Licensed to: Licensed to: Fundamentals of Nursing Standards & Practice Fourth Edition Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: Fundamentals of Nursing Standards & Practice Fourth Edition Sue C. DeLaune, MN, RN Assistant Professor RN-BSN Coordinator William Carey University School of Nursing New Orleans, Louisiana President and Education Director SDeLaune Consulting Mandeville, Louisiana Patricia K. Ladner, RN, MS, MN Former Consultant for Nursing Practice Louisiana State Board of Nursing New Orleans, Louisiana Australia (cid:129) Brazil (cid:129) Japan (cid:129) Korea (cid:129) Mexico (cid:129) Singapore (cid:129) Spain (cid:129) United Kingdom (cid:129) United States Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially a ffect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit w ww.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest. Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 5522660099__0000__ffmm__ppii--ppxxxxvvii..iinndddd iiii 22//11//1100 1111::3377::4433 PPMM Licensed to: FundamentalsofNursing:StandardsandPractice ª2011,2006,2002,1998,Delmar,CengageLearning FourthEdition ALLRIGHTSRESERVED.Nopartofthisworkcoveredbythecopyrightherein BySueC.DeLauneandPatriciaK.Ladner maybereproduced,transmitted,stored,orusedinanyformorbyanymeans graphic,electronic,ormechanical,includingbutnotlimitedtophotocopying, VicePresident,CareerandProfessional recording,scanning,digitizing,taping,Webdistribution,informationnetworks,or Editorial:DaveGarza informationstorageandretrievalsystems,exceptaspermittedunderSection107 DirectorofLearningSolutions:MatthewKane or108ofthe1976UnitedStatesCopyrightAct,withoutthepriorwritten ExecutiveEditor:StephenHelba permissionofthepublisher. ManagingEditor:MarahBellegarde SeniorProductManager:PatriciaGaworecki Forproductinformationandtechnologyassistance,contactusat EditorialAssistant:MeghanOrvis CengageLearningCustomer&SalesSupport,1-800-354-9706 Forpermissiontousematerialfromthistextorproduct,submitallrequests VicePresident,CareerandProfessionalMarketing: onlineatcengage.com/permissions. JenniferMcAvey Furtherpermissionsquestionscanbee-mailedto MarketingDirector:WendyE.Mapstone [email protected]. SeniorMarketingManager:MicheleMcTighe MarketingCoordinator:ScottChrysler LibraryofCongressControlNumber:2009937406 ProductionDirector:CarolynMiller ISBN-13:978-1-4354-8067-4 ProductionManager:AndrewCrouth ISBN-10:1-4354-8067-8 SeniorContentProjectManager:KennethMcGrath Delmar SeniorArtDirector:JackPendleton 5MaxwellDrive CliftonPark,NY12065-2919 USA CengageLearningisaleadingproviderofcustomizedlearningsolutionswith officelocationsaroundtheglobe,includingSingapore,theUnitedKingdom, Australia,Mexico,Brazil,andJapan.Locateyourlocalofficeat: international.cengage.com/region CengageLearningproductsarerepresentedinCanadabyNelsonEducation,Ltd. Foryourlifelonglearningsolutions,visitdelmar.cengage.com Visitourcorporatewebsiteatcengage.com. Purchaseanyofourproductsatyourlocalcollegestoreoratourpreferredonline storewww.CengageBrain.com. NoticetotheReader Publisherdoesnotwarrantorguaranteeanyoftheproductsdescribedhereinorperformanyindependentanalysisinconnectionwithanyofthe productinformationcontainedherein.Publisherdoesnotassume,andexpresslydisclaims,anyobligationtoobtainandincludeinformationother thanthatprovidedtoitbythemanufacturer.Thereaderisexpresslywarnedtoconsiderandadoptallsafetyprecautionsthatmightbeindicatedby theactivitiesdescribedhereinandtoavoidallpotentialhazards.Byfollowingtheinstructionscontainedherein,thereaderwillinglyassumesall risksinconnectionwithsuchinstructions.Thepublishermakesnorepresentationsorwarrantiesofanykind,includingbutnotlimitedto,the warrantiesoffitnessforparticularpurposeormerchantability,norareanysuchrepresentationsimpliedwithrespecttothematerialsetforthherein, andthepublishertakesnoresponsibilitywithrespecttosuchmaterial.Thepublishershallnotbeliableforanyspecial,consequential,or exemplarydamagesresulting,inwholeorpart,fromthereaders’useof,orrelianceupon,thismaterial. PrintedintheUnitedStatesofAmerica 1234567121110 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: To Jenniferand RyanCardinal, KatieandJacob Segrave,and Sarabethand JayAccardo. I especiallywantto thankmyhusband andbestfriend, Jay,forhiscontinuedsupportand beliefin me.I wantto acknowledgemyfather, GlynnEdwardCarter, forunending supportandencouragement,especiallyformyacademicendeavors. -SCD To Wayne,Kelly,WayneJr., Gretchen,and Michael. -PKL Wededicatethisbook to ourgrandchildren:CamilleAnnaCardinal, CarolineAlexa Cardinal,Leah Marie Ladner, CharlesThomasLee, MichaelandJoshuaLadner, and Cooperand PaigeLadner. Youare ourfuture.‘‘G’’and‘‘Mimi’’ Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: Brief Contents UNIT 1: Nursing’sPerspective:Past, Present, andFuture Chapter 1 Evolution of Nursing andNursing Education 3 Chapter 2 Nursing Theory 23 Chapter 3 Research andEvidence-BasedPractice 41 Chapter 4 Health Care Delivery, Quality,andtheContinuumof Care 53 UNIT 2: Nursing Process:TheStandardofCare Chapter 5 Critical Thinking,Decision Making,andthe NursingProcess 75 Chapter 6 Assessment 89 Chapter 7 Nursing Diagnosis 109 Chapter 8 Planning andOutcome Identification 125 Chapter 9 Implementation 139 Chapter 10 Evaluation 153 UNIT 3: Professional Accountability Chapter 11 Leadership, Delegation,and Power 165 Chapter 12 Legal andEthical Responsibilities 187 Chapter 13 DocumentationandInformatics 213 UNIT 4: PromotingClientHealth Chapter 14 Nursing,Healing,and Caring 245 Chapter 15 Communication 261 Chapter 16 Health andWellnessPromotion 281 Chapter 17 FamilyandCommunity Health 297 Chapter 18 TheLifeCycle 309 Chapter 19 TheOlder Client 357 Chapter 20 Cultural Diversity 379 Chapter 21 Client Education 401 UNIT 5: RespondingtoBasic PsychosocialNeeds Chapter 22 Self-Concept 423 Chapter 23 Stress, Anxiety, Adaptation,and Change 439 Chapter 24 Spirituality 463 Chapter 25 Lossand Grief 475 UNIT 6: RespondingtoBasic Physiological Needs Chapter 26 Vital Signs 501 Chapter 27 PhysicalAssessment 539 Chapter 28 Diagnostic Testing 601 Chapter 29 Safety, InfectionControl, andHygiene 653 Chapter 30 Medication Administration 749 Chapter 31 Complementaryand Alternative Modalities 833 Chapter 32 Oxygenation 859 Chapter 33 Fluidsand Electrolytes 919 Chapter 34 Nutrition 993 Chapter 35 Comfort andSleep 1043 Chapter 36 Mobility 1087 Chapter 37 SkinIntegrity andWoundHealing 1161 Chapter 38 Sensation,Perception, andCognition 1207 Chapter 39 Elimination 1231 Chapter 40 Nursing Care of thePerioperativeClient 1295 Glossary 1337 References 1363 Index 1383 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: TABLE OF CONTENTS ListofProcedures/xix DoctoralPrograms.............................. 17 Contributors/xxiii StaffDevelopmentandContinuingEducation ....... 18 Reviewers/xxv PreparingNursesforTomorrow’s Preface/xxix Challenges ................................. 18 HowtoUseThisText/xxxiii DifferentiatedPractice........................... 19 Acknowledgments/xxxvi AcceleratedDegreePrograms.................... 19 TechnologyChangesinNursingEducation ......... 19 AbouttheAuthors/xxxvii ServiceLearning ............................... 20 CHAPTER 2 UNIT 1 NURSING THEORY / 23 Nursing’s Perspective: Past, ComponentsoftheTheoreticalFoundation..... 24 Present, and Future / 1 WhatIsaConcept?............................. 24 WhatIsaProposition? .......................... 24 CHAPTER 1 WhatIsaTheory? .............................. 24 UseofTheoriesfromOtherDisciplines......... 25 EVOLUTION OF NURSING AND NURSING ImportanceofNursingTheories............... 25 EDUCATION / 3 ScopeofTheories ........................... 26 EvolutionofNursing .......................... 4 GrandTheories ................................ 26 OriginsofNursing ............................... 4 Middle-RangeTheories.......................... 26 ReligiousInfluences.............................. 7 Micro-RangeTheories........................... 26 DemandsofWar ................................ 7 EvolutionofNursingTheory................... 26 FlorenceNightingale(1820–1910) .................. 8 KnowledgeDevelopmentinNursing ........... 28 NursingPioneersandLeaders..................... 9 MetaparadigmofNursing........................ 28 NursingintheTwentiethCentury.................. 11 ParadigmsinNursing ........................... 29 SocialForcesAffectingNursing................... 14 SelectedNursingTheories.................... 30 NursingEducationOverview.................. 15 FlorenceNightingale............................ 30 DiplomaEducation ............................. 15 EarlyNursingTheories .......................... 30 AssociateDegreePrograms...................... 17 ContemporaryNursingTheories .................. 33 BaccalaureatePrograms......................... 17 TheoriesfortheNewWorldviewofNursing ......... 37 Master’sPrograms ............................. 17 ContinuingEvolutionofNursingTheory ........ 38 vii Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: viii TABLEOFCONTENTS CHAPTER 3 UNIT 2 RESEARCH AND EVIDENCE-BASED Nursing Process: The Standard PRACTICE / 41 of Care / 73 Research:SubstantiatingtheScienceof Nursing .................................... 42 CHAPTER 5 HistoricalDevelopment.......................... 42 Framework.................................... 43 CRITICAL THINKING, DECISION ResearchUtilization............................. 47 MAKING, AND THE NURSING NursingStudents............................... 47 PROCESS / 75 Evidenced-BasedPractice.................... 48 EvidenceReports............................... 49 CriticalThinking............................. 76 TrendsinResearchandEvidence-BasedPractice.... 50 ComponentsofCriticalThinking .................. 76 DevelopmentofCriticalThinkingSkills............. 77 CriticalThinkingandCreativity.................... 78 CHAPTER 4 CriticalThinkingandProblemSolving.............. 78 CriticalThinkingandDecisionMaking.............. 78 HEALTH CARE DELIVERY, QUALITY, TheNursingProcess......................... 79 AND THE CONTINUUM OF CARE / 53 HistoricalPerspective........................... 79 HealthCareDelivery:Organizational OverviewoftheNursingProcess.................. 79 Frameworks ................................ 54 Assessment................................... 79 Diagnosis..................................... 81 PublicSector .................................. 54 OutcomeIdentificationandPlanning............... 83 PrivateSector.................................. 55 Implementation ................................ 84 HealthCareTeam ........................... 55 Evaluation..................................... 84 Nurse:RolesandFunctions...................... 55 CriticalThinkingAppliedinNursing............ 85 AdvancedPracticeNurse:RolesandFunctions...... 55 ReimbursementMethods..................... 57 PrivateInsurance............................... 57 CHAPTER 6 ManagedCare................................. 57 GovernmentPlans.............................. 58 ASSESSMENT / 89 FactorsInfluencingtheDeliveryof PurposeofAssessment ...................... 90 HealthCare................................. 59 TypesofAssessment ........................ 90 Cost ......................................... 59 ComprehensiveAssessment ..................... 90 Access ....................................... 60 FocusedAssessment ........................... 90 Quality........................................ 60 OngoingAssessment ........................... 91 NursingSupplyandDemand ..................... 60 DataCollection.............................. 91 ResponsestoHealthCareChanges ........... 60 TypesofData.................................. 91 NursingAgendaforHealthCareReform............ 60 SourcesofData................................ 91 PublicversusPrivatePrograms................... 61 MethodsofDataCollection ...................... 92 VulnerablePopulations.......................... 61 DataVerification ............................ 96 CommunityNursingOrganizations ................ 61 DataOrganization ........................... 97 ContinuumofCare .......................... 62 AssessmentModels ............................ 97 LevelsofCare ................................. 62 DataInterpretation .......................... 98 HealthCareSettings............................ 62 DataDocumentation......................... 98 FragmentationofCare........................... 63 TypesofAssessmentFormats.................... 98 QualityManagementinHealthCare............ 65 DefiningQuality................................ 65 FactorsInfluencingQualityinHealthCare .......... 66 CHAPTER 7 QualityandHealthCareEconomics ............... 67 PrinciplesofQualityImprovement................. 67 NURSING DIAGNOSIS / 109 CustomerSatisfaction........................... 67 WhatIsaNursingDiagnosis? ................ 110 OrganizationalStructureforQuality ComparisonofNursingandMedical Management................................ 68 Diagnoses.................................... 110 OrganizationalCulture........................... 68 HistoricalPerspective....................... 111 ProcessImprovement........................... 70 Research .................................... 111 Nursing’sRoleinQualityManagement......... 70 PurposesofNursingDiagnoses.............. 111 TrendsinHealthCareDelivery ................ 71 Professionalism............................... 111 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Licensed to: TABLE OF CONTENTS ix Communication............................... 112 NursingInterventions .......................... 144 Holistic,IndividualizedCare..................... 112 EvaluatingInterventions ........................ 149 NursingDiagnosesandNursingInformatics........ 112 DocumentationofInterventions.................. 149 ComponentsofaNursingDiagnosis.......... 114 TheTwo-PartStatement........................ 115 TheThree-PartStatement....................... 115 CHAPTER 10 CategoriesofNursingDiagnoses............. 115 EVALUATION / 153 TaxonomyofNursingDiagnoses ............. 116 EvaluationofClientCare .................... 154 ClinicalJudgmentinNursing:Developing ComponentsofEvaluation................... 154 NursingDiagnoses ......................... 116 Techniques................................... 154 GeneratingCues .............................. 117 SourcesofData............................... 155 ValidatingCues ............................... 117 GoalsandExpectedOutcomes.................. 155 InterpretingCues.............................. 117 MethodsofEvaluation ...................... 155 ClusteringCues............................... 118 EstablishingStandards......................... 155 UsingNANDA-ApprovedNursingDiagnoses....... 118 CollectingData................................ 155 WritingtheNursingDiagnosisStatement .......... 118 DeterminingGoalAchievement .................. 155 AvoidingErrorsinDevelopmentandUse RelatingNursingActionstoClientStatus.......... 155 ofNursingDiagnoses ....................... 118 JudgingtheValueofNursingInterventions......... 155 AssessmentErrors............................. 118 ReassessingtheClient’sStatus.................. 155 DiagnosticErrors.............................. 119 ModifyingthePlanofCare...................... 155 LimitationsofNursingDiagnosis ............. 120 CriticalThinkingandEvaluation.................. 156 OvercomingBarriersandLimitations EvaluationandQualityofCare ............... 156 toNursingDiagnosis........................ 120 ElementsinEvaluatingtheQualityofCare ......... 156 NursingAudit................................. 158 CHAPTER 8 PeerEvaluation ............................... 159 EvaluationandAccountability................ 159 PLANNING AND OUTCOME MultidisciplinaryCollaborationin IDENTIFICATION / 125 Evaluation................................. 159 PurposesofPlanningandOutcome Identification............................... 126 ProcessofPlanningandOutcome Identification............................... 126 UNIT 3 CriticalThinking............................... 126 EstablishingPriorities .......................... 127 Professional Accountability / 163 EstablishingGoalsandExpectedOutcomes ....... 128 ComponentsofGoalsandExpectedOutcomes .... 129 CHAPTER 11 ProblemsFrequentlyEncounteredinPlanning...... 130 PlanningNursingInterventions................... 132 LEADERSHIP, DELEGATION, AND EvaluatingCare ............................... 134 POWER / 165 NursingOutcomesClassification(NOC)....... 134 ProfessionalNursingPractice................ 166 PlanofCare ............................... 135 CriteriaofaProfession ......................... 166 TypesofCarePlans............................ 135 ProfessionalAccountability.................. 168 StrategiesforEffectiveCarePlanning......... 136 ElementsofProfessionalAccountability........... 168 LegislativeAccountability....................... 170 CHAPTER 9 IndividualAccountability........................ 171 StudentAccountability ......................... 172 IMPLEMENTATION / 139 AdvancedPracticeNursing.................. 172 PurposesofImplementation................. 140 LeadershipinNursing....................... 175 RequirementsforEffectiveImplementation.... 140 ManagerialFunctions .......................... 175 CognitiveSkills................................ 140 LeadershipStyles ............................. 175 PsychomotorSkills ............................ 140 LeadershipCharacteristics...................... 175 InterpersonalSkills ............................ 140 Power....................................... 180 ImplementationActivities.................... 140 Mentoring.................................... 181 OngoingAssessment .......................... 140 Networking................................... 181 EstablishmentofPriorities ...................... 141 Empowerment................................ 182 AllocationofResources ........................ 142 PoliticsofNursing.......................... 182 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.