills and knowledge, students
should also be able to plan and integrate several tasks
when delivering nursing care; recognise their own
scope of practice; meet workplace responsibilities
and expectations; and respond appropriately to
unexpected outcomes or occurrences. Performance
evidence that contributes towards a student’s
competence can be collected using many different
methods, including observation of performed skills
during nursing skills laboratories, in simulation-based
assessments and the workplace (i.e. during clinical
placement experience).
Students are novice practitioners (Benner, 1984)
who benefit from guidelines and direction, and
who need to have complex interactions simplified
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xi
into recognisable and achievable steps to enhance
learning and reduce distress. With the skills broken
down into steps, the student is more able to
concentrate on the complexities of the situation than
if the task were an overwhelming whole. Initially,
these skills are taught in the safety of the laboratory
using demonstrations and discussions from a skilled
and current nursing practitioner. They should then
be used together as part of simulation scenarios to
reinforce skill development, build critical thinking
skills and the student’s ability to individualise
patient care. The skills and the linked theory can be
read, digested, conceptualised and discussed before
the student completes required simulation-based
assessments or attempts the use of a new skill in the
workplace and on a vulnerable person. This increases
student confidence and fosters critical thinking
around the skill.
Using this clinical skills manual
This text has been developed as a guide to be used by
enrolled nursing students when they are learning new
skills. Students can use the skills grids to assess their
own performance, gain feedback on their performance
and maintain a personal record of skills they have
practised. Theory about each skill can help build and
consolidate knowledge about how or why a skill is
implemented.
The skill descriptions are generic and can be
adapted to meet organisation policies, different
workplace situations and patient needs. Organisational
policies and procedures must always be checked
before undertaking any procedure as they may create
variations on how a skill is completed. It is designed to
support the learning of skills required in the different
units of competence in the Diploma of Nursing in the
Health Training Package.
This text can be used in skills laboratories,
simulation scenarios, classroom lectures and clinical
placement in conjunction with demonstrations
and discussions of the various aspects of a skill.
The individual skills grids can give structure to a
skill that is being learnt by the student. The theory
provided before each skills grid is general and needs
to be adapted to, and integrated with, the specific
context (i.e. what type of facility, its geographical
location, the staff available, shift, time of day, day
of the week, season) and the individual differences
between patients (taking into consideration the age
and developmental stage of the patients, their culture,
gender, wellness, needs and desires, diagnosis, stress
levels and ability to communicate).
xii N e w t o t hi s e di t i o n
The theory underlying the skills has been gleaned
from a number of sources. This includes fundamental
nursing texts, searches of various databases and
government, medical and health related websites
(including publicly available nursing clinical practice
guidelines). Recent evidence-based material was
used. The databases searched included ProQuest
Health, CINAHL and Cochrane Library. Some nursing
care skills have limited evidence, or research-based
references, and the information is based on clinical
practice experience validated by peer input and review.
The information presented in each skill set is not
exhaustive in relation to the subject but does give the
student and assessor a mutual, basic understanding of
the procedure.
Guidelines for lecturers, clinical
facilitators and preceptors
Lecturers, clinical facilitators and preceptors need
to be skilled nurses, who are also emotionally
intelligent, confident of their own abilities,
understanding of how students learn and aware of
their own need for professional development. They
need to draw on these attributes to create safe and
positive student learning opportunities that will
support enrolled nursing students in gaining not
only their required skills, but also a positive vision of
their own career path. Experienced nurses, lecturers,
preceptors and clinical facilitators are able to integrate
theoretical principles and knowledge with realistic
practical application to a patient situation, and thus
become positive role models for students developing
these same clinical skills.
This text is not designed to be used as an actual
assessment tool, as each education facility will have
its own moderated and validated assessment tool for
use in clinical, laboratory and simulation settings.
It is designed to support these tools by providing a
guideline for how different skills should be completed
when collecting evidence of student performance.
The skills grids can be used by students to assess their
own performance, and gain formative learning or
peer assessment input during the practice of their
skills. The grids also provide a quick reference point
to refresh what is required to complete a nursing
skill when used on clinical placement. Columns
are provided for individual clinical skills to provide
feedback to the student being assessed as ‘Satisfactory’
or ‘Requires Development’. This skill achievement
would then be recorded within the educational
institution’s documentation for skills required.
Competence would be achieved when all required
skills and knowledge for the unit of competence have
been consistently and satisfactorily demonstrated over
a period of time.
Each exemplar in the skills grid is linked to one or
more of the interpretative cues in the Enrolled Nurse
Standards for Practice (NMBA, 2016). The number of
the appropriate professional standard indicator has
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been recorded beside each exemplar. This facilitates
linking the student’s performance with the relevant
standard. The lecturer, facilitator or preceptor can
gather many cues in relation to one competency
standard before giving the student feedback on their
performance. The student may then be given a verbal
or written observation of their progress for each
professional standard indicator.
Theoretical knowledge of a procedure should
be reviewed both before and after the procedure
to ascertain the student’s level of understanding
of the implemented nursing care, which will vary
according to the context and the individual patient.
When a student has implemented patient care and
the relevant skills, the facilitator/preceptor needs to
promote student self-assessment and reflection on
their performance, provide immediate constructive
feedback about the student’s performance and
ascertain their reasons for the actions they performed.
Feedback should be fair, relevant to their scope and
experience plus enable the student to determine when
they have met industry standards or areas that require
improvement and how they can improve. Always
create a plan with a student to engender their trust
in the learning environment and support them to
improve their clinical skills.
Students should be given feedback on their ability
to interact with the patient, to solve problems,
manage their time and resources, as well as
performing the procedure competently , cleaning up
afterwards and completing documentation. The two
or three pages that make up the theoretical section
of each skill give an overview of the procedure and
the items within each guideline that are mandatory
for the enrolled nursing student to know. As noted
at the end of these sections, the notes are summaries
of the most important points in the procedure and
are not exhaustive on the subject. The student is
expected to have read widely, attended laboratory
and classroom sessions and absorbed the material
from them, and discussed concerns with the lecturer,
clinical facilitator or preceptor, to broaden their
knowledge prior to implementing a skill in the
clinical setting.
Criteria for skill performance
The criteria for skill performance have been broken
into arbitrary sections. However, the entire skill should
be seamless. Students should not be assessed on
their first attempt to complete a procedure. Practice
improves performance and fosters confidence in the
student. The levels for completion – `Satisfactory’
and `Requires Development’ – are meant as a guide
for the student in their progress towards becoming a
confident and competent enrolled nurse practitioner.
Bondy (1983) describes degrees of performance in
clinical skill development and avoiding subjectivity.
These concepts have been recognised, but simplified to
reflect VET sector outcomes, within the two outcomes
 N e w t o t hi s e di t i o n xiii

used in the grids. A brief description of the levels for

completion follows:
Enrolled Nurse Standards for
■■ Satisfactory indicates that the student is able Practice
to complete the procedure/skill efficiently and
At the time of publication the current version
without any prompts or assistance from the clinical
of the Australian Nursing and Midwifery
facilitator on more than one occasion. This student
Accreditation Council Enrolled Nurse Standards
can discuss the theory as it relates to the practical
for Practice is available on the Nursing and
situation for the individual patient. The clinical
Midwifery Board of Australia website at http://www.
facilitator would feel confident that the student
nursingmidwiferyboard.gov.au/Codes-Guidelines-
is able to perform this procedure, or one similar,
Statements/Codes- Guidelines.aspx. Check the
without supervision.
website to ensure you are referring to the most current
■■ Requires development indicates that the student
standards.
is unable to complete the procedure without
For further information, visit the Australian
assistance (e.g. moderate amounts of verbal
Nursing and Midwifery Accreditation Council website
prompting, supervision to enable student
at http://www.anmac.org.au.
competence and confidence, or physical assistance
to complete the skill) from the clinical facilitator.
This student has difficulty linking theoretical References
knowledge to practical situations. The clinical Benner, P. (1984). From Novice to Expert: Excellence and Power in
facilitator would not allow this student to complete Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley.
this or a similar procedure without supervision. Bondy, K.N. (1983). Criterion-referenced definitions for rating scales in
As stated above, each number in the skills grid clinical evaluation. Journal of Nursing Education, 22(9), pp. 376–82.
relates to one or more of the EN standards for practice. Department of Training and Workforce Development. (2016).
This helps to link the skill to the relevant standards Assessment in the VET Sector (2nd ed.). Government of Western
indicator element. This text contains the major skills Australia https://www.dtwd.wa.gov.au/sites/default/files/uploads/
Assessment%20in%20the%20VET%20Sector%20-%202016%20-%20
taught in core units and some elective units of the
Final.pdf
undergraduate enrolled nurse programs throughout
National Centre for Vocational Education and Research (NCVER).
Australia. It also includes some of the skills that (n.d.). Glossary of terms. Retrieved from http://www.voced. edu.au/
are part of the Advanced Diploma of Nursing. It is content/glossary-term-competency
designed to be used throughout the entire program, Nursing and Midwifery Board of Australia (NMBA). (2016). Enrolled
both on clinical placement and in theory-building Nurse Standards for Practice. Dickson, ACT: NMBA.
encounters during each semester. At the end of their
course, students will have a personal record of the
skills they have practised throughout their nursing
education.

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xiv
ABOUT THE AUTHORS
Joanne Tollefson (RN, BGS, MSc, PhD) was Senior
Lecturer in the School of Nursing Sciences at James
Cook University. She is a registered nurse with many
years of clinical experience in several countries and
extensive experience in nursing education at both
the hospital and tertiary levels. Her research interests
include competency-based education and clinical
assessment, development of reflective practitioners
for a changing work environment, chronic pain and
arbovirus disease in the tropics. She is a two-time
recipient of the National Awards for Outstanding
Contributions to Student Learning (Carrick Award,
2007 and Australian Teaching and Learning Council
Award, 2008). Since retirement, she has maintained an
interest in nursing through researching, writing and
editing nursing textbooks.
Gayle Watson (RN, BNurs (Hons), MEd Studies,
Cert IV T&D) has more than 30 years’ experience in
nursing and nursing education, with a focus on the
VET sector. She has actively worked in the delivery
of the Diploma of Nursing, along with development
of program delivery and giving feedback as part of
statewide meetings to the planned 2021 update of the
Diploma of Nursing qualification. Her background
teaching experience includes classroom, nursing
laboratory, simulation laboratory and clinical
placement areas. She is currently employed in a senior
academic and leadership role in the nursing portfolio
at North Metropolitan TAFE (WA). During recent
years Gayle has focused on applying her research and
study interests of education into establishing enrolled
nursing education that promotes active and engaged
learners who become not just competent beginner
practitioners, but lifelong learners.
Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
Eugenie Jelly (RN, BAppSc[NsgEd], MEdMgt) is
a hospital-trained registered nurse whose career
progressed into the educational sphere, supported by
tertiary academic studies in that area. Her teaching
experience of over 40 years includes both registered
and enrolled nursing programs within hospital-based
schools of nursing, university and the TAFE sector.
Her work within TAFE has included curriculum
development, resource and assessment development,
course coordination and teaching in the classroom,
nursing laboratory and clinical area. She works
currently with an active focus on the supervision/
facilitation of nursing students on clinical placement,
along with other nursing laboratory and classroom
teaching.
Karen Tambree (RN, BNurs, GradCertTEd) has
worked as a nurse for more than 40 years. Her
area of expertise is palliative care and oncology,
both paediatric and adult. Karen has worked in
both the university and TAFE sector. Within the
university sector Karen has lectured within both the
undergraduate and master’s levels, and has been
involved in nurse education within the TAFE sector
for over 15 years. She is experienced in nursing course
development, resource development and leadership.
She has taught within the classroom, nursing
laboratory and clinical supervision. Karen originally
trained as an enrolled nurse and later completed
a Bachelor of Nursing and Graduate Certificate in
Tertiary Education. Karen is currently employed
within one of Perth’s university nursing programs.
 xv

ACKNOWLEDGEMENTS

The publisher would like to acknowledge Toni Bishop ■■ Michelle Hay-Chapman, Charlton Brown
for her contribution to the development of Essential ■■ Hellene Heron, TAFE SA
Clinical Skills. ■■ Shalet Mamachan, Job Training Institute,
The authors and publishing team would like to Dandenong
thank the following reviewers for their incisive and ■■ Susan Nursey, Skills Training Australia
helpful comments: ■■ Kathy Pearce, Charles Sturt University and TAFE
■■ Amanda Beetson, TAFE QLD South West Western
■■ Kylie Brennan, TAFE NSW Ultimo ■■ Vicki Smith, TAFE Gold Coast
■■ Ingrid Devlin, Health Skills Australia ■■ Carmel Storer, GoTAFE Benalla Campus
■■ Leanne Ferris, Manager for Curriculum and ■■ Diane Taylor, TAFE East Coast
Compliance with Mater Education Limited ■■ Herma Waters, ANMF (HERC)
■■ Annelize Grech, RDNS and Silverchain Training

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 PART
1
HAND HYGIENE

1.1 HAND HYGIENE

Note: These notes are summaries of the most important points in the assessments/procedures and are not exhaustive on the subject.
References of the materials used to compile the information have been supplied. The student is expected to have learnt the material
surrounding each skill as presented in the references. No single reference is complete on each subject.

1
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2
CHAPTER
1.1
HAND HYGIENE
IDENTIFY INDICATIONS
Hand hygiene is a basic infection-control measure that
reduces the number of microorganisms on the hands,
therefore reducing the risk of transferring microorganisms
to a patient. Hand hygiene encompasses both handwashing
and use of an alcohol-based hand rub (ABHR). Hand
hygiene reduces the risk of cross-contamination; that is,
spreading microorganisms from one patient to another. This
reduces the risk of infection among health care workers
and transmission of infectious organisms to oneself and
others. A current national priority in place by the Australian
Commission on Safety and Quality in Health Care (ACSQHC,
2019) is to reduce the number of healthcare-associated
infections (HCAIs). The COVID-19 coronavirus pandemic
reinforces the importance of hand hygiene.
GATHER EQUIPMENT
• Running water that can be regulated to
warm is most important. Warm water
damages the skin less than hot water,
which opens pores, removes protective
oils and causes irritation. Cold water is less effective at
removing microorganisms and can be uncomfortable.
• The sink should be of a convenient height and large
enough that splashing is minimised since damp
uniforms/clothing allow microbes to travel and grow.
• Soap or an antimicrobial solution is used to cleanse
the hands. The choice is dictated by the condition of
PERFORM HAND HYGIENE
Prepare and assess hands
Preparation of hands includes inspection for any
lesions, open cuts and abrasions. Removal of jewellery
ensures the principles of ‘bare below elbow’ are
followed. These precautions protect both the nurse
and the patient and will determine whether further
precautions are needed; for example, gloving or
non-contact (some agencies prevent nurses with open
Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
Hand Hygiene Australia recommends ‘5 Moments for
Hand Hygiene‘:
1. before touching a patient
2. before a procedure
3. after a procedure or body fluid exposure risk
4. after touching a patient
5. after touching a patient’s surroundings.
Hand hygiene must also be performed before putting on
gloves and after the removal of gloves.
Contact with contaminated hands is a primary source of
hospital-acquired infection. Not only does the nurse need
to be diligent in handwashing, but also in educating both
patients and family members of the importance of effective
hand hygiene.
the patient – antimicrobial soap is recommended if the
nurse will attend immuno-suppressed patients or the
pathogens present are virulent.
• A convenient dispenser (preferably non-hand-operated)
increases hand hygiene compliance.
• Paper towels are preferred for drying hands because
they are disposable and prevent the transfer of
microorganisms. Ensure the paper towels are removed
without contaminating the remaining paper towels,
which could lead to cross-infection.
lesions from caring for high-risk patients). Jewellery
harbours microorganisms. Removing jewellery will
reduce the potential risk of infection. A simple
wedding band may be left on, but must be moved
about on the finger during hand hygiene so that soap/
gel and friction are applied to the metal and to the
underlying skin to dislodge dirt and microorganisms.
Following the policy of the organisation so that
the touching of hair or clothing does not later
contaminate clean hands. Long or artificial nails, or
nails with chipped or old nail polish, have been linked

to outbreaks of infection and should all be removed
(National Health and Medical Research Council,
2019).
Turn on the water flow
Using whatever mechanism is available (hand, elbow,
knee or foot control), establish a flow of warm water.
Flowing water rinses dirt and microorganisms from
the skin and flushes them into the sink.
Thoroughly wet hands and apply soap
Do not touch the inside or outside of the sink. The
sink is contaminated and touching it will transfer
microorganisms onto the nurse’s hands. Wet hands
to above the wrists, keeping hands lower than elbows
to prevent water from flowing onto the arms and,
when contaminated, back onto the clean hands. Add
liquid soap or an antimicrobial cleanser. Five millilitres
is sufficient to be effective; less does not effectively
remove microbes. More soap would be wasteful of
resources. Lather hands to above the wrists.
Clean under the fingernails
Under the nails is a highly soiled area and high
concentrations of microbes on hands come from
beneath fingernails. The area under the nails should
be cleansed thoroughly.
Wash hands
Lather and wash your hands for a period of not less
than 30 seconds before care or after care if touching
‘clean’ objects (clean materials, limited patient contact
such as pulse-taking), and 1 to 2 minutes if engaged in
‘dirty’ activities (Hand Hygiene Australia, 2017), such
as direct contact with excreta or secretions. A surgical
handwash will take 3 to 6 minutes, depending on
policies.
Rub one hand with the other, using vigorous
movements since friction is effective in dislodging
dirt and microorganisms. Pay particular attention to
palms, backs of hands, knuckles and webs of fingers.
Dirt and microorganisms lodge in creases of the hands
and fingers. Lather and scrub up over the wrist, and
onto the lower forearm if doing a longer wash to
remove dirt and microorganisms from this area. The
wrists and forearms are considered less contaminated
than the hands, so they are scrubbed after the hands
to prevent the movement of microorganisms from
a more contaminated to a less contaminated area.
Repeat the wetting, lathering with additional soap and
rubbing if hands have been heavily contaminated.
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1.1: H an d h y g i ene 3
Rinse hands
C H A P T E R 1.1
Rinse the hands and fingers under running water to
wash microorganisms and dirt from skin, and prevent
residual soap from irritating the skin.
Dry hands
Using paper towels, dry hands commencing at the
fingers, hands and then the forearm. Dry well to
prevent chafing. Damp hands are a source of microbial
growth and transfer, as well as contributing to chafing
and then lesions of the hands.
Turn off taps
Using dry paper towels, turn hand-manipulated taps
off, taking care not to contaminate hands on the
sink or taps. Carefully discard paper towels so that
hands are not contaminated. Turn off other types
of taps with foot, knee or elbow as appropriate.
After several washes, hand lotion should be applied
to prevent chafing. Frequent hand hygiene can be
very drying and chafed skin becomes a reservoir for
microorganisms.
ALTERNATIVE HAND HYGIENE
Apply alcohol-based hand rub as required
ABHR is now considered the gold standard of care
for hand hygiene. Hand hygiene using a waterless,
ABHR has been demonstrated to reduce the microbial
load on hands when 5 mL of the 70% ethanol-based
solution is vigorously rubbed over all hand and finger
surfaces (pay the same attention to the palms, back of
the hands, finger webs, knuckles and wrists as during
the traditional handwash) for 30 seconds. The use of
such a rub is effective for minimally contaminated
hands. It increases compliance and reduces skin
irritation. Thorough handwashing is still required
for contaminated hands or following ‘dirty’ activities
(Hand Hygiene Australia, 2017).
Hands must be visibly clean and dry prior to using
the ABHR.
Further information
The National Hand Hygiene Initiative has an online
learning package accessible from the site for correct
handwashing, with the ability to create a certificate
once you have studied the package. This certificate
can be used as an assessment tool and some hospitals
require students to present it before commencing
clinical practice in that area.
 4 PA R T 1: H A N D H YGI E N E
PA R T 1

SOURCE: REPRINTED FROM SAX, 2007 WITH PERMISSION FROM ELSEVIER.

FIGURE 1.1.1 5 Moments for Hand Hygiene

CASE STUDY
During the COVID-19 global pandemic, hand hygiene was 2. Why is hand hygiene so important in reducing the
the key message sent from the World Health Organization spread of COVID-19?
(WHO) and health authorities worldwide. 3. For how long should you wash your hands?
Answer the following questions as an enrolled nurse 4. When would you use an alcohol-based hand gel as
working in a tertiary hospital in Australia. opposed to performing a soap and water wash?
1. Where would you find the relevant information on the
precautions you need to take when nursing a patient
with COVID-19?
Note: These notes are summaries of the most important points in the assessments/procedures, and are not exhaustive on the subject. The naming of
documents or charts may differ from state to state, and facility to facility. In all possible situations the guidelines of the ACSQHC are used when describing
national charts or documents (e.g. the ACSQHC Observation and Response Chart is named the Adult Observation and Response Chart in WA, and the
Rapid Detection and Response Observation Chart in SA). References of the materials used to compile the information have been supplied. The student is
expected to have learned the material surrounding each skill as presented in the references. No single reference is complete on the subject.

CRITICAL THINKING
What would be the implications of not performing appropriate hand hygiene in both the hospital and community settings?

REFERENCES
Australian Commission on Safety and Quality in Health Care
(ACSQHC). (2019). Preventing and Controlling Healthcare-
Associated Infection Standard. https://www.safetyandquality.
gov.au/standards/nsqhs-standards/preventing-and-controlling-
healthcare-associated-infection-standard
Hand Hygiene Australia. (2017). http://www.hha.org.au
National Health and Medical Research Council. (2019). Australian
Guidelines for the Prevention and Control of Infection in
Healthcare. https://www.nhmrc.gov.au/health-advice/public-
health/preventing-infection

RECOMMENDED READINGS
Australian Commission on Safety and Quality in Health Care
(ACSQHC). (2017). National Hand Hygiene Initiative. https://
www.safetyandquality.gov.au/our-work/healthcare-associated-
infection/hand-hygiene
Australian Commission on Safety and Quality in Health Care
(ACSQHC). (2019). Hand Hygiene. https://www.safetyandquality.
gov.au/our-work/infection-prevention-and-control/national-hand-
hygiene-initiative-nhhi/what-hand-hygiene
Gray, S., Ferris, L., White, L.E., Duncan, G. & Baumle, W. (2018).
Foundations of Nursing: Enrolled Nurses (2nd ANZ ed.).
Melbourne: Cengage.
World Health Organization (WHO). (2009). WHO guidelines on hand
hygiene in health care. In World Alliance for Patient Safety. First
Global Patient Safety Challenge Clean Care is Safer Care (1st ed.).
Geneva: World Health Organization Press.

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
 1.1: H an d h y g i ene 5

ESSENTIAL SKILLS COMPETENCY

C H A P T E R 1.1
Hand Hygiene
Demonstrates the ability to effectively reduce the risk of infection by appropriate hand hygiene

Criteria for skill performance Y D

(Requires
(Numbers indicate Enrolled Nurse Standards for Practice, 2016) (Satisfactory)
development)
1. Identifies indication (8.3, 8.4)
2. Gathers equipment (1.2, 6.4, 8.4, 9.4):
■■ warm running water
■■ soap
■■ paper towels

3. Prepares and assesses hands (1.2, 1.4, 8.2, 8.3, 8.4, 9.4)
4. Turns on and adjusts water flow and water temperature (1.2, 1.3, 1.4, 1.8, 3.2, 3.9, 4.4, 6.4,
8.4, 9.4)
5. Wets hands, applies soap (1.2, 1.3, 1.4, 1.8, 3.2, 3.9, 8.4, 9.4)
6. Cleans under the fingernails when required (1.2, 1.3, 1.4, 1.8, 3.2, 3.9, 8.4, 9.4)
7. Thoroughly washes hands (1.2, 1.3, 1.4, 3.2, 3.9, 8.4, 9.4)
8. Rinses hands (1.2, 1.3, 1.4, 1.8, 3.2, 3.9, 8.4, 9.4)
9. Turns off the water if elbow taps used; if ordinary taps, turns off after drying hands
(1.2, 1.3, 1.4, 1.8, 3.2, 3.9, 4.4, 6.4, 8.4, 9.4)
10. Dries hands (1.2, 1.3, 1.4, 1.8, 3.2, 3.9, 8.4, 9.4)
11. Uses alcohol-based hand rub as an alternative to hand hygiene, when appropriate (1.2, 1.3,
1.4, 1.8, 3.2, 3.9, 8.4, 9.4)
12. Demonstrates ability to link theory to practice (8.3, 8.4, 8.5, 9.4)

Student:

Clinical facilitator: Date:

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
Another random document with
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 random, or deliberately conceal their most sacred institutions, or have
never paid any attention to the subject? (l.c., p. 41).

To remove this reproach was the work of Professor Tylor.

Edward Burnett It is difficult to express in adequate terms what
Tylor. Professor E. B. Tylor has done for ethnology. He is
the founder of the science of comparative ethnology; and his two
great works, Early History of Mankind (1865) and Primitive Culture
(1871), while replete with vast erudition, are so suggestive and
graced by such a charming literary style and quiet humour that they
have become “classics,” and have profoundly influenced modern
thought. From their first appearance it was recognised that a master-
mind was guiding the destinies of the nascent science. Some idea of
the magnitude and diversity of his work may be gathered from the
bibliography of 262 items, published between 1861 and 1907,
collected by Miss Freire-Marreco, Anthropological Essays Presented
to Edward Burnett Tylor in Honour of his Seventy-first Birthday, Oct.
2, 1907. An appreciation of the labours of Professor Tylor is given by
Andrew Lang in this volume. The true significance of the aims of “Mr.
Tylor’s Science,” as Max Müller called it, may be best gathered from
Professor Tylor’s own words:—
For years past it has become evident that the great need of
anthropology is that its methods should be strengthened and
systematised. The world has not been unjust to the growing science, far
from it. Wherever anthropologists have been able to show definite
evidence and inference, for instance, in the development series of arts in
the Pitt-Rivers Museum at Oxford, not only specialists, but the educated
world generally, are ready to receive the results and assimilate them into
public opinion. Strict method has, however, as yet, only been introduced
over part of the anthropological field. There has yet to be overcome a
certain not unkindly hesitancy on the part of men engaged in the precise
operations of mathematics, physics, chemistry, biology, to admit that the
problems of anthropology are amenable to scientific treatment. It is my
aim to show that the development of institutions may be investigated on a
basis of tabulation and classification.

This is the opening of a masterly paper “On a Method of

Investigating the Development of Institutions; applied to Laws of
Marriage and Descent.”[100]
100. J. A. I., xviii., 245, 1889.
The tabular method is not applicable to much of the vast mass of
material with which Tylor dealt; but the accuracy and systematising
of method are found throughout, and were of invaluable service to a
science peculiarly attractive to the vague speculator and enthusiastic
dilettante.
Tylor (1871) insisted on the necessity of sifting and testing all the
evidence, relying to a great extent on “the test of recurrence,” or of
undesigned coincidence in testimony; he says: “the more odd the
statement, the less likely that several people in several places
should have made it wrongly. This being so, it seems reasonable to
judge that the statements are in the main truly given, and that their
close and regular coincidence is due to the cropping-up of similar
facts in various districts of culture. Now the most important facts of
ethnography are vouched for in this way” (2nd ed., 1873, p. 10).
Avebury. A further stimulus to the study of comparative
ethnology in this country was given by the
publication of Sir John Lubbock’s (Lord Avebury’s) Origin of
Civilisation (1870), and opened the eyes of a large public to the
interest of ethnology and its value in throwing light upon the earlier
stages of culture of civilised peoples.
Sociology. The question as to the influence of environment
on the development of social organisation is as old
as the world’s oldest thinkers, and finds expression in Aristotle and in
Plato, though Sociology, as a science, is a product of the last
century. The word “Sociology” was first used by Auguste Comte
(1798-1857), who showed its aim to be to discover the nature, the
natural causes, and the natural laws of society. With the
development of natural science came the insistence on a naturalistic
interpretation of social differences, demonstrated by Guyot (1807-
1884) and Draper (1811-1882), and over-emphasised by Buckle
(1821-1862).
Comte Buckle.
 Comte’s method was that of deductive construction and
prescription. Buckle’s plan was to evolve a social science inductively
through a study of history, with the help of economics and statistics.
His History of Civilisation answers the great question which he sets
himself: “Are the actions of men, and therefore of societies,
governed by fixed laws, or are they the result either of chance or of
supernatural interference?” He attempted to show how “Climate,
Food, Soil, and the General Aspect of Nature” were the dominant
influences in early societies, determining the food supply, the degree
of population, and the economic condition.
Unfortunately, in pursuit of this idea Buckle was apt to overlook the
influences of culture-contact, and of economic factors; thus
deserving, to some extent, the censure of Jevons: “Buckle referred
the character of a nation to the climate and the soil of its abode.”[101]
At the same time Buckle must be regarded as the first historical
sociologist of the modern scientific movement.
101. Letters and Journal of Stanley Jevons, 1866, p. 454.
Herbert Spencer. The evolutionist explanation of the natural world
as applied to sociology found its fullest exponent
in Herbert Spencer (1820-1903), who studied the anatomy of the
social frame. He derived the principles of sociology from the
principles of psychology and of biology, and regarded social
development as a super-organic evolution.
But all these earlier attempts to discover a social science were
speculative rather than practical. The solid foundations of inductive
sociology were laid by Bachofen, Morgan, J. F. McLennan, and
others.
Bachofen, Bachofen (1861) was the first to study the
Morgan, system of filiation through the mother, or mother-
McLennan, and right, which was widely distributed among ancient
others.
peoples, and still occurs in many regions in a
more or less developed condition. McLennan frankly states that “the
honour of that discovery, the importance of which, as affording a new
starting-point for all history, cannot be over-estimated, must, without
stint or qualification, be assigned to him” (1876, p. 421).
Independently, however, J. F. McLennan (1827-1881), in his
Primitive Marriage (1865), arrived at the conclusion “that the most
ancient system in which the idea of blood-relationship was embodied
was a system of kinship through females only.”[102] He points out
more than once that “Mr. Maine seems not to have been able to
conceive of any social order more primitive than the patriarchal.”[103]
This book was reprinted with additions in 1876, and his two other
books were published posthumously (1885, 1896). In these and
more fugitive writings McLennan was a keen controversialist, and
with unnecessary vigour and animus attacked Morgan, Sir Henry
Maine, and Dr. Howitt. McLennan’s attitude may be partly explained
by the fact that he was a lawyer and a theorist, but he possessed
great enthusiasm, with which he infused those who came into
contact with him, and his labours served to advance the study of
sociology.
102. P. 124 of 1876 ed.

103. P. 181, ibid.

“From the time of Plato downwards, theories of human society

have been current in which the family living under the headship of a
father is accepted as the ultimate social unit. These theories have
taken various shapes ... with Sir Henry Maine (Ancient Law, 1861)
the theory becomes a theory of the origin of society, or at least of the
earliest stage of society in which Comparative Jurisprudence is
called upon to take interest.”[104]
104. D. McLennan, The Patriarchal Theory, 1885, p. x.
Morgan was undoubtedly the greatest sociologist of the past
century, and in his monumental work (1871) laid a solid foundation
for the study of the family and kinship systems; he formulated a
scheme of the evolution of the family based on a study of the
classificatory system of relationships,[105] of which he was the
discoverer. According to this scheme, human society has advanced,
through gradual evolution, from a state of complete promiscuity to
one characterised by monogamy. Dr. Rivers[106] points out that “In
recent years the scheme has encountered much opposition.... The
opponents of Morgan have made no attempt to distinguish between
different parts of his scheme, but, having shown that certain of its
features are unsatisfactory, they have condemned the whole.” The
greater part of Morgan’s work is, however, of lasting value. Morgan
based his conclusions on an enormous number of kinship terms
collected by himself and others from every available source. Dr.
Rivers has introduced[107] a new method of collecting similar data by
means of recording exhaustive genealogies from a limited area. In
this way not only can kinship terms be collected with accuracy, but a
large number of other sociological data are obtained with a
readiness and precision not hitherto possible. Indeed, it is no
exaggeration to say that this method is producing a revolution in the
method of sociological field work.
105. W. H. R. Rivers, “On the Origin of the Classificatory System of
Relationships,” Anthropological Essays (Tylor Volume), 1907.

106. Jour. Anth. Inst., xxx., 1900, p. 74; Sociological Rev., 1910.

107. In the classificatory system most of the kin in the same generation are
grouped under one general term; e.g., all the males of the grandfather’s
generation are called by one term—another term includes father, father’s
brothers, father’s male cousins, mother’s sisters’ husbands, mother’s female
cousins’ husbands, and so on.

In a later book (1878) Morgan summarised his earlier conclusions

and proposed a classification of culture consisting of a lower, middle,
and an upper Status of Savagery, a lower, middle, and an upper
Status of Barbarism, and the Status of Civilisation based upon
certain inventions and industries.
About this time various students wrote on marriage and the family,
of whom the foremost were Giraud Teulon (1867, 1874, 1884), H.
Post (1875), Letourneau (1888), Von Hellwald (1889), and others,
the conclusions of the earlier writers being summed up by Professor
E. Westermarck in his masterly History of Human Marriage (1891);
but much has been written since that date on this subject of
perennial interest.
 Professor F. H. Giddings, in his Principles of Sociology, sums up in
the following words the trend of modern writers on ethnological
sociology:—
Professor Ludwig Gumplowicz [1883] has tried to demonstrate that the
true elementary social phenomena are the conflicts, amalgamations, and
assimilations of heterogeneous ethnical groups. M. Novicow [1893],
generalising further, argues that social evolution is essentially a
progressive modification of conflict by alliance, in the course of which
conflict itself is transformed from a physical into an intellectual struggle.
Professor De Greef [1886], looking at the question in a very different way,
finds the distinctive social fact in contract, and measures social progress
according to the displacement of coercive authority by conscious
argument. Mr. Gabriel Tarde [1890], in an original and fascinating study,
which has made an enduring impress on both psychological and
sociological thought, argues that the primordial social fact is imitation, a
phenomenon antecedent to all mutual aid, division of labour, and
contract. Professor Émile Durkheim [1895], dissenting from the
conclusions of M. Tarde, undertakes to prove that the characteristically
social process, and therefore the ultimate social phenomenon, is a
coercion of every individual mind by modes of action, thought, and feeling
that are external to itself (p. 14).

According to Giddings, the original and elementary subjective fact in

society is “the consciousness of kind.”
Social psychology offers a vast and fertile field which has been but
little worked, and there was needed an introduction to the subject
which should afford that general point of view which is the starting-
point of further studies. This Dr. W. McDougall has attempted in a
recently published little book.[108] His general conclusion is that the
life of societies is not merely the sum of the activities of individuals
moved by enlightened self-interest, or by intelligent desire for
pleasure and aversion from pain; but that the springs of all the
complex activities that make up the life of societies must be sought
in the instincts and in the other primary tendencies that are common
to all men and are deeply rooted in the remote ancestry of the race.
Professor E. A. Ross, of Wisconsin, simultaneously attacked the
same subject, on the problems of which he had previously written.
[109]
Magic and Magic and religion are very generally held to be
Religion. not only distinct from one another, but antithetical.
There is, however, a tendency among certain living students to
regard them as analogous phenomena, both being expressions of a
belief in a power or energy which may be designated by the
Melanesian term “mana,” or the American “orenda.” It has more than
once been pointed out that it is in some cases very hard—perhaps
impossible—to determine whether certain actions can be classed as
either magical or religious, as they appear to belong to both
categories. As in the case of religion from the ethnological
standpoint, magic has been investigated in the field, and immediate
references to it are to be found in ethnological literature—the
comparative study of magic has to some extent been undertaken by
Frazer, Jevons, and others; but one of the most important
contributions to the subject is by Hubert and Mauss,[110] who treat it
from a sociological aspect.
108. An Introduction to Social Psychology, 1908.

109. Congress of Arts and Sci., St. Louis, 1904, v. (1906), p. 869.

110. H. Hubert et M. Mauss, “Esquisse d’une théorie générale de la magie,”

L’Année sociologique, vii., 1904. M. Mauss, “L’Origine des pouvoirs
magiques dans les sociétés Australiennes,” École pratique des Haute Études
(Sec. Relig.), 1904.
Anthropology Parson Thwackum in Tom Jones says: “When I
and Religion. mention religion I mean the Christian religion; and
not only the Christian religion, but the Protestant religion; and not
only the Protestant religion, but the Church of England.”
Anthropology, by a reverse process, passes “in larger sympathy from
specific creeds to partake of the universal spirit which every creed
tries to embody.”[111] The interest of Anthropology in religion was
defined by Huxley.[112] “Anthropology has nothing to do with the truth
or falsehood of religion—it holds itself absolutely and entirely aloof
from such questions—but the natural history of religion, and the
origin and growth of the religions entertained by the different tribes of
the human race, are within its proper and legitimate province.”
111. Clodd, Animism, 1905, p. 11.

112. Address to Dept. of Anthrop., Brit. Ass. Dublin, 1878.

This is not the place to attempt a definition of religion—a task

which has led to so many failures. We must be content with the
statement that it most frequently presents itself under the aspects of
ritual, myth, and belief. Anthropology has hitherto practically confined
its attention to ritual and myth, and but too frequently exclusively to
the last.
As Andrew Lang (1887)[113] points out, in the sixth century B.C.
Xenophanes complained that the gods were credited with the worst
crimes, and other classical writers were shocked at the
contradictions between the conception and ritual worship of the
same god. In ancient Egypt the priests strove to shift the burden of
absurdity and sacrilege from their own deities. It taxed the ingenuity
of pious Brahmans to explain the myths which made Indra the slayer
of a Brahman. Euhemerus (316 B.C.), in his philosophical romance,
Sacra Historica, in rationalising the fables about the gods was
regarded as an atheist. Certain writers like Plutarch (60 A.D.) and
Porphyry (270 A.D.) made the ancient deities types of their own
favourite doctrines, whatever these might happen to be. The early
Christians had a good case against the heathen. Eusebius, in the
Præparatio Evangelica, anticipating Andrew Lang himself, “ridiculed,
with a good deal of humour, the old theories which resolved so many
mythical heroes into the sun” (p. 20). “The physical interpreters,” said
Eusebius, “do not even agree in their physical interpretations.” The
light of the anthropological method had dawned on Eusebius. Many
centuries later Spencer, Master of Corpus Christi College,
Cambridge (1630-93), had no other scheme in his mind in his erudite
work on Hebrew ritual,[114] which he considered was but an
expurgated adaptation of heathen customs. Fontenelle[115] explained
the irrational element in myth as inherited from savagery.
113. 1899 ed., pp. 6, 7.

114. De Legibus Hebræorum Ritualibus, 1732.

115. De l’Origine des Fables: Œuvres, Vol. III., 1758.

 The revival of learning made scholars acquainted with the religions
not only of Greece and Rome, but of the nations with whom the
Greeks and Romans had come in contact—Egyptians, Semites,
Persians, and Indians. Travellers gave accounts of the religions they
found in remote parts of the world, and missionaries reported on
beliefs and customs of many nations. These were the sources from
which were compiled the comprehensive works on religion, from
Alexander Ross, View of All the Religions in the World, etc., 1652, to
Dupuis, Origine de tous les cultes ou Religion Universelle, 1794. All
heathen religions were believed to be based on sun and star
worship.
New vistas were opened up by the writings of De Brosses (1760),
who investigated the beliefs of savage races and based all religion
on “Fetishism.”
To quote once more from Lang: “In the beginning of the
[nineteenth] century Germany turned her attention to mythology. In a
pious kind of spirit, Friedrich Creuzer [1771-1858] sought to find
symbols of some pure, early, and Oriental theosophy in the myths
and mysteries of Greece. The great Lobeck, in his Aglaophamus
(1829), brought back common-sense, and made it the guide of his
vast, his unequalled learning. In a gentler and more genial spirit, C.
Ottfried Müller [1797-1840] laid the foundation of a truly scientific and
historical mythology. Neither of these writers had, like Alfred Maury
[1857], much knowledge of the myths and faiths of the lower races,
but they often seem on the point of anticipating the ethnological
method.” (L.c., p. 23.)
Folklore. The mythological aspect of the subject was
illuminated by the researches of the brothers
Grimm (J. L. K., 1785-1863; W. K., 1786-1859), whose collections of
Märchen (1812-5) were found to contain Teutonic myths, and by their
resemblance to Norse, Greek, and Vedic mythology suggested that
in German folklore were remains of a common Indo-Germanic
tradition. This was the beginning of the intelligent study of Folklore.
Mannhardt (1865) and others investigated popular, and especially
peasant, customs and beliefs connected with agriculture and
vegetation; and showed that here, in what Christianity had reduced
to superstition, were to be found survivals of the religions that
Christianity had supplanted. Thenceforward the study of Folklore,
and of the “lower mythology” of beliefs, customs, and superstitions,
gradually developed into a science, which is now recognised as the
valuable ally of Anthropology. Meanwhile the anthropological
signification of religion was emerging from the mass of materials
collected from all over the globe. Anthropology established its
universality, and made many attempts to find a common factor, first
in astral worship, then in Euhemerism (Banier, 1738), Fetishism (De
Brosses, 1709-1777), Nature-worship (Max Müller, etc.), Ancestor-
worship (Herbert Spencer, Lippert [1866], etc.), and later in
Totemism. These hypotheses were based on the erroneous
assumption that savage religion represented the primitive mode of
thought, out of which civilised religions had evolved. Later it was
realised that “The Australian black or the Andaman Islander is
separated by as many generations from the beginning of religion as
his most advanced contemporaries; and in these tens or hundreds of
thousands of years there has been constant change, growth, and
decay—and decay is not a simple return to the primal state. We can
learn a great deal from the lowest existing religions, but they cannot
tell us what the beginning of religion was, any more than the history
of language can tell us what was the first human speech.”[116]
116. G. F. Moore, “The Hist. of Religions in the Nineteenth Cent.,” Congress Arts
and Sci., St. Louis, 1904, p. 440.
Comparative The study of comparative religion, though not
Religion. originated by Max Müller (1823-1900), owed much
to his energy. His lectures on Comparative Mythology (1856) were
followed by lectures on the Science of Religion (1870), and on the
religions of the world (1873). He inaugurated the annual series of the
Hibbert Lectures with a study of the origin and growth of Religion, as
illustrated by the religions of India; and as Gifford lecturer at
Glasgow (1888-1892), discussed Natural Religion, Physical Religion,
Anthropological Religion, and Theosophy or Psychological Religion.
His Contributions to the Science of Mythology appeared in 1897. His
method of investigation was almost entirely linguistic, based on
phonetic laws which later research has discredited; and his theory of
“mythology as the disease of language” is no longer tenable.
The charm of the writings of Max Müller, and the interest which
they awakened in Vedic studies, gave a new impulse to the study of
the history of religions. The hymns of the Rig-Veda are by no means
the product of a simple society, as he supposed; in his view hymns
and myths were dissociated from ritual religion, and gods were
identified with natural objects. The death-blow to this method of
studying religion in our country was given by the keen criticism of
Andrew Lang (1884, 1887). The too-narrow basis of Max Müller’s
theories was overthrown by arguments derived from comparative
ethnology; “the silly, senseless, and savage element” (as he termed
it) in classical mythology proved to be the stumbling-block over
which he fell.
A firmer foundation for the study was laid by Tylor and Lubbock.
Though Max Müller originated the name Science of Religion, it was
Tylor who first introduced into it a scientific method, and so laid the
foundations for future investigation.
Later workers in the field fall naturally into two groups. Some make
intensive studies of particular forms of religion, either historical, such
as Robertson Smith (1846-1894), or living, such as Codrington in
Melanesia, J. O. Dorsey[117] in America, Spencer and Gillen in
Australia, and many others.
117. “Omaha Sociology,” Ann. Rep. Bur. Am. Ethn. Rep. iii., 1884; “Siouan
Sociology,” xv., 1897.

Other workers attempt, by correlating the mass of material, to

discover the fundamental religious conceptions of man, and to trace
their subsequent development. Among these may be noted Grant
Allen, Crawley, Frazer, Hartland, Jevons, Andrew Lang, Marett, and
many others.
To those who are acquainted with the modern study of
comparative religion in this country it is unnecessary to point out the
influence of such workers as Mannhardt, Tylor, and Robertson Smith
on subsequent writers; nor is it needful to draw attention to the vast
erudition and eloquent writing of Professor J. G. Frazer, whose
monumental work on The Golden Bough has become a classic, or to
the memorable Legend of Perseus by E. S. Hartland.
The study of the myths of various peoples is receiving the
attention of numerous students, and in Germany certain
ethnologists, such as Ehrenreich, Foy,[118] and Frobenius,[119] find sun
and moon gods in the most unlikely places. There is, however,
considerable danger that this nature-mythology is being carried too
far.
118. Archiv für Religionswissenschaft, x., 1907, etc.

119. “Die Weltanschauung der Naturvölker,” Beitr. z. Volks-und Völkerkunde, vi.,

1898; Das Zeitalter des Sonnengottes, i., 1904; The Childhood of Man, 1909.

The origin of the moral idea has also been discussed from the
ethnological point of view, as Hobhouse (1906) and Westermarck
(1906) have exemplified in their great books.
Magic, religion, and morality have, as we have seen, especially of
late years, been regarded almost entirely from the anthropological
standpoint. But a new school of French students has arisen who
maintain that these are essentially social phenomena. The writings
of Durkheim, Hubert and Mauss[120] have initiated a new method of
study which promises to have far-reaching results.
120. The work of this school is mainly to be found in L’Année sociologique (1898).
 Chapter XI.

LINGUISTICS

Linguistics as a department of Anthropology may be regarded from

many points of view. To the evolutionist language forms one of the
tests dividing the Hominidæ from the other anthropoids; the
somatologist is interested in correlating the phonetic system with the
structure of the organs connected with the mechanism of speech;
and the ethnologist studies language for the evidence it affords of
ethnic affinity or social contact, or as a means of determining the
grade of culture to which a particular people has attained, or, again,
as a reflection of their character or psychology. The linguistic
classifications of Gallatin, Humboldt, and Müller are referred to later.
The Aryan The connection between linguistics and
Controversy. anthropology assumed its greatest importance in
the middle of the nineteenth century, when the discoveries and
theories of philologists were adopted wholesale to explain the
problems of European ethnology, and the Aryan controversy became
the locus of disturbance throughout the Continent. “No other
scientific question, with the exception, perhaps, of the doctrine of
evolution, was ever so bitterly discussed or so infernally confounded
at the hands of Chauvinistic or otherwise biassed writers.”[121]
121. Ripley, 1899, p. 453.

In 1786 Sir William Jones had pointed out the relationship

between Sanskrit, Greek, Latin, German, and Celtic, and suggested
a common parentage, which was confirmed by Bopp in 1835.
Unfortunately, a primitive unity of speech was held to imply a
primitive unity of race.
Among the ethnological papers read at the meeting of the British
Association in 1847 was one “On the Results of the recent Egyptian
Researches in reference to Asiatic and African Ethnology, and the
Classification of Languages,” in which Baron Bunsen sought to show
that the whole of mankind could be classified according to language.
In fact, it was taken for granted in 1847 that the study of comparative
philology would be in future the only safe foundation for the study of
anthropology.[122] The spread of this fallacy is usually attributed to
Max Müller, whose charm of style and high reputation as a Sanskrit
scholar did much to popularise the new science of philology. He
invented the term “Aryan,” which in itself contains two erroneous
assumptions—one linguistic, that the Indo-Iranian group of
languages is older than its relatives; and the other geographical, that
its “cradle” was in ancient Ariana, in Central Asia. Moreover, in his
lectures he not only spoke of an Aryan language, but of an “Aryan
race.” He is credited with having made “heroic reparation” for these
errors when he wrote later: “To me an ethnologist who speaks of an
Aryan race, Aryan blood, Aryan eyes and hair, is as great a sinner as
a linguist who speaks of a dolichocephalic dictionary or a
brachycephalic grammar. It is worse than a Babylonian confusion of
tongues—it is downright theft.” But, as he pointed out,[123] he himself
never shared the misconception that he was accused of launching
on the world. He admits that he was not entirely without blame, as he
allowed himself occasionally the freedom to speak of the Aryan or
the Semitic race, meaning the people who spoke Aryan or Semitic
languages; but as early as 1853 he had protested against the
intrusion of linguistics into ethnology, and
called, if not for a complete divorce, at least for a judicial separation
between the study of Philology and the study of Ethnology.... The
phonologist should collect his evidence, arrange his classes, divide and
combine as if no Blumenbach had ever looked at skulls, as if no Camper
had ever measured facial angles, as if no Owen had ever examined the
base of a cranium. His evidence is the evidence of language, and nothing
else; this he must follow, even though in the teeth of history, physical or
 political.... There ought to be no compromise between ethnological and
phonological science. It is only by stating the glaring contradictions
between the two that truth can be elicited.[124]

122. Rep. Brit. Assoc. (Cardiff), 1891, p. 787.

123. Rep. Brit. Assoc. (Cardiff), 1891, p. 787.

124. Rep. Brit. Assoc. (Cardiff), 1891, p. 787.

The protest was in vain. The belief in an “Aryan race” became an
accepted fact both in linguistics and in ethnology, and its influence
vitiates the work of many anthropologists even at the present day.
Naturally the question of the identity of the Aryan race was soon a
subject of keen debate. The French and German schools at once
assumed opposite sides, the Germans claiming that the Aryans were
tall, fair, and long-headed, the ancestors of the modern Teutons; and
the French, mainly on cultural evidence, claiming that the language,
together with civilisation, came into Europe with the Alpine race,
which forms such a large element in the modern French population.
There are two ways in which linguistics may be studied as an aid
to Anthropology—first, with regard to structural analysis, by which
linguistic affinities may be proved; secondly, by what has been called
“linguistic palæontology,” or the study of root words, by means of
which the original culture of a people may be ascertained. Philology
pushed both these methods too far. It claimed the right, by proof of
structural analysis, to link up the racial relationships of the European
and Asiatic peoples, and, by linguistic palæontology, to determine
the culture of the original “Aryans,” and to identify their original
home. It was over the question of the “Aryan cradle” that they were
forced to relinquish their too ambitious claims.
At the beginning of the nineteenth century it was generally
believed that our first ancestors were created in 4004 B.C. and
spoke Hebrew, and that the origin of the European languages dated
from the migration of Japhet from the plains of Shinar, cir. 2247. The
Asiatic origin of race and language was for long unchallenged. But in
1839 Omalius d’Halloy, followed by Latham in 1851, began to cast
doubts on the Asiatic “cradle,” noting that the Asiatic languages had
no real claim to be considered older than those of Europe, and that
in many ways the Lithuanian and Armenian were the most archaic in
the family. More important still was the work of Benfey,[125] who may
be regarded as the originator of linguistic palæontology, and who
used its evidence to shift the original dispersal from Asia to Europe.
Various philologists followed, employing different methods to prove
different theories; and the Aryan cradle was located in many parts of
Europe and Asia, ranging from the Pamir plateau to the Baltic plains.
Max Müller confessed in 1888 that “the evidence is so pliant that it is
possible to make out a more or less plausible case” for almost any
part of the world.
125. T. Benfey, in preface to Fick’s Vergleichendes Wörterbuch der
Indogermanischen Sprachen, 1868.
Language and From claiming too much the swing of the
Race. pendulum brought linguistics into disrepute with
ethnologists, and for a time the evidence of language was looked
upon with suspicion. Even philologists were accused of going too far
in this direction.
Professor Sayce[126] says: “Identity or relationship of language can
prove nothing more than social contact.... Language is an aid to the
historian, not to the ethnologist.” But, as Professor Keane points out,
there are many cases in which language infallibly proves the
existence of ethnic elements which would otherwise have been
unsuspected—as, for example, in the case of the Basques of
Europe. “Language used with judgment is thus seen to be a great
aid to the ethnologist in determining racial affinities, and in solving
many anthropological difficulties” (1896, p. 205).
Although Max Müller wrote nearly twenty years ago, “I believe the
time will come when no anthropologist will venture to write on
anything concerning the inner life of man without having himself
acquired a knowledge of the language in which that inner life finds its
truest expression,” we are obliged still to echo his lament: “How few
of the books in which we trust with regard to the characteristics or
peculiarities of savage races have been written by men ... who have
learnt their languages until they could speak them as well as the
natives themselves!”[127]
126. Science of Language, ii., p. 317.

127. Rep. Brit. Assoc. (Cardiff), 1891, p. 792.

 Chapter XII.

CULTURAL CLASSIFICATION AND THE INFLUENCE OF

ENVIRONMENT

We have seen that in its beginning the science of man was little
more than a branch of zoology, and that his structural characters
were the first to attract attention and to form the material of study;
hence all the earlier classifications were based on physical features.
Gallatin was one of the first to classify mankind rather by what they
do than by what they are.
Gallatin. Albert Gallatin (1761-1849) was born at
Geneva, emigrated to America before he was
twenty, and rose rapidly to the position of one of the foremost of
American statesmen, becoming United States Minister to France,
and later to England. He noted the unsatisfactoriness of groupings
by colour, stature, head-form, etc., in the case of the races of
America, and made a preliminary classification of the native tribes on
the basis of language. Major J. W. Powell (1834-1902) and Dr.
Brinton (1837-1899) elaborated the linguistic classification of the
American Indians.
Wilhelm von Classification by language had already been
Humboldt. utilised by Wilhelm von Humboldt (1767-1835) in
the introduction to his great work on the Kawi language of Java,
entitled Ueber die Verschiedenheit des menschlichen Sprachbaues
und ihren Einfluss auf die geistige Entwickelung des
Menschengeschlechts, which was published posthumously, 1836-40.