Preface

Customization

Fundamentals of Nursing 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 Fundamentals of Nursing, 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standards, practices, data, and legal circumstances in nursing change frequently, and portions of the text may become out of date.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 2.1 AA compliant—and most current. Print versions are available for individual purchase, or they may be ordered through your campus bookstore.

Summary

Fundamentals of Nursing aligns with the core curriculum of a nursing fundamentals course and is designed to provide nursing students with the foundational knowledge and practical expertise essential for delivering holistic patient care. This textbook emphasizes the application of clinical judgment across diverse healthcare environments, ensuring readiness to deliver high-quality, compassionate, and patient-centered care to patients from various backgrounds and in different clinical scenarios. As the cornerstone of nursing education, the principles and practices presented in this text provide the foundational knowledge for students embarking on their journey into the nursing profession.

Fundamentals of Nursing features a variety of engaging and informative resources designed to prepare students for real-world practice. By simulating patient interactions, students develop critical communication skills essential for effective nursing care. Insights from practicing nurses provide real-world perspectives, helping bridge the gap between theory and practice. Focus on Quality and Safety Education for Nurses (QSEN) equips students with the skills necessary for providing safe, high-quality care.

Fundamentals of Nursing is more than just a textbook; it is a vital resource guiding students through the initial stages of their nursing education and beyond. By integrating a holistic approach and respecting inclusivity, this textbook prepares students for clinical rotations and provides a solid groundwork for their future careers as professional nurses.

Pedagogical Foundation

Fundamentals of Nursing offers comprehensive instruction on fundamental nursing concepts such as hygiene, mobility assistance, vital signs assessment, medication administration, safety, and wound care. With 43 chapters, Fundamentals of Nursing offers an in-depth exploration of the roles and responsibilities of a nurse, the healthcare environment, and the application of critical thinking and evidence-based practice for effective care delivery. Structured to build confidence and competence, Fundamentals of Nursing starts with fundamental concepts and progressively introduces more complex topics. It emphasizes holistic care, addressing the physical, emotional, spiritual, and social needs of patients, and highlights the importance of communication, cultural competence, and ethical decision-making in nursing practice.

Organizational Framework

The table of contents for Fundamentals of Nursing presents content in 43 chapters, organized into 7 thematic units.

• Unit 1 introduces the evolution, theories, and practice of the nursing profession. It covers the history and development of nursing theories, effective communication strategies, and the structure and barriers within healthcare delivery systems. The unit also emphasizes health, wellness, community-based health care, and cultural competence, ensuring that students understand the diverse contexts in which they will work.
• Unit 2 focuses on essential nursing skills and procedures, from taking vital signs to ensuring patient safety and administering medications. It provides the foundational skills necessary for effective patient care and emphasizes infection control, patient transfer, and discharge processes.
• Unit 3 explores the nursing process, covering assessment, diagnosis, planning, implementation, and evaluation. It teaches students how to systematically approach patient care, ensuring thorough and effective management of patient needs.
• Unit 4 addresses advanced topics such as evidence-based research, quality improvement, and collaborative practice. It also covers legal and ethical considerations, patient and family education, and leadership and management in nursing, preparing students for the complexities of professional practice.
• Unit 5 provides in-depth coverage of physiological aspects, including oxygenation, perfusion, fluid and electrolyte balance, nutrition, and more. It prepares students to manage various physiological conditions effectively.
• Unit 6 covers the psychosocial dimensions of nursing, including self-concept, sexuality, stress, adaptation, spirituality, and end-of-life care. It highlights the importance of holistic care that addresses both the physical and psychological needs of patients.
• Unit 7 emphasizes health promotion and disease prevention across different stages of life. It covers family dynamics, growth and development from conception through older adulthood, and care for patients with disabilities and chronic illnesses. The unit also focuses on the development of clinical judgment and critical thinking skills through case studies and practical applications. The final chapter brings all the information together in an unfolding case study.

Nursing Features

To further enhance learning, Fundamentals of Nursing includes the following features:

• Clinical Judgment Measurement Model boxes guide students through the application of the Clinical Judgment Measurement Model. 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 detailed explanations of safety protocols and procedures specific to nursing fundamentals. This feature emphasizes the importance of patient safety and quality care and offers checklists, step-by-step, or tips on various safety practices.
• Cultural Context boxes explore the impact of cultural factors on nursing procedures and practices. Some features describe care provided in other countries, while other features discuss cultural considerations for patients in the United States. Cultural Context boxes encourage students to approach each patient individually, respecting their culture and values.
• Life-Stage Context features describe topics that are affected by a patient’s age. Age-related topics allow the students to critically think about what influences certain conditions and the specific considerations needed for patients at different life stages.
• 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 features provide students with key information about how to interact with patients, including patient assessment guidelines for various situations and steps describing how to teach specific skills, such as adopting a healthy lifestyle, to a patient.
• Real RN Stories feature firsthand accounts from registered nurses in the field. These stories help students make connections to topics on a deeper level.
• Unfolding Case Studies present a hypothetical client scenario that unfolds in three parts across chapters, 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 two 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, Fundamentals of Nursing 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 apprehension of key concepts.
  • Check Your Understanding Questions require students to explain concepts in their own 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 Authors

Senior contributing authors: Christy Bowen (left), Lindsay Draper (middle), and Heather Moore (right)

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 20 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; develop a standardized concept-based curriculum for the state of Texas. She has led over 50 Workshops as part of the Implementation and Customization service for schools across the US transitioning to Concept-based Nursing. She developed over 20 Board of Nursing Continuing Education (CE) Certified Workshops and presented as Keynote speaker for all workshops to Universities and Colleges across the US. Throughout Dr Bowens 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.

Lindsay L. Draper, University of North Carolina Greensboro. Dr. Lindsay Draper, DNP, MSN/MBA, CNE, RN-BC, ACUE, is an Associate Professor and the Director of Faculty Credentialing, Compliance, and Special Initiatives at UNC Greensboro’s School of Nursing. In this role, Dr. Draper provides leadership and systematic oversight to ensure compliance with regulatory and accrediting standards, oversees faculty onboarding, orientation, and mentoring programs, and spearheads the integration of artificial intelligence and virtual reality into teaching and learning. She holds a Bachelor of Science in Nursing from East Carolina University, a dual Master of Science in Nursing/Master of Business Administration in Health Management from UNC Greensboro, and a Doctor of Nursing Practice in Executive Leadership from UNC Greensboro. Dr. Draper brings over 14 years of nursing experience, with certifications in medical-surgical nursing and nursing education. Her clinical expertise encompasses both medical-surgical and occupational health nursing. Throughout her career, she has held a range of progressive leadership positions, including Assistant Director of Nursing, Associate Department Chair, Director, and Provost Fellow. Dr. Draper has actively contributed to curriculum development and has taught across a range of academic levels, including bachelor's, master's, and doctoral programs. Her work includes securing AI teaching grants and presenting on the utilization of AI in teaching, learning, and workforce development. Dr. Draper’s contributions to the field have been recognized through prestigious awards, including the North Carolina Great 100 Nurse, Nursing Excellence awards, North Carolina Nurse Scholar distinction, Nurse of the Month, UNC Greensboro Graduate Leadership Award, and Gamma Zeta’s Excellence in Leadership Award. She was selected through a competitive process to participate in the National League for Nurses’ LEAD Institute, honored as the inaugural Helen Brooks Faculty Scholar, and had the privilege of serving as the keynote speaker at UNC Greensboro’s commencement ceremony.

Heather Moore, Xavier University. Dr. Heather Moore, DNP, RN, CNL, serves as an Assistant Professor of Nursing at Xavier University. She holds a Bachelor of Science in Nursing (BSN) degree from Ohio Northern University, a Master of Science in Nursing (MSN) degree with a specialty in Education from Lourdes University, and a Doctor of Nursing Practice (DNP) degree with a specialty in Healthcare Systems Leadership from Chamberlain University. Dr. Moore is a licensed Clinical Nurse Leader (CNL) and has completed specialized training in Universal Design for Learning (UDL), diversity and inclusion teaching practices, and curriculum design. She began her nursing career by completing a nurse residency program, followed by many years working in the general pediatric unit, pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU). She has held key clinical leadership roles, including unit manager, clinical team leader, and education manager. Dr. Moore has demonstrated scholastic excellence in her faculty roles, mastering clinical and didactic courses through in-person, online, and hybrid formats. She has successfully taught courses in undergraduate, graduate pre-licensure, and graduate post-licensure nursing programs. During her time in academia, Dr. Moore has served on numerous college and university committees, including multiple terms in elected chair and co-chair positions. As an active member of Kappa Gamma Pi and Sigma Theta Tau International Honor Society, she works to improve the nursing profession in both clinical and academic realms. As a subject matter expert in nursing, Dr. Moore has written and reviewed licensing examination questions for the traditional NCLEX, NextGen NCLEX, and Clinical Nurse Leader (CNL) exams. She has published and presented at various national and international conferences over the last decade and has authored textbooks on fundamentals, public health, and nursing skills. Dr. Moore's specialty areas include pediatric and family care nursing, leadership and management, capstone projects, and community health. Her research interests include family-centered care, HCAHPS scores, international collaboration, infection prevention, nursing leadership, and pediatric pain management.

Contributing Authors

Taranee Albert, Northwestern Medicine

Rebecca Brunelle (Retired)

Kelly Coloff

Kim English, Trent/Fleming School of Nursing

Alissa Hershberger, University of Central Missouri

Aimee Gilliland, West Tennessee Healthcare

Fang Lei, The University of New Mexico

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

Elizabeth Arnold, Vernon College

Nancy Bonard

Jessica Crockett, Baptist Health Care

Diane Glowacki, Clinical Nurse Specialist

Leigh Goldstein, The University of Texas at Austin

Victoria Haynes, MidAmerica Nazarene University

Veronica Hughes, Texas State University

Stephanie Hoffman, Chamberlain University

Christopher Jackson, South College

Tracey Long, Chamberlain University

Melissa Massey, Chamberlain University

Eileen McCann

Cara M. McNally

Jessica Peckham, Duke University

Jenna Reyes, Azusa Pacific University

Tanya Rose, Tarrant County College

Ansu Sebastian, Chamberlain University

Deanna Suber, Midlands Technical College

Julie Thomison, Baylor University

Teresa White

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.

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.