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Rosdahl’s Textbook of Basic

Nursing

TWELFTH EDITION

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Table of Contents

Part A Foundations of Nursing

Unit 1 The Nature of Nursing

1 The Origins of Nursing

Nursing’s Heritage

Nursing in the United States

Nursing Insignia

2 Beginning Your Nursing Career

Healthcare: A Multidisciplinary Approach

Types of Nursing Programs

Approval and Accreditation of Nursing Programs

Licensure of Nurses

Theories of Nursing

Roles and Responsibilities of the Nurse

Nursing Organizations

3 The Healthcare Delivery System

Healthcare Trends in the 21st Century

Healthcare Settings and Services

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Quality Assurance

Organization and Ownership of Healthcare Facilities

Financing Healthcare

Complementary Healthcare

Consumer Fraud

4 Legal and Ethical Aspects of Nursing

Legal Issues of Nursing Practice

Regulations of Nursing Practice

Advance Directives

Vulnerable Persons

Definitions of Death

Ethical Standards of Healthcare

Clients’ Rights and Responsibilities

Unit 2 Personal and Environmental Health

5 Basic Human Needs

Maslow’s Hierarchy of Human Needs

Nursing’s Relationship to Basic Needs

Overview of Individual Needs

Family and Community Needs

6 Health and Wellness

Health and Wellness

Inconsistencies in Healthcare

Morbidity and Mortality

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Finances and Healthcare

Prevention and Healthcare

The Wellness–Illness Continuum

Lifestyle and Risk Factors

Education and Health Promotion

Age-Related Health Concerns

Categories of Disease and Disorders

7 Community Health
Healthcare Worldwide

Healthcare on the National Level

Healthcare at the State Level

Healthcare at the Local Level

The Environment

8 Transcultural Healthcare
Culture, Ethnicity, and Race

Cultural Sensitivity

Culturally Influenced Components

Religious/Spiritual Customs and Traditions

Implementing Culturally Competent Care

Unit 3 Development Throughout the Life Cycle

9 The Family
Characteristics of the Family

Family Structure

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Influence of Culture, Ethnicity, and Religion

Family Stages

Stress and Family Coping

10 Infancy and Childhood

Concepts of Growth and Development

Developmental Milestones and Developmental Delays

Growth and Development

The Newborn

Infancy:1–12 Months

Toddlerhood:1–3 Years

Preschool:3–6 Years

School Age:6–10 Years

11 Adolescence
Growth and Development Theories

Adolescent Growth and Development

In Practice

12 Early and Middle Adulthood

Erikson’s Adult Growth and Development Theory

Early Adulthood

Middle Adulthood

Transition From Middle Adult to Older Adult

13 Older Adulthood and Aging

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Words Related to Aging

Erikson’s Adult Growth and Development Theory

Development in Older Adulthood

14 The End of Life: Death, Dying, Grief, and Loss

The Dying Process

Kübler-Ross Stages of Grief and Loss

Unit 4 Structure and Function

15 Organization of the Human Body

Chemistry and Life

Medical Terminology

Anatomy and Physiology

Body Directions, Areas, and Regions

Structural Levels in the Body

Cells

Tissues

Organs and Systems

16 The Integumentary System

Structure and Function

Skin

Accessory Structures

System Physiology

Protection

Thermoregulation

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Vitamin D Production

Maintenance of Healthy Skin

17 Fluid and Electrolyte Balance

Homeostasis

Body Fluids

Fluid and Electrolyte Transport

Fluid and Electrolyte Balance

Acid–Base Balance

18 The Musculoskeletal System

The Skeleton

Vertebral Column

Thoracic (Rib) Cage

The Muscles

Formation Of Bone Tissue

Muscle Contractions

Exercise

Mobility

19 The Nervous System

Structure and Function

Cells of the Nervous System

Divisions of the Nervous System

Transmission of Nerve Impulses

Reflexes

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20 The Endocrine System

Structure and Function

System Physiology

21 The Sensory System

The Eye

The Ear

Vision

Hearing

Balance and Equilibrium

Taste

Smell

Touch/Tactile Sense

Other Sensations

22 The Cardiovascular System

Structure and Function

Heart

Systemic Blood Vessels

Cardiac Conduction

Cardiac Cycle

Cardiac Output

Blood Pressure

23 The Hematologic and Lymphatic Systems

Blood

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Lymph

Blood Circulation

Lymphatic Circulation

24 The Immune System

Structure and Function

Bone Marrow and Lymphocyte Production

Lymphoid Organs

The Mononuclear Phagocyte System

Nonspecific Defense Mechanisms

Specific Defense Mechanisms

Antigen–Antibody Reaction

25 The Respiratory System

Structure and Function

Upper Respiratory Tract

Lower Respiratory Tract

Ventilation

External (Pulmonary) and Internal (Tissue) Respiration

Regulation of Acid–Base Balance

Respiratory Reflexes

Vocalization

26 The Digestive System

Structure and Function

Mouth

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Pharynx

Esophagus

Stomach

Small Intestine

Duodenum

Jejunum and Ileum

Large Intestine

Cecum and Appendix

Colon

Rectum and Anus

Accessory Organs

System Physiology

Metabolism

Elimination

27 The Urinary System

Kidneys

Organs of Urine Storage and Elimination

Blood Pressure Regulation

Urine Formation

Characteristics and Composition of Urine

Micturition

28 The Male Reproductive System

Testes

The Ductal System

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Scrotum

Penis

Accessory Glands

Hormonal Influences

Sperm Cells and Spermatogenesis

Copulation

29 The Female Reproductive System

Reproductive Organs

Breasts

Hormonal Influences

Egg Cells and Oogenesis

Menstrual Cycle

Female Sexual Response

Unit 5 Nutrition and Diet Therapy

30 Basic Nutrition
Nutrients

Creating the Healthy Diet

Nutrition Across the Lifespan

31 Transcultural and Social Aspects of Nutrition

Regional Preferences

Ethnic Heritage

Cultural Groups

Religious Beliefs and Practices

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Vegetarian Diets

Sociocultural Factors

32 Diet Therapy and Special Diets

Helping the Client Meet Nutritional Needs

Serving Food

The Client Who Needs Assistance With Eating

House Diets

Modified Diets

Nutritional Support

Food and Medication Interactions

Part B Nursing Care Skills

Unit 6 The Nursing Process

33 Introduction to the Nursing Process

Problem-Solving

Critical Thinking

The Nursing Process

34 Nursing Assessment
Data Analysis

35 Nursing Diagnosis and Planning

Nursing Diagnosis

Planning Care

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36 Implementing and Evaluating Care

Implementing Nursing Care

Evaluating Nursing Care

37 Documenting and Reporting

Documentation

Reporting

Unit 7 Safety In the Healthcare Facility

38 The Healthcare Facility Environment

The Client Unit

Provision of Nursing Care

Healthcare Personnel and Services

39 Emergency Preparedness
Safety and Preparedness

The Disaster Plan

The Fire Plan

40 Introduction to Microbiology
Microorganisms

Metabolism and Growth

Infectious Disease

Response to Infection

41 Medical Asepsis

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Standard Precautions

Medical Asepsis

Client and Family Teaching

42 Infection Control
Infection Control

Isolation

Antibiotic-Resistant Organisms and Special Infections

43 Emergency Care and First Aid

Principles of Emergency Care

Assessing the Person in an Emergency

Sudden Death and Life Support

First-Aid Measures

Unit 8 Client Care

44 Therapeutic Communication Skills

Communication

Therapeutic Communication Techniques

Facilitating Communication in Healthcare

45 Admission, Transfer, and Discharge

Admission

Transfer to Another Unit

Discharge

Leaving the Healthcare Facility Against Medical Advice

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Communications Among Healthcare Team Members

46 Vital Signs
The Graphic Record

Assessing Body Temperature

Determining Pulse

Assessing Respiration

Assessing Blood Pressure

Pulse Oximetry

47 Data Collection in Client Care

Medical and Nursing Diagnosis

Factors That Influence Data Collection

The Physical Examination

48 Moving and Positioning Clients

Body Mechanics

Positioning the Client

Joint Mobility and Range of Motion

Using Mobility Devices

Moving an Immobile Client

Using Client Safety Devices

49 Beds and Bed Making

Bed Making

Attachments and Accessories

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Special Beds and Mattresses

50 Personal Hygiene
Mouth Care

Routine Eye Care

Ear Care

Care of Hands and Feet

Shaving

Hair Care

Skin Care

Skin Infestations

51 Elimination
Urinary Elimination

Bowel Elimination

Assisting With Toileting

Assisting With Urinary Elimination

Assisting With Bowel Elimination

Nausea and Vomiting

52 Specimen Collection
The Stool Specimen

The Sputum Specimen

Collecting Other Specimens

53 Bandages and Binders

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Bandages

Binders

54 Heat and Cold Applications

Normothermia

Heat Therapy

Cold Therapy

55 Pain Management
Pain

Collection of Client Data About Pain

Pain Management

56 Preoperative and Postoperative Care

Perioperative Care

Preoperative Nursing Care

Intraoperative Nursing Care

Postoperative Nursing Care

57 Surgical Asepsis
Asepsis

Disinfection and Sterilization

Medical and Surgical Asepsis

Sterile Technique (Surgical Asepsis)

Procedures Requiring Sterile Technique

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58 Special Skin and Wound Care

Wounds

Special Considerations

Wound Healing

59 End-of-Life Care
Stages of Dying

The Client’s Wishes

Basic Needs, as Related to the Death Experience

Nursing Care of the Dying Client’s Family

Signs of Approaching Death

Care Following the Death of a Client

Feelings of the Nurse

Unit 9 Pharmacology and Administration of Medications

60 Review of Mathematics
Systems of Measurement

The Metric System

Dosage Calculation

61 Introduction to Pharmacology
Legal Aspects

Medication Preparations and Actions

Prescribed Medications

62 Classification of Medications

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Interactions Between Food and Medications

Interactions Between Drugs (Drug–Drug Interactions)

Introduction to Drug Classifications

Antibiotics and Other Anti-Infective Agents

Medications That Affect the Integumentary System

Medications That Affect the Nervous System

Medications That Affect the Endocrine System

Medications That Affect the Sensory System

Medications That Affect the Cardiovascular System

Medications That Affect the Blood

Antineoplastic Medications

Medications That Affect the Immune System

Medications That Affect the Respiratory System

Medications That Affect the Gastrointestinal System

Medications That Affect the Urinary Tract

Medications That Affect the Reproductive Systems

63 Administration of Noninjectable Medications

Preparation for Administration

Safety

General Principles of Medication Administration

Enteral Administration Methods

Parenteral Administration Methods

64 Administration of Injectable Medications

Syringes and Needles

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Preparations

Intradermal Injections

Subcutaneous (SubQ) Injections

Intravenous Administration

Administration of Intravenous Medications

Venipuncture

Part C Nursing Throughout the Life Cycle

Unit 10 Maternal and Newborn Nursing

65 Normal Pregnancy
Defining Pregnancy as a Normal Process

Healthcare During Pregnancy

Preparing to Be a Parent

66 Normal Labor, Delivery, and Postpartum Care

Labor and Birth as Normal Processes

Nursing Care During Labor

67 Care of the Normal Newborn

Important Concepts in Newborn Care

Care of the Newborn Immediately After Birth

Characteristics of the Normal Newborn

Care of the Newborn After Delivery

Daily Newborn Care

Nutrition

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Discharge

68 High-Risk Pregnancy and Childbirth

Tests to Assess Fetal Status

Interrupted Pregnancy

Maternal Complications During Pregnancy

Existing Disorders Complicating Pregnancy

Disorders Affecting the Fetus

Placental and Amniotic Disorders

Other High-Risk Pregnancies

Complications of Labor and Delivery

Umbilical Cord Complications

Considerations Related to Delivery

Complications of the Postpartum Period

When a Newborn Dies

69 The High-Risk Newborn

Categories of High-Risk Newborns

Nursing Considerations for the High-Risk Newborn

Potential Complications in the High-Risk Newborn

Hemolytic Disease of the Newborn

Intrauterine Disorders: Congenital and Acquired Infections

Congenital Musculoskeletal Disorders

Neural Tube Defects

Congenital Cardiovascular Disorders

Congenital Gastrointestinal Disorders

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Congenital Genitourinary Disorders

Substance Misuse and the Newborn

70 Sexuality, Fertility, and Sexually Transmitted Infections

Human Sexuality

Infertility

Contraception

Sexually Transmitted Infections

Unit 11 Pediatric Nursing

71 Fundamentals of Pediatric Nursing

Health Maintenance

The Hospital Experience

Basic Pediatric Care and Procedures

Intermediate Pediatric Care and Procedures

Advanced Pediatric Care and Procedures

The Child Having Surgery

72 Care of the Infant, Toddler, or Preschooler

Communicable Diseases

Parasitic Infestations

Trauma

Child Abuse

Skin Disorders

Musculoskeletal and Orthopedic Disorders

Neurologic Disorders

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Metabolic and Nutritional Disorders

Disorders of the Eyes

Disorders of the Ears, Nose, Throat, and Mouth

Cardiovascular Disorders

Blood and Lymph Disorders

Respiratory Tract Disorders

Gastrointestinal Disorders

Urinary System Disorders

Reproductive System Disorders

Nutritional Considerations in Young Children

73 Care of the School-Age Child or Adolescent

Communicable Diseases

Skin Disorders

Musculoskeletal Disorders

Endocrine Disorders

Vision Disorders

Gastrointestinal Disorders

Reproductive System Disorders

Sleep Deprivation and Disorders

Eating Disorders

Nutritional Considerations

74 The Child or Adolescent With Special Needs

Disabilities and Disorders

Special Learning Disabilities

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Etiology of Disabilities and Disorders

Common Disorders

Unit 12 Adult Care Nursing

75 Skin Disorders
Diagnostic Tests

Common Medical Treatments

Common Surgical Treatments

Acute and Chronic Skin Conditions

Infections

Parasitic Infestations

Sebaceous Gland Disorders

Burns

Neoplasms

76 Disorders in Fluid and Electrolyte Balance

Diagnostic Tests

Common Medical Treatments

Maintenance of Fluid Balance

Maintenance of Electrolyte Balance

Maintenance of Acid–Base Balance

77 Musculoskeletal Disorders
Diagnostic Tests

Common Medical Treatments

Common Surgical Treatments

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Common Musculoskeletal Disorders

Systemic Disorders With Musculoskeletal Manifestations

Traumatic Injuries

Trauma Care and Management

Complications of Fractures or Bone Surgery

Neoplasms

78 Nervous System Disorders

Diagnostic Tests

Craniocerebral Disorders

Nerve Disorders

Spinal Cord Disorders

Degenerative Disorders

Inflammatory Disorders

Head Trauma

Neoplasms

79 Endocrine Disorders
Diagnostic Tests

Common Medical and Surgical Treatments

Pituitary Gland Disorders

Thyroid Gland Disorders

Parathyroid Gland Disorders

Adrenal Gland Disorders

Pancreatic Endocrine Disorders

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80 Sensory System Disorders

Diagnostic Tests

Common Medical Treatments

Common Surgical Treatments

The Eye and Vision Disorders

Trauma to the Eye

The Ear and Hearing Disorders

Disorders of Other Special Senses

81 Cardiovascular Disorders
Diagnostic Tests

Common Medical Treatments

Common Surgical Treatments

Abnormal Conditions That May Cause Cardiovascular Disease

Heart Disorders

Blood Vessel Disorders

82 Blood and Lymph Disorders

Diagnostic Tests

Common Treatments

Hematopoietic Stem Cell Transplantation

Hematologic System Disorders

83 Cancer
Cancer Development

Diagnostic Tests

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Treatment Modalities for Cancer

Nursing Considerations for Clients With Cancer

84 Allergic, Immune, and Autoimmune Disorders

Diagnostic Tests

Allergies

Immune Disorders

Autoimmune Disorders

85 HIV and AIDS

History of HIV/AIDS

Transmission

Signs and Symptoms of HIV Infection

Acquired Immunodeficiency Syndrome

HIV Exposure Guidelines

86 Respiratory Disorders
Diagnostic Tests

Common Medical Treatments

Common Surgical Treatments

Infectious Respiratory Disorders

Chronic Respiratory Disorders

Trauma

Neoplasms

Disorders of the Nose

Disorders of the Throat

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87 Oxygen Therapy and Respiratory Care

Oxygen Provision

The Client Who Is Having Difficulty Breathing

The Client Who Is Unable to Breathe

88 Digestive Disorders
Diagnostic Tests

Common Medical and Surgical Treatments

Disorders of the Mouth

Disorders of the Esophagus

Disorders of the Stomach

Disorders of the Small or Large Bowel

Peritonitis

Disorders of the Sigmoid Colon and Rectum

Disorders of the Liver

Disorders of the Gallbladder

Disorders of the Pancreas

Conditions of Overnutrition and Undernutrition

89 Urinary Disorders
Diagnostic Tests

Urinary Incontinence

Urinary Tract Infections

Inflammatory Disorders

Obstructive Disorders

Urinary Tract Tumors

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Urinary Tract Trauma

Renal Failure

90 Male Reproductive Disorders

Diagnostic Tests

Common Medical Treatments

Erectile Disorders

Structural Disorders

Inflammatory Disorders

Neoplasms

91 Female Reproductive Disorders

Diagnostic Tests

Common Surgical Treatments

Disorders Related to the Menstrual Cycle

Structural Disorders

Inflammatory Disorders

Cervicitis

Neoplasms

Unit 13 Gerontologic Nursing

92 Gerontology: The Aging Adult

Geriatric Care Settings

Helping the Older Adult Meet Basic Needs

Helping the Older Adult Meet Emotional Needs

Special Concerns of the Adult Related to Increasing Age

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Elder Abuse

93 Cognitive Impairment in the Aging Adult

Cognitive Impairment

Aspects of Dementia

Unit 14 Mental Health Nursing

94 Psychiatric Nursing
Mental Health

Mental Illness

The Mental Healthcare Team

Methods of Psychiatric Therapy

The Client in an Inpatient Setting

Mental Health Nursing Skills

95 Substance Use Disorders

Nursing Care Measures

Detoxification and Recovery

Alcohol Use Disorder

Other Substance Use Disorders

Special Populations

Unit 15 Nursing in a Variety of Settings

96 Extended Care
Extended-Care Options

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The Concept of Transitional Care

97 Rehabilitation Nursing
Definitions of Rehabilitation

Rehabilitation and Maslow Hierarchy of Needs

Stages of Adjustment to a Disability

The Rehabilitation Team

Nursing Considerations in Rehabilitation

Activities of Daily Living

The Scope of Rehabilitative Services

Community Resources

Barriers to Rehabilitation

98 Home Care Nursing

Reasons for Home Care

Types of Agencies and Services

Telehealth

Self-Management of Chronic Conditions

Payment for Home Care

Members of the Home Care Team

Nursing Duties in Home Care

Safety for the Home Care Team

Suggestions for Primary Caregivers

99 Ambulatory Nursing
The Role of the Nurse

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Types of Ambulatory Facilities

Use of the Electronic Health Record

100 Hospice Nursing

Evolution of the Hospice Movement

The Hospice Concept

Assisting the Hospice Client to Meet Basic Needs

Pain Management

Children in Hospice Programs

When the Client Dies

Part D Your Career

Unit 16 The Transition to Practicing Nurse

101 From Student to Graduate Nurse

Nursing Licensure

Role Transition

Personal Life

102 Career Opportunities and Job-Seeking Skills

Employment Opportunities

Obtaining Employment Information

Job-Seeking Skills

103 Advancement and Leadership in Nursing

Advancement in Nursing

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Leadership

Index

Appendix A: Key English-to-Spanish Healthcare Phrases

Appendix B: Key Abbreviations and Acronyms Used in Healthcare

Appendix C: Medical Terminology: Prefixes, Roots, and Suffixes Commonly

Used in Medical Terms

Indicates material is available online

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Summary of Special Displays

Nursing Procedures
32-1 Inserting a Nasogastric (NG) Tube (Nasogastric Intubation) 405
32-2 Administering a Tube Feeding 409
41-1 Handwashing 505
41-2 Using Clean (Nonsterile) Gloves 506
41-3 Using a Mask 507
43-1 Applying a Sling 546
43-2 Assisting the Client Who Has a Nosebleed 547
43-3 Applying a Tourniquet 547
45-1 Undressing the Immobile Client 580
46-1 Measuring Body Temperatures 597
46-2 Measuring Radial Pulse Manually 601
46-3 Measuring Apical Pulse 601
46-4 Counting Respirations 602
46-5 Measuring Blood Pressure (Aneroid Manometer and Manual Cuff) 603
46-6 Using a Pulse Oximeter 605
48-1 Turning the Client to a Side-Lying Position 671
48-2 Logroll Turn 673
48-3 Performing Passive ROM Exercises 674
48-4 Using a Transfer Belt, With Metal-Toothed Buckle 675
48-5 Dangling 676
48-6 Helping the Client From Bed and/or Into a Chair 677
48-7 Pushing a Nonmotorized Wheelchair or Wheeled Stretcher/Gurney (Litter) 679
48-8 Walking With a Cane 680
48-9 Using a Walker 681
48-10 Moving the Client From Bed to Wheeled Stretcher/Gurney 682
48-11 Adjusting Pillows and Moving the Client Up in Bed 683
48-12 Using Client Safety/Protective Devices 684
49-1 Making an Unoccupied Bed 694
49-2 Making an Occupied Bed 696
49-3 Making a Postoperative Bed 698
49-4 Using a Bed Cradle 699
50-1 Routine Daily Mouth Care 717
50-2 Flossing the Teeth 718
50-3 Caring for Dentures 719
50-4 Special Mouth Care: The Dependent Client 720
50-5 Caring for Fingernails and Toenails 721
50-6 Giving a Foot Soak 722
50-7 Shaving a Client 723
50-8 Using the Shampoo Cap 724

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50-9 The Bed Shampoo 725

50-10 Giving a Backrub 726
50-11 Assisting With a Tub Bath 727
50-12 Giving a Bed Bath 729
50-13 Assisting With Perineal Care 732
51-1 Giving and Removing the Bedpan and Urinal 755
51-2 Emptying the Urinary Drainage Bag 757
51-3 Bladder Retraining With Closed Urinary Drainage 757
51-4 Giving an Enema 758
51-5 Performing Manual Disimpaction 760
51-6 Assisting With Bowel Retraining 761
51-7 Helping to Relieve Flatus 761
52-1 Measuring Urinary Output 772
52-2 Measuring Urine Specific Gravity 773
52-3 Collecting a Single-Voided Specimen 773
52-4 Collecting a 24-hr Urine Specimen 774
52-5 Collecting a Urine Specimen From an Indwelling Catheter 774
52-6 Collecting a Stool Specimen 776
52-7 Collecting a Sputum Specimen 776
53-1 Applying Antiembolism Stockings (TED sox) 785
53-2 Applying Montgomery Straps 786
54-1 Using an Aquathermia (Aqua-K) Pad 796
54-2 Applying Warm, Moist Compresses and Packs 797
54-3 Administering a Therapeutic Soak to an Arm or Leg 798
54-4 Using a Sitz Bath 799
54-5 Applying an Icecap or Ice Collar 800
56-1 Receiving the Client From the Postanesthesia Care Unit (PACU) 839
57-1 Opening a Sterile Package 848
57-2 Putting on Sterile Gloves (Open Gloving) 850
57-3 Catheterizing the Female Client 851
57-4 Catheterizing the Male Client 854
57-5 Removing the Retention Catheter 856
58-1 Changing a Dry, Sterile Dressing 875
58-2 Performing a Sterile Wound Irrigation 878
59-1 Postmortem Care of the Body 892
63-1 Administering Oral Medications 969
63-2 Administering Medications Through a Gastrointestinal Tube 970
63-3 Administering a Rectal Suppository 972
63-4 Administering a Vaginal Suppository 972
63-5 Administering Eye Medications 973
63-6 Administering Ear Medications 975
63-7 Administering a Transdermal Patch 977
64-1 Drawing Medication From an Ampule or Vial 999
64-2 Administering Intradermal Injections 1001
64-3 Administering Subcutaneous or Intramuscular Injections 1002
64-4 Giving a Subcutaneous (SubQ) Injection 1003
64-5 Giving an Intramuscular (IM) Injection 1004
64-6 Changing the Intravenous (IV) Bag, Dressing, and/or Tubing 1005
64-7 Converting a Continuous Intravenous (IV) Infusion to an Intermittent Line (Saline Lock) 1008
64-8 Flushing the Saline Lock; Administration of Medications Via Saline Lock 1009

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64-9 Discontinuing an Intravenous (IV) Infusion or Saline Lock 1010

64-10 Administration of IV Medications Via Piggyback Setup (Small Volume Delivery System) 1011
64-11 Administration of Medications Via Volume-Controlled Infusion 1013
64-12 Administration of Medications Into a Continuous Infusion (IV Push) 1014
64-13 Venipuncture (Phlebotomy)/Obtaining a Blood Specimen 1015
64-14 Initiating Intravenous Infusions 1018
65-1 Listening to Fetal Heart Tones (FHTs) 1051
66-1 Application of External Monitor 1074
66-2 Fundal Massage 1075
67-1 Assisting a Newborn With Breathing 1099
67-2 Prophylaxis for the Eyes of the Neonate 1100
67-3 Weighing a Neonate 1100
67-4 Measuring Head Circumference 1101
67-5 Bathing a Neonate 1101
67-6 Performing a Heel Stick Procedure on a Newborn 1102
71-1 Collecting a Pediatric Urine Specimen 1198
78-1 Assisting With a Lumbar Puncture 1380
79-1 Testing for Blood Glucose Level 1411
80-1 Using a Cotton-Tipped Applicator 1433
80-2 Irrigating the Ear 1433
86-1 Suctioning to Remove Secretions 1564
87-1 Supplying Oxygen With the Nasal Cannula 1578
87-2 Using the Simple Mask 1579
87-3 Applying the Partial-Rebreathing Mask 1579
87-4 Applying the Venturi Mask 1580
87-5 Assisting at a Tracheostomy 1580
87-6 Suctioning and Providing Tracheostomy Care 1581
88-1 Irrigating the NG Tube 1627
88-2 Changing the Ostomy Appliance 1628
91-1 Performing a Vaginal Irrigation (Douche) 1695

Nursing Care Guidelines

32-1 Helping at Hospital Mealtimes 390
32-2 Feeding Clients 391
37-1 Change-of-Shift Reporting 453
38-1 General Guidelines for Performing Nursing Procedures 459
38-2 Guidelines for Performing Grouped Procedures 460
39-1 Preventing Accidents in the Healthcare Facility or Client’s Home 467
41-1 Implementing Standard Precautions 493
41-2 Preventing Infection for Nursing Staff and Clients 497
42-1 Caring for the Body of a Deceased Person Who Was in Isolation 514
43-1 Treating Shock in an Emergency 522
43-2 Providing Emergency First Aid for Burns 533
43-3 First Aid for Avulsed Teeth 535
43-4 Giving First Aid for Eye Injuries 536
43-5 Assisting the Client Who Feels Faint 537
43-6 Giving First Aid in Suspected Heart Attack (MI) 538

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43-7 Giving First Aid in Poisoning or Overdose 542

44-1 Using Therapeutic Communication 550
47-1 Measuring Reflexes 620
48-1 Positioning the Client for Comfort 647
48-2 Assisting the Client to Walk 658
48-3 Using Client Reminder or Protective (Safety) Devices 666
50-1 Caring for a Client Who Wears Dentures or Other Mouth Appliances 702
50-2 Caring for the Eyes 703
50-3 Caring for a Hearing Aid 705
50-4 Performing Hand Massage 706
50-5 Caring for Hair 708
50-6 Backrub 711
50-7 Washing the Client’s Face and Hands 712
51-1 Straining Urine for Calculi 736
51-2 Listening for Bowel Sounds 738
51-3 Performing Catheter Care 743
51-4 Using External Catheter Systems 744
51-5 Using the Ultrasound Bladder Scanner 747
51-6 Administering the Harris Flush 749
51-7 Administering an Enema 751
51-8 Assisting the Client Who Is Nauseated or Vomiting 753
52-1 Collecting Specimens and Samples 763
52-2 Collecting Urine Specimens 765
52-3 Collecting Clean-Catch Midstream Urine Specimens 767
53-1 Applying a Roller Bandage (Arm or Leg) 780
53-2 Applying a Stretch-Net Dressing to a Finger 781
53-3 Applying a T-Binder 782
53-4 General Nursing Care of the Client With a Bandage or Binder 783
54-1 Applying Heat Therapy 789
54-2 Applying Cold Therapy 792
54-3 Applying Cold Moist Compresses 793
54-4 Giving a Tepid Sponge to Reduce Body Temperature 794
56-1 Caring for the Client Who Is Receiving Anesthesia 817
56-2 Organizing Preoperative Nursing Care 819
56-3 Assisting the Client With Postoperative Exercises 833
57-1 Sterile Technique 843
63-1 Setting Up Medications 953
63-2 Administering Medications Safely 956
63-3 Crushing or Splitting Tablets 963
63-4 Administering Orally Disintegrating Tablets 963
63-5 Administering Aerosolized and Powdered Respiratory Medications 966
63-6 Administering Nasal Sprays or Drops 967
64-1 Caring for the Client Receiving Intravenous (IV) Therapy 986
64-2 Managing Parenteral Nutrition 993
64-3 Administering Intravenous (IV) Medications 994
66-1 Postpartum Period 1070
67-1 Care of the Normal Newborn 1090
68-1 Assisting in an Emergency Delivery 1122
71-1 Reducing Anxiety and Calming Children for Procedures 1180
71-2 Providing Pediatric Safety 1184
71-3 Using Pediatric Restraints 1185

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71-4 The Child and IV Therapy 1188

71-5 Giving an Infant a Bath 1189
71-6 General Considerations for Oxygen (O2) Administration 1190
71-7 Diagnostic Procedures 1192
71-8 Managing a Fever 1193
71-9 Administering Medications to Children 1193
71-10 Preoperative Care for Children 1195
71-11 Postoperative Care for Children 1196
74-1 Working With an Individual With Special Needs 1266
74-2 Feeding the Intellectually Impaired Child 1268
75-1 Giving a Therapeutic Bath 1291
75-2 Application of Moist Dressings 1292
77-1 Preparing for Casting 1336
77-2 Performing Cast Care 1337
77-3 Caring for Clients in Traction 1342
77-4 Caring for Clients With New Hip Replacements 1347
78-1 Maintaining the Client’s Safety During a Seizure 1358
78-2 Caring for the Client With Paralysis 1365
78-3 Determining Cerebrospinal Fluid (CSF) in Drainage 1375
81-1 Administering the Cardiotonic Drug Digoxin (Lanoxin) 1451
81-2 Caring for Clients With Peripheral Vascular Disease 1459
81-3 Communicating With the Client With Aphasia 1463
82-1 Precautions During Blood Transfusions 1471
82-2 Managing a Transfusion Reaction 1472
82-3 Administering Iron Supplements 1475
83-1 Providing Care for the Person Receiving Chemotherapy 1494
83-2 Providing Care for Clients Receiving External-Beam Radiation Therapy 1497
83-3 Providing Care for Clients With Implanted Radioactive Isotopes 1499
86-1 Assisting With Postural Drainage 1537
86-2 Caring for the Person Who Has Had Chest Surgery 1538
86-3 Caring for the Person With Chest Suction 1540
86-4 Caring for the Person With Pneumonia 1548
86-5 Caring for the Person Who Has Had Nasal Surgery 1561
87-1 Providing Oxygen 1567
87-2 Nursing Care Priorities for the Client Receiving Mechanical Ventilation 1576
88-1 Providing Care Before and After Barium Studies 1585
88-2 Giving Care for a Gastrostomy, Colostomy, or Ileostomy 1598
88-3 Caring for the Client With a Liver Disorder 1618
88-4 Caring for the Hospitalized Client Who is Obese 1624
89-1 Caring for the Client Receiving Dialysis 1654
90-1 Managing Continuous TURP or Bladder Irrigation 1667
93-1 Monitoring a Client’s Hydration Status 1732
93-2 Communicating With the Person Who Has Dementia 1733
94-1 Caring for the Client Who Is to Have ECT 1749
94-2 Administering Medication Therapy in the Mental Health Unit 1756
94-3 Maintaining the Client’s Dignity in Mental Health Units 1760
94-4 Supervised Visits 1760
94-5 Using Safety Devices for the Client With Mental Illness 1762
94-6 Suicide Prevention 1770
94-7 Care of the Client Who Is Manic/Hypomanic 1772

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94-8 Care of the Combative or Assaultive Client 1772

94-9 Assisting the Client Who Has Delusions or Hallucinations 1773
94-10 Assisting the Client Who Is Confused or Demented 1773
94-11 Assisting the Client Who Is Withdrawn or Depressed 1774
94-12 Assisting the Client Who Is Regressed 1774
95-1 Caring for the Alcohol- or Drug-Using Person in the Emergency Department 1782
95-2 Nursing Care in Alcohol Withdrawal 1789
95-3 Nursing Considerations in Antabuse Therapy 1794
100-1 Providing Care in Hospice Nursing 1857

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PA RT A
Foundations of Nursing

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UNIT 1
The Nature of Nursing

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The Origins of Nursing

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Learning Objectives
1. Explain how certain events in ancient and medieval times influenced the development of
contemporary nursing.
2. Discuss Florence Nightingale’s influence on modern nursing practice.
3. List at least 10 of Florence Nightingale’s nursing principles that are still practiced today.
4. Identify important individuals who contributed to the development of nursing in the United
States.
5. Name some pioneer nursing schools in the United States.
6. List important milestones in the history of practical nursing education.
7. Explain war-related developments in nursing.
8. Discuss current trends that are expected to influence the nursing profession in the 21st century.
9. Describe the importance of nursing insignia, uniforms, and the nursing school pin.

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Important Terminology
Caduceus
Hippocratic oath
holistic healthcare
insignia
Nightingale lamp

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Introduction
ou have chosen to become a nurse. The word nurse derives from the

Y Latin word meaning to nourish. You are embarking on a career that

combines scientific principles, technical skills, and personal
compassion. Although people have been performing many nursing skills for
centuries, nursing in its present form began to emerge only in the 19th -
century. Contemporary nursing continues to evolve as society and its
healthcare needs and expectations change. Nursing must continue to adapt to
meet society’s goals and to provide needed services in the changing world.
Nursing is a practical and noble profession. It provides a stable career in
the ever-changing world of healthcare, with plenty of career options.
Individual attributes required to be a nurse include a strong sense of
responsibility and the highest standards of integrity. Personal conviction and
flexibility are necessary foundations of a nurse. A nurse must be well
educated and integrate the art and the science of working with people.
Nurses interact with a vast assortment of individuals, including numerous
and varied healthcare personnel who have their own fields of expertise. Many
of these healthcare fields were originally included in the broader roles and
responsibilities of nursing. For example, the nurse was originally responsible
for nutrition and diets. Nurses were also responsible for rehabilitative needs
of the persons under their care. The role of the nurse became so important to
the healthcare system that the functions of the nurse had to become diverse
and specialized to meet fast-growing needs. Many of these duties were
broken into specialties that are seen today, such as nutritionist, dietitian,
physical therapist, or occupational therapist.
As the role of the nurse has evolved, so has the role of the person receiving
care. When the physician was the primary manager or leader of health issues,
the individual receiving care was typically called a client. During the 20th
century, the client became more aware of his or her own health issues.
Instead of being a passive participant, the client became a more
knowledgeable consumer of healthcare and, as in other service industries, the
consumer became a client of the primary care provider, nurse, and healthcare
system. In the 21st century, all of these terms are currently used to describe

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the individual who receives healthcare. This textbook uses the term client
because the term client reflects the roles of the nurse who actively interacts
with individuals, families, and the healthcare system. In everyday
conversations, the terms patient, client, and/or consumer may be heard.

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Nursing’s Heritage
A detailed history of nursing is beyond the scope of this book. All nurses
should become familiar with some important people and developments in the
history of nursing. Several internet sites record nursing’s heritage. As your
nursing career develops, you will be part of nursing’s ongoing history.

Early Influences
In ancient times, people often attributed illness to punishment for sins or to
possession by evil spirits. Most primitive tribes had a medicine man, or
shaman, who performed rituals using various plants, herbs, and other
materials, to heal the sick. Tribal rituals included dances, chants, and special
costumes and masks. Some groups used human or animal sacrifices. Women
had various folk roles in ancient health practices, depending on the culture
and social customs. Women were often involved with assisting in childbirth.
Religious images of the nurse developed as care of the sick became
associated with concepts that are discussed in the Bible, the Talmud, and
other ancient texts. Centers in India and Babylonia provided care for the sick
before the time of Christ. By 500 bc, the advanced Greek civilization had
begun to acknowledge causes of disease other than punishment by God or
demonic possession. Based on mythical figures, the caduceus and the staff of
Aesculapius are the modern symbols of medicine (Fig. 1-1). The Greeks
began to establish centers, sometimes called hostels or hospitals, for care of
the sick and injured. They used warm and mineral baths, massage, and other
forms of therapy that priestesses sometimes administered. Pregnant women
or people with an incurable illness were not admitted to these hostels.

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FIGURE 1-1 Symbols of medicine. A. Aesculapius, a mythical Greek god of healing

and son of Apollo, had many followers who used massage and exercise to treat clients.
This god is also believed to have used the magical powers of a yellow, nonpoisonous
serpent to lick the wounds of surgical clients. Aesculapius was often pictured holding
the serpent wrapped around his staff or wand; this staff is a symbol of medicine. B.
Another medical symbol is the caduceus, the staff of the Roman god Mercury, shown as
a winged staff with two serpents wrapped around it.

The Influence of Hippocrates

One of the early outstanding figures in medicine was Hippocrates, born in
460 bc on the Greek island of Kos. Hippocrates is the acknowledged “Father
of Medicine.” Hippocrates denounced the idea of mystical influence on
disease. He was also the first person to propose concepts such as physical

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assessment, medical ethics, client-centered care, and systematic observation

and reporting. By emphasizing the importance of caring for the whole person
(holistic healthcare), he helped to lay the groundwork for nursing and
medicine. Contemporary healthcare practitioners preserve the principles of
Hippocrates. Typically, a physician will repeat the Hippocratic oath when
graduating from a school of medicine. The Florence Nightingale pledge and
Practical Nurses’ pledge are based on this oath.
Early medical educators helped to solidify the need for practitioners to be
well-educated individuals. Physicians were eventually required to obtain a
university degree as a doctor of medicine (MD). Specialized healthcare
education and training became standard as scientific knowledge increased.
Modern medicine has multiple medical and surgical specializations; for
instance, the client can be described as having heart and lung diseases, or
injury and trauma. Nursing has developed a role of assistant to the physician,
serving their needs and following orders regarding care of individuals.
Relatively unchanged from the beginning is the concept that the nurse must
be aware of the whole client. The holistic approach translates into the nurse’s
attentiveness to a client’s personal needs from various perspectives. The
nurse is aware of the client’s emotions, lifestyles, physical changes, spiritual
needs, and individual challenges. Nursing is unique in this approach to
healthcare.

The Roman Matrons

The first recorded history of nursing begins with Biblical women who cared
for the sick and injured. Many were in the religious life. For instance,
Phoebe, mentioned in the Epistle to the Romans (about 58 ad), is known as
the first deaconess and visiting nurse.
Fabiola, a Roman woman, is credited with influencing and paying for the
construction of the first free hospital in Rome in 390 ad. Another Roman
woman, Saint Marcella, converted her beautiful home into a monastery,
where she taught nursing skills. She is considered the first nursing educator.
Saint Paula is credited with establishing inns and hospitals to care for
pilgrims traveling to Jerusalem. She is said to be the first person to teach the
philosophy that nursing is an art rather than a service. Saint Helena, the
mother of the Roman Emperor Constantine, is credited with establishing the

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first gerontologic facility, or home for the aged.

Monastic and Military Nursing Orders

Beginning in the first century, several monastic orders were established to
care for the sick. Sometimes, the monastery itself became the refuge for the
sick; in other cases, members of a religious order founded a hospital. Both
men and women of religious orders performed nursing care.
During the Crusades (1096–1291), female religious orders in northern
Europe were nearly eliminated. Male military personnel, such as the Knights
Hospitallers of St. John in Jerusalem, conducted most nursing care. Because
these military men were required to defend the hospital as well as care for the
sick, they wore suits of armor under their religious habits. The symbol for
this order was the Maltese cross, which later became the symbol of the
Nightingale School. This symbol was the forerunner of nursing school pins
worn today.

The Reformation
In the 1500s, during the European religious movement called the
Reformation, many monasteries closed and the work of women in religious
orders nearly ended. Until the 1800s, the few women who cared for the sick
were prisoners or prostitutes. Nursing was considered the most menial of all
tasks, and the least desirable. This period is called the dark ages of nursing.

Fliedner in Kaiserswerth
In 1836, Pastor Theodor Fliedner established the Kaiserswerth School for
Nursing in his parish in Kaiserswerth, Germany. It was one of the first
formally established schools of nursing in the world. Out of it grew the
Lutheran Order of Deaconesses, which Fliedner directed. Its most famous
student was Florence Nightingale.
By the late 1800s, many schools for trained nurses existed throughout
Europe. The status of nursing began to improve, and many women, including
members of religious orders, once again became involved in nursing care.

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Florence Nightingale
Even during the days when nursing was considered menial and undesirable,
some women continued to care for the sick. Probably the most famous was
Florence Nightingale (Fig. 1-2). Most nurses before her time received almost
no training. Not until she graduated from Kaiserswerth and began to teach her
concepts did nursing become a respected profession.

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FIGURE 1-2 Florence Nightingale.(Photo courtesy of the Center for the Study of the
History of Nursing.)

Nightingale was born in Italy in 1820 to wealthy English parents. When

she was still very young, her parents returned to England.
In 1851, Nightingale entered the Deaconess School in Kaiserswerth. She
was 31 years old, and her family and friends were strongly opposed to her
becoming a nurse. After her graduation in 1853, she became superintendent
of a charity hospital for governesses. She trained her attendants on the job
and greatly improved the quality of care. In 1854, the Crimean War began.
Nightingale gained fame during this conflict. She entered the battlefield near
Scutari, Turkey, with 38 other nurses and cared for the sick and injured. The
nurses had few supplies and little outside support. Nonetheless, Nightingale
insisted on establishing sanitary conditions and providing quality nursing
care, which immediately reduced the mortality rate. Her persistence made her
famous, and she and her nurses were greatly admired. Her dedicated service
both during the day and at night, when she and her nurses made their rounds
carrying oil lamps, created a public image of the lady with the lamp. In time,
the Nightingale lamp or the “Lamp of Learning” (Fig. 1-3) became a symbol
of nursing and nursing education. Today, many schools of nursing display a
model of the lamp or a picture of Florence Nightingale carrying a lamp.

FIGURE 1-3 The “Nightingale lamp” (also known as the “Lamp of Nursing” or the

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“Lamp of Learning”) is an insignia of nursing and nursing education.The lamp

represents the warmth of caring. The light of the lamp symbolizes the striving for
excellence. The oil represents the energy and commitment of the nurse to heal others.

Nightingale’s Definition of Nursing

Nightingale had definite and progressive ideas about nursing, as discussed in
her book, titled Notes on Nursing: What It is, and What It is Not (published in
1859). These ideas remain foundations of contemporary nursing. Nightingale
states:
The very elements of what constitutes good nursing are little
understood for the well as for the sick. The same laws of health or
of nursing, for they are in reality the same, obtain among the well
as among the sick….If a patient is cold, if a patient is feverish, if
a patient is faint, if he is sick after taking food, if he has a bed-
sore, it is generally the fault not of the disease, but of the
nursing….I use the word nursing for want of a better. It (nursing)
has been limited to signify little more than the administration of
medicines and the application of poultices. It ought to signify the
proper use of fresh air, light, warmth, cleanliness, quiet, and the
proper selection and administration of diet—all at the least
expense of vital power to the patient.
Nightingale specified five essential points that are necessary for the
maintenance of health and the support of recuperation. These include clean
air, clean water, efficient drainage, cleanliness, and light.

The Nightingale School

Building on the respect she had established in the Crimean War, Nightingale
opened the first nursing school outside a hospital in 1860. The nursing course
was 1 year in length and included both classroom and clinical experience, a
major innovation at that time. Students gained clinical experience at St.
Thomas Hospital in London. Because it was financially independent, the
school emphasized learning, rather than service to the hospital. Some

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principles of the Nightingale School for Nurses are still taught today:
Cleanliness is vital to recovery.
The sick person is an individual with individual needs.
Nursing is an art and a science.
Nurses should spend their time caring for others, not cleaning.
Prevention is better than cure.
The nurse must work as a member of a team.
The nurse must use discretion but must follow the physician’s orders.
Self-discipline and self-evaluation are important.
A good nursing program encourages a nurse’s individual development.
The nurse should be healthy in mind and body.
Teaching is part of nursing.
Nursing is a specialty.
A nurse does not graduate but continues to learn throughout his or her career.
Nursing curricula should include both theoretical knowledge and practical experience.

The Nightingale School included other innovations:

Establishment of a nurses’ residence
Entrance examinations and academic and personal requirements, including a character reference
Records of each student’s progress—later known as the “Nightingale plan,” a model for current
nursing programs
Records of employment of students after graduation, or a formal register—the beginnings of
nursing practice standards

NCLEX Alert
NCLEX questions are based on the contents of the official NCLEX-PN Test Plan. Students need to
be aware of these general categories because specific questions, better referred to as clinical
scenarios, can involve one or more components of the Plan. The answers provided by NCLEX are
referred to as options. When taking the NCLEX, read the clinical scenario carefully and read all of
the options. Keep in mind that more than one option may be correct. You must choose the BEST
correct option.

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Nursing in the United States

Nursing in the colonial United States was primarily a family matter, with
mothers caring for their own families or neighbors helping each other.
Throughout the 19th and 20th centuries, historical and nursing developments
interacted to build the foundation of modern nursing practice. The
establishment and growth of a system of nursing education is the most
important development that has shaped today’s nursing.

The First Nursing Schools

The influence of Florence Nightingale and the Kaiserswerth School extended
to the United States when Pastor Fliedner came to Pittsburgh, Pennsylvania,
with four nurse-deaconesses. In 1849, he became involved with the
Pittsburgh Infirmary, the first Protestant hospital in the United States. Today
it is called Passavant Hospital. The four deaconesses trained other nurses and
started the movement to educate American nurses. The Pittsburgh Infirmary
was the first real school of nursing in the United States, although limited
training existed in other hospitals in New York and Pennsylvania before
1849.
In 1873, three nursing programs based on the Nightingale plan were
formally established: Bellevue Hospital School of Nursing in New York;
Connecticut Training School in New Haven; and Boston Training School at
Massachusetts General Hospital.

Notable American Nurses

With the onset of the Civil War (1861–1865), the public need for nurses
became more evident. In 1861, the Union Army appointed Dorothea Lynde
Dix (1802–1887) Superintendent of Female Nurses. Her job was to recruit
volunteer nurses to treat men injured in the war. Dix is especially
remembered for her campaign against the inhumane treatment of the mentally
ill. One of Dix’s volunteers was Louisa May Alcott (author of Little Women).
Another was Clara Barton (1821–1912), who in 1881 founded the

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organization now known as the American Red Cross.

Melinda Ann (Linda) Richards (1841–1930) was the first trained nurse in
the United States. She graduated in the early 1870s and organized the school
of nursing at Massachusetts General Hospital, then called the Boston
Training School.
Isabel Hampton Robb (1860–1910) was the founder of the school of
nursing at Johns Hopkins University. She is credited with founding two
national nursing organizations, one in 1911, which eventually emerged as the
American Nurses Association (originally called the Alumnae Association).
She and Lavinia Lloyd Dock (1858–1956) founded the American Society of
Superintendents of Training Schools of Nursing in 1894, which in 1903
evolved into the Education Committee of the National League for Nursing.
Robb wrote one of the earliest nursing textbooks, Materia Medica for Nurses,
and coauthored a four-volume History of Nursing. Robb also founded the
American Journal of Nursing. She introduced charting and nurse licensure to
improve continuity of care. She also initiated the idea of graduate nursing
study in the late 1800s.
Lillian Wald (1867–1940) is considered the founder of American public
health nursing. She is best known for founding the Henry Street Settlement
Visiting Nurse Society (VNS) in New York City in 1893. The Henry Street
Settlement was a neighborhood nursing service that became a model for
similar programs in the United States and other countries. Wald also
convinced New York City schools to have a nurse on duty during school
hours. She persuaded President Theodore Roosevelt to create a Federal
Children’s Bureau and insisted that nursing education occur in institutions of
higher learning.
Mary E. Mahoney (1845–1926) promoted fair treatment of African
Americans in healthcare. She was the first African American graduate nurse
and promoted integration and better working conditions for minority
healthcare workers in Boston.
Mary Breckinridge (1881–1965) was a pioneer as a visiting nurse-midwife
to the mountain people of Kentucky in the early 1900s, often making her
rounds on horseback. She also started one of the first midwifery schools in
the United States.

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Collegiate Nursing Education

In 1907, Mary Adelaide Nutting (1858–1947) and Isabel Robb were
instrumental in establishing the first college-based nursing program at
Teachers College of Columbia University. Nutting thus became the first
nurse to be on a university staff. She was also instrumental in founding the
International Council of Nurses.
In 1909, the University of Minnesota established the first continuous
program to educate nurses at the university level, with an enrollment of four
students. Isabel Robb strongly influenced the organization of this program,
which is considered the beginning of nursing as a profession. This program,
however, did not lead to a bachelor’s degree until 1919, when several other
schools had also initiated college- and university-based nursing programs.

The History of Practical Nursing Education

Practical nursing, also called vocational nursing, has existed for many years.
Women often cared for others and called themselves practical nurses. Not
until the 1890s, however, was formal education in practical nursing available.

Pioneer Schools
Curricula in all of the early practical nursing schools included child care,
cooking, and light housekeeping, in addition to care of the sick at home.
Hospital care was not necessarily included.

Ballard School
In 1892, the Young Women’s Christian Association (YWCA) opened the
first practical nursing school in the United States in Brooklyn, New York.
Later, it was named the Ballard School because Lucinda Ballard provided the
funding. Practical nursing (attendant nursing) was one of several courses
offered to women. This program was a 3-month course to train women in
simple nursing care, emphasizing care of infants and children, older adults,
and the disabled in their own homes. The Ballard School closed in 1949
because of YWCA reorganization.

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Thompson Practical Nursing School

Thomas Thompson, a wealthy man who lived in Vermont during the Civil
War, learned that women were making shirts for the army at only a dollar a
dozen. In his will, he left money to help them. Richard Bradley, his executor,
was a public-spirited man and determined that the local citizens needed
nursing service. In 1907, he used some of Thompson’s money to establish the
Thompson Practical Nursing School in Brattleboro, Vermont. This school
still exists today.

Household Nursing School

In Boston, a group of women wanted to provide nursing care in the home for
people who were sick. They called on Bradley for advice, and he encouraged
them to follow Brattleboro’s example. In 1918, the Household Nursing
Association School of Attendant Nursing opened. The school was later
renamed the Shepard-Gill School of Practical Nursing in honor of Katherine
Shepard Dodge, the first director, and Helen Z. Gill, her associate and
successor. This school operated until 1984.
In all, 36 practical nursing schools opened during the first half of the 20th
century in the United States. Between 1948 and 1954, 260 additional
programs had opened. Today, more than 1,500 practical nursing programs
exist in the United States. There is a growing need for licensed
vocational/licensed practical nurses (LVN/LPNs) in multiple healthcare
settings. Many LVN/LPNs choose to continue their nursing education and
become registered nurses (RNs) via utilization of resources, such as career
ladder programs, which accept LVN/LPN curricula for RN programs.
Chapter 2 discusses the education requirements for nurses in greater detail.

American Red Cross Training

In 1908, the American Red Cross began offering home nursing education to
teach lay women appropriate nursing care for illnesses within their own
families. Jane Delano (1862–1919) was an Army nurse who was instrumental
in this movement. Chapter 7 discusses the Red Cross in more detail.

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Practical Nursing in Vocational and Community

Colleges
In the early part of the 20th century, nursing schools—training both practical
nurses and registered nurses—were traditionally located in or affiliated with
hospitals. In 1917, the U.S. Congress passed the Smith-Hughes Act, the funds
from which gave impetus to vocational-technical and public education. In
1919, the first vocational school-based nursing program opened in
Minneapolis at Minneapolis Vocational High School. Today, the majority of
practical nursing and associate’s-degree nursing programs are located in
vocational education settings or in community colleges.

Other Milestones in Practical Nursing Education

The Association of Practical Nurse Schools was founded in 1941. It was later
renamed the National Association of Practical Nurse Education and Service.
In 1914, Mississippi became the first state to designate LPNs. By 1955, all
states had laws that regulated the licensure of practical nurses. The first state
to have mandatory licensure for LPNs to practice was New York. Chapter 2
discusses permissive and mandatory licensure more fully.
During World War II, people realized that nurses needed a consistent
curriculum. In 1942, the U.S. Office of Education planned and advocated the
first practical nursing curriculum for the entire country.
In 1966, the Chicago Public School system’s program was the first
practical nursing program to be accredited by the National League for
Nursing (NLN).

Nursing During Wartime

Nursing during wartime has long been important. From Florence Nightingale
in the Crimean War to the American Civil War, Spanish–American War,
Korea, Vietnam, and continuing to the wars of the 21st century, nurses have
always played a vital role.
World War I marked the first emergency training of nurses. The Army
School of Nursing was established; Annie W. Goodrich (1876–1955) wrote
the curriculum. Hundreds of women were trained in this abbreviated

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program; however, nearly all of them left nursing and returned to

homemaking after the war’s end in 1918.
The U.S. Cadet Nurse Corps was established during World War II, with
Lucile Petry Leone (1902–1999) as Director. More than 14,000 volunteer
nurses graduated in about 2 years. Originally, the plan was to draft nurses
into the Army. A major opponent to this idea was Katherine J. Densford
(1890–1978), Director of the School of Nursing at the University of
Minnesota. She promised to train expanded numbers of nurses in a short
time, if the government abandoned the nurse draft. Because of Densford’s
efforts, the student population at the University of Minnesota multiplied by
five in a matter of weeks; more than 1,200 cadets graduated from that school
alone.
World War II also marked the first time that men as well as women were
actively recruited into nursing. Male nurses were not given equal rank to
female nurses in the Armed Forces, however, until 1954. By the war’s end in
1945, the world had changed. Many cadet nurses remained in the field,
especially in the military. This employment gave many women a measure of
independence that they had not previously known. After this time, emphasis
was placed on improved graduate education for nurses. Nurses also began to
assume a broader, more responsible role—a trend that continues today.

Current Nursing Trends

Nursing evolved rapidly in the 20th century, which promoted the needs and
status of nurses. Technology, economics, and healthcare access continue the
evolution of nursing in the 21st century. Many factors influenced trends that
are expected to continue in the 21st century. The responsibilities of the nurse
have increased as a direct result of these trends. This book has been written
with these trends in mind:

Higher Client Acuity in Hospital and Long-Term Settings

Because of limitations on payment for healthcare, hospital stays are markedly
shorter than they were in the 20th century. Clients in all healthcare facilities
are more acutely ill than in years past. Long-term care facilities also have
seen an increase in clients with highly acute conditions because of the growth

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of home care for those with more manageable conditions. Such developments
require nurses working in all care areas to have higher levels of skill,
additional education, and more specialization.

Shift to Community-Based Care

Most clients now receive healthcare outside acute care settings. For example,
much surgery is now done on an outpatient basis; many clients receive care
for chronic or long-term conditions at home; and community clinics provide
primary healthcare for many clients. Thus, today’s nursing care is delivered
in a much wider range of settings than in the past.

Technology
Nurses, clients, and family members often must learn to operate highly
sophisticated equipment to manage conditions in the home. This equipment
makes accuracy in diagnosis and treatment possible. The teaching role of
nursing is emphasized to a greater extent.

Social Factors
Many clients experience homelessness, are unemployed, or are
underemployed. Devastating diseases, such as the coronavirus disease 2019
(COVID-19) pandemic, acquired immunodeficiency syndrome (AIDS),
tuberculosis, measles, or pertussis, are more prevalent. These factors create a
need for more healthcare services in the public sector. National and state
healthcare legislation are promoting the concepts of preventative treatment
and universal availability of healthcare.

Lifestyle Factors and Greater Life Expectancy

Today’s society and the healthcare industry emphasize prevention of disease,
healthy lifestyles, and wellness programs. Many people are living much
longer and are more active and healthy into their later years than in past
generations. Greater life expectancy is causing huge growth in the areas of
extended, long-term, and home care. This growth will require many more
nurses to work in such fields.

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Changes in Nursing Education

Today’s nursing programs emphasize education over service to clinical sites;
they identify specific objectives (outcomes) for students. An earlier edition of
this textbook was the first to identify learning objectives in practical nursing.
Many LVN/LPNs are returning to school to become RNs, and many “career
ladder” programs are available.

Autonomy
The social concept that all people, regardless of gender, should have equal
access to opportunities has influenced nurses, most of whom are women, to
be more assertive and independent. Today’s nursing role is to collaborate
with others in the healthcare field. Primary care, previously delivered only by
physicians, can be delivered by nurses who succeed in advanced educational
opportunities and specialized clinical experiences.

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Nursing Insignia
An insignia is a distinguishing badge of authority or honor. The symbolism
dates back to the 16th century in Europe, when only a nobleman could wear a
coat of arms. Later this privilege was expanded to include members of guilds
(craftsmen). Certain types of training schools, including religious nursing
orders, were also given the privilege. In the past, female nurses wore nursing
caps and all nurses were awarded a school pin at graduation. Some schools
also had distinguishing capes. The “Nightingale lamp,” “Lamp of Nursing,”
or “Lamp of Learning” remain a standard of nursing insignia (see Fig. 1-3).

Nursing Uniforms
Although the style of uniform has changed throughout the years, nurses have
always dressed professionally (Fig. 1-4). Clients usually feel more
comfortable when nurses are easily identifiable and distinguishable from
other staff. Today, a nametag, which includes your name, a current photo ID,
and your job title, is required whenever you provide nursing care, no matter
where you are employed.

FIGURE 1-4 Nursing uniforms have changed throughout the years.(Courtesy of the
National Institutes of Health/Department of Health and Human Services.)

The Nursing School Pin

You may receive a nursing pin at graduation that symbolizes your school of
nursing. Early nursing symbols were usually religious in nature. Today, many
nursing school pins bear some religious symbol, such as a cross (based on the

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Maltese cross) or a Star of David, even though the school may not be directly
affiliated with a religious organization. The Nightingale lamp is also a
common component of the nursing pin.

Key Concept
Remember that as you embark on your nursing career, you continue nursing’s history and heritage.

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STUDENT SYNTHESIS
KEY POINTS
Medicine men and women and religious orders cared for the sick in early times.
Florence Nightingale contributed a great deal to the development of contemporary nursing.
Establishment of nursing schools in the United States began in the late 19th century.
The first practical nursing school in the United States opened in 1892 in New York.
Nursing during the World Wars I and II contributed to the profession’s and to women’s evolving
roles in society.
Many current societal and healthcare trends are influencing the nursing profession, including
higher levels of client acuity in hospital settings, more community-based care, technological
advances, changing lifestyles, greater life expectancy, changing nursing education, and more
nursing autonomy.
Nursing insignia, such as those found on nursing school pins, often symbolize nursing’s history
and heritage.

CRITICAL THINKING EXERCISES

1. Explain how the changing role of women in society helped contribute to the changing role of
nursing.
2. Determine why established standards of nursing practice and education are so important to the
development of nursing as a respected profession.
3. A friend interested in nursing asks you about the profession’s history and its place in today’s
society. How would you answer your friend? What developments and milestones would you
highlight?

NCLEX-STYLE REVIEW QUESTIONS

1. Which trends in nursing are expected to influence nursing in the 21st
century? Select all that apply.
a. Higher client acuity in hospital and long-term settings
b. Traditional nursing education programs
c. Shift to community-based care
d. Advancements in technology
e. Greater life expectancy
2. A client has been involved in a motor vehicle crash and has multiple
injuries. Which guiding principles of Florence Nightingale would assist

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this client’s recuperation and health maintenance? Select all that apply.
a. Clean air and water
b. Cleanliness
c. Blood administration
d. Light
e. Efficient drainage
3. The nurse caring for a client must be attentive to the client’s emotions,
lifestyles, physical changes, spiritual needs, and individual challenges.
When the nurse attends to these needs, the nurse is providing which type
of care?
a. Behavioral healthcare
b. Specialized healthcare
c. Caring healthcare
d. Holistic healthcare
4. A nurse working in a mental healthcare facility understands that the
clients are to be treated respectfully and their rights maintained. Which
nurse was an advocate for the humane treatment of the mentally ill?
a. Florence Nightingale
b. Melinda Richards
c. Isabel Robb
d. Dorothea Dix
5. The first practical nursing school was a 3-month course. What was the
primary role of the practical nurse after graduation from this program?
a. Care of infants, children, older adults, and disabled in the client’s home
b. Care of all client populations in the hospital setting
c. Advanced care of adult clients in home and hospital
d. Assisting the physician in surgical procedures

CHAPTER RESOURCES
Enhance your learning with additional resources on !
Student Resources related to this chapter can be found at
thePoint.lww.com/Rosdahl12e.

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