Preface

Customization

Clinical Nursing Skills is licensed under a Creative Commons Attribution 4.0 International (CC BY) license, which means that you can distribute, remix, and build upon the content, as long as you provide attribution to OpenStax and its content contributors.

Because our books are openly licensed, you are free to use the entire book or select only the sections that are most relevant to the needs of your course. Feel free to remix the content by assigning your students certain chapters and sections in your syllabus, in the order that you prefer. You can even provide a direct link in your syllabus to the sections in the web view of your book.

Instructors also have the option of creating a customized version of their OpenStax book. Visit the Instructor Resources section of your book page on OpenStax.org for more information.

Art Attribution

In Clinical Nursing Skills, art contains attribution to its title, creator or rights holder, host platform, and license within the caption. Because the art is openly licensed, anyone may reuse the art as long as they provide the same attribution to its original source.

Errata

All OpenStax textbooks undergo a rigorous review process. However, like any professional-grade textbook, errors sometimes occur. In addition, the wide range of evidence, standards, practices, data, and legal circumstances in nursing change frequently, and portions of the text may become out of date. Since our books are web-based, we can make updates periodically when deemed pedagogically necessary. If you have a correction to suggest, submit it through the link on your book page on OpenStax.org. Subject matter experts review all errata suggestions. OpenStax is committed to remaining transparent about all updates, so you will also find a list of past and pending errata changes on your book page on OpenStax.org.

Format

You can access this textbook for free in web view or PDF through OpenStax.org, and for a low cost in print. The web view is the recommended format because it is the most accessible—including being WCAG 2.2 AA compliant—and most current. Print versions are available for individual purchase, or they may be ordered through your campus bookstore.

Summary

Clinical Nursing Skills is designed to equip nursing students with the practical knowledge and hands-on skills necessary to provide comprehensive patient care. This text emphasizes the application of clinical judgment in a variety of settings, ensuring that students are prepared to deliver high-quality care across different patient populations and clinical scenarios. Covering a wide range of clinical skills, including fundamental nursing procedures, advanced technical skills, and critical thinking techniques, the book provides step-by-step instructions and evidence-based guidelines to help students master the competencies required for effective nursing practice.

The text explores fundamental nursing skills, offering detailed instructions on basic procedures such as hygiene, mobility, vital signs assessment, medication administration, and wound care. It also guides students through more complex skills, including intravenous therapy, catheterization, tracheostomy care, and emergency interventions. By integrating the Clinical Judgment Measurement Model, the book helps students recognize, analyze, prioritize, create, act, and evaluate outcomes in various clinical situations, fostering critical thinking and clinical decision-making.

By studying Clinical Nursing Skills, students will gain the confidence and competence needed to perform essential nursing tasks, make informed clinical decisions, and provide compassionate, patient-centered care. This text serves as a foundational resource for nursing students, preparing them for success in their clinical rotations and future professional practice.

Pedagogical Foundation

Clinical Nursing Skills provides a thorough and evidence-based introduction for entry-level undergraduate nursing students. The focus is on performing a comprehensive assessment. Content includes normal and abnormal findings, explanation of how the body maintains homeostasis, and its systems as a critical component of health and wellness. The content utilizes concepts promoting the development of clinical judgment by building upon the systematic model developed by the National Council of State Boards of Nursing (NCSBN).

Clinical Nursing Skills is structured to support the flexible integration of nursing skills content across both system-based and nursing competency-based curricula and can be used whether skills assessment is taught as a stand-alone course or as part of another nursing course. The text describes techniques for obtaining a health history and performing a basic physical assessment using a body systems approach. It also includes evidence-based clinical skills with related mathematical calculations and conversions. Tailoring this text to nursing students helps prepare them not only throughout the curriculum but also as a prerequisite to direct patient care. Instructors may pair the chapters from this textbook with similar body system topics in a disease course, such as Fundamentals, or Medical-Surgical Nursing.

Organizational Framework

The table of contents for Clinical Nursing Skills presents content in 28 chapters, organized into 4 thematic units:

• Unit 1 features introductory chapters that introduce concepts of comprehensive clinical care include historical nursing profession knowledge, foundational skills for performing a comprehensive assessment, cultural competence, and infection control and prevention.
• Unit 2 covers general assessment and special considerations the assessment findings of the body’s systems.
• Unit 3 details medication management, including the principles and procedures of dosage calculation.
• Unit 4 dives into the skills and assessment of each body system. The final chapter includes a dissection of an unfolding case study. Utilizing the Clinical Judgment Measure Model, students can develop critical thinking skills more deeply.

Nursing Features

To further enhance learning, Clinical Nursing Skills includes the following features:

• Clinical Judgment Measurement Model boxes guide students through the application of the Clinical Judgment Measurement Model in clinical practice. The content explores the critical thinking and decision-making processes necessary to navigate patient care at different points in the process, from recognizing cues to evaluating outcomes.
• Clinical Safety and Procedures (QSEN) align with the Quality and Safety Education for Nursing competencies by providing step-by-step procedures in specific clinical settings to ensure proper protocols are followed, evidence-based practice is explained, and patient safety remains the focus.
• Cultural Context boxes highlight cultural considerations as they relate to specific skills or topics. Cultural differences, such as skin tone or hair texture, may affect the way certain conditions or symptoms present or impact the steps a nurse takes. These boxes help students pay attention to these differences and explain how they may impact their approach to patient care.
• Life-Stage Context boxes highlight age considerations across the life span as they relate to specific skills or topics. For example, age might affect the steps a nurse takes to bathe a neonatal patient as compared to an older child or adult.
• Link to Learning features provide a very brief introduction to online resources—videos, interactives, collections, maps, and other engaging resources that are pertinent to students’ exploration of the topic at hand.
• Patient Conversations present students with short dialogues between a nurse and a patient, a family member of a patient, or another nurse to help students sharpen their critical thinking and communication skills in the clinical setting.
• Real RN Stories feature vignettes from actual nurses who faced a problem related to chapter topics. Reading a story about a topic makes it real for the learners and helps them unlock concepts and make connections in a way that mere descriptions cannot. The nurses highlighted in this feature represent a diversity of scholars with experience in various clinical settings and who vary in terms of age, geographic location, gender, and racial and cultural background.
• Unfolding Case Studies present a hypothetical client scenario that unfolds in parts throughout the chapter, with each subsequent part presenting new information on the same client, to help foster clinical judgment. In each part of an unfolding case feature, the scenario is followed by questions that require students to apply their knowledge of evidence-based care and allow them to practice with questions that mimic the style of Next-Gen NCLEX. The answers to these questions, with explanations, are included in the Answer Key for students at the end of the book.

Pedagogical Features

To support student learning, Clinical Nursing Skills includes the following standard elements:

• Learning Outcomes: Every chapter section begins with a set of clear and concise student learning outcomes. These outcomes are designed to help the instructor decide what content to include or assign and can guide students on what they can expect to learn and be assessed on.
• Assessments: A variety of assessments allow instructors to confirm core conceptual learning, elicit brief explanations that demonstrate student understanding, and offer more in-depth assignments that enable learners to dive more deeply into a topic or history-study skill.
  • Review Questions test for conceptual comprehension of key concepts.
  • Check Your Understanding Questions require students to explain concepts in words.
  • Reflection Questions and Competency-Based Assessment Questions dive deeply into the material to support longer reflection, group discussion, or written assignments.
  • What Should the Nurse Do? and Critical Thinking About Case Study Questions assess students’ clinical judgment skills using case-based scenarios. Students review either a single case or an unfolding case that reveals information gradually. In response to their observations of the patient, students must decide how to navigate the Clinical Judgment Measurement Model process. This approach challenges them to apply theoretical knowledge to practical situations, determining the most appropriate interventions based on the patient’s specific circumstances.
• Answers to Questions in the Book: The assessments are intended for homework assignments or classroom discussion; thus, student-facing answers are not provided in the book. Answers and sample answers are provided in the Instructor Answer Guide for instructors to share with students at their discretion, as is standard for such resources.
• Chapter Summary: Chapter summaries assist both students and instructors by outlining the primary subtopics addressed within the chapter.
• Key Terms: Key terms are presented in bold text and are followed by an explanation in context. Definitions of key terms are also listed in the end-of-chapter glossary.
• References: References are listed at the end of each chapter.

Senior Contributing Author

Senior contributing author: Christy Bowen

Christy Bowen, Chamberlain University. Dr. Christy Bowen DNP, RN, serves as the Dean of Academic Affairs for Chamberlain University’s BSN-Online. Dr. Bowen holds an ASN from Excelsior University, a BSN in Nursing and MSN in nursing education with a focus in curriculum development and revision from Western Governor’s University, and a Doctor in Nursing Practice in nursing leadership and management from Capella University. Dr. Bowen has been a nurse for more than twenty years and is certified in the specialty of critical care nursing, and wound care. In her clinical practice she held roles such as Department Chair, Unit Educator, and Lead Nurse. In her academia role, she has served as Lead Instructor, Curriculum Chair, Program Coordinator, Program Director, and Associate Dean of Faculty. Dr. Bowen has taught courses throughout all levels of nursing education such as associate, bachelor, master, and doctoral level programs. She enjoys teaching both clinical and didactic learning for nursing students. Dr. Bowen served as a key member of the curriculum team to develop a concept-based curricula as part of the Texas Nursing Concept-Based Curriculum (TxNCBC) project and develop a standardized concept-based curriculum for the state of Texas. She has led over fifty Workshops as part of the implementation and customization service for schools across the United States transitioning to concept-based nursing. She developed over twenty board of nursing continuing education certified workshops and presented as keynote speaker for all workshops to universities and colleges across the United States. Throughout Dr. Bowen's career, she has received many prestigious awards including Nurse of the Year, Clinical Nurse Leader of the Year, Employee of the Year, Top Requested Nursing Education Consultant (NEC), Phi Theta Kapa Faculty Member of the Year, and Presidential Award Outstanding Faculty Service.

Contributing Authors

Taranee Albert, Northwestern Medicine

Mary Anne Bera

Jessica Crockett, Baptist Health Care

Lindsay L. Draper, University of North Carolina Greensboro

Sandy Grimm, Nurse Educate

Alissa Hershberger, University of Central Missouri

Stephanie Hoffman, Chamberlain University

Czarina Hounsel, University of Texas at Arlington

Lindsay Jusino, The University of West Florida

Lori Kelly, Lipscomb University

Heather Moore, Xavier University

Amisha Parekh de Campos, University of Connecticut

Margaret Riley, Nurse Educate

Susan M. Rouse (Retired)

Leigh A. Waldron, Western Governors University

Reviewers

Karla M. Abela, The University of Texas Health Science Center at Houston

Theresa Allison, TSAZ Healthcare Solutions

Elizabeth Arnold, Vernon College

Kelly Coloff

Debra Fagan, Tallahassee Community College

Aimee Gilliland, West Tennessee Healthcare

Diane Glowacki, Clinical Nurse Specialist

Leigh Goldstein, The University of Texas at Austin

Chris Jackson, South College

Kathy Kump, Ottawa University

Cara M. McNally

Dolores Northrup, Western Governors University

Michelle Ollivierre-Lawrence, Chamberlain Institute

Jessica Peckham, Duke University

Jenna Reyes, Azusa Pacific University

Tanya Rose, Tarrant County College

Carreen Rush, Orlando Health Bayfront Hospital

Rachel Sandora, Herzing University

Deanna Suber, Midlands Technical College

Joan Yankalunas

Student and Instructor Resources

We have compiled additional resources for both students and instructors, including Getting Started Guides, an instructor’s answer guide, test bank, and image slides. Instructor resources require a verified instructor account, which you can apply for when you log in or create your account on OpenStax.org. Take advantage of these resources to supplement your OpenStax book.

Instructor’s answer guide. Each component of the instructor’s guide is designed to provide maximum guidance for delivering the content in an interesting and dynamic manner.

Test bank. With more than 1,100 assessments, instructors can customize tests to support a variety of course objectives. The test bank includes review questions (multiple-choice, identification, fill-in-the-blank, true/false), short answer questions, and long answer questions to assess students on a variety of levels. The test bank is available in Word format.

PowerPoint lecture slides. The PowerPoint slides provide learning objectives, images and descriptions, feature focuses, and discussion questions as a starting place for instructors to build their lectures.

Skills checklists. The skills checklists resource, linked throughout each chapter, identifies step-by-step competency checklists for commonly performed nursing skills.

Academic Integrity

Academic integrity builds trust, understanding, equity, and genuine learning. While students may encounter significant challenges in their courses and their lives, doing their own work and maintaining a high degree of authenticity will result in meaningful outcomes that will extend far beyond their college career. Faculty, administrators, resource providers, and students should work together to maintain a fair and positive experience.

We realize that students benefit when academic integrity ground rules are established early in the course. To that end, OpenStax has created an interactive to aid with academic integrity discussions in your course.

Visit our academic integrity slider. Click and drag icons along the continuum to align these practices with your institution and course policies. You may then include the graphic on your syllabus, present it in your first course meeting, or create a handout for students. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

At OpenStax we are also developing resources supporting authentic learning experiences and assessment. Please visit this book’s page for updates. For an in-depth review of academic integrity strategies, we highly recommend visiting the International Center of Academic Integrity (ICAI) website at https://academicintegrity.org/.

Community Hubs

OpenStax partners with the Institute for the Study of Knowledge Management in Education (ISKME) to offer Community Hubs on OER Commons—a platform for instructors to share community-created resources that support OpenStax books, free of charge. Through our Community Hubs, instructors can upload their own materials or download resources to use in their own courses, including additional ancillaries, teaching material, multimedia, and relevant course content. We encourage instructors to join the hubs for the subjects most relevant to your teaching and research as an opportunity both to enrich your courses and to engage with other faculty. To reach the Community Hubs, visit www.oercommons.org/hubs/openstax.

Technology partners

As allies in making high-quality learning materials accessible, our technology partners offer optional low-cost tools that are integrated with OpenStax books. To access the technology options for your text, visit your book page on OpenStax.org.

Special Thanks

The Division of Digital Learning at the Texas Higher Education Coordinating Board (THECB) has a history of dedicated research initiatives, services, and programs that have advanced open education in Texas by providing support, advocacy, and resources to Texas institutions in their OER efforts. The Division maintains a diverse OER portfolio including OERTX, a digital library and community space for open education work. The leadership and collaboration of the Division of Digital Learning staff made the OER Nursing Essentials (ONE) project possible, throughout research, planning, and development phases of the eight-textbook series.

This work was supported in whole or in part by the THECB. The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policies of the THECB.