Margins Study Assistant

Chapter 1

Introduction to the Nursing Profession: Evolution, Theories, and Practice

Summary

In the contemporary landscape, several trends shape nursing practice , including the increasing emphasis on technology, with EHRs and telehealth becoming integral to healthcare delivery. Today, the art and science of nursing practice are evident in the balance between the compassionate, interpersonal aspects (art) and the evidence-based, technical components (science). The diverse landscape of nursing education is composed of various levels of education, from practical and vocational programs to advanced degrees, each contributing uniquely to the development of nursing professionals. The licensure process, overseen by regulatory bodies, serves as a crucial gateway to nursing practice, ensuring that individuals meet essential qualifications and competencies.

Key terms

nursing: a profession that encompasses the art and science of providing comprehensive and holistic care to promote and maintain health, prevent illness, and alleviate suffering for…
nursing practice: the application of nursing knowledge, skills, and principles in the delivery of health care to individuals, families, and communities
diverse landscape of nursing education: composed of various levels of education, from practical and vocational programs to advanced degrees, each contributing uniquely to the development of nursing professional
associate degree in nursing (ADN): a two-year program offered by various educational institutions that is designed to prepare individuals for a career as a registered nurse (RN)
developmental theory: a theory that is influenced by broader theories of human development and that explores the stages and transitions individuals go through across the life span
scope of practice: defined limits and parameters within which a professional is authorized to work, make decisions, and provide services
phenomenon: a specific aspect of interest or an observable occurrence that is the focus of theoretical exploration and study
assumption: a foundational belief or proposition that is accepted without direct empirical evidence

Chapter 2

Communication

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Summary

The nurse should establish a trusting relationship with the patient and use appropriate communication demonstrating active listening , pertinent inquiry, and empathy throughout each patient encounter. The nurse should use verbal communication with the patient, making sure there is congruency with nonverbal communication during the patient encounter. The nurse should use both interpersonal and small-group communication while engaged in patient care, as each helps the nurse provide safe and effective care. Nurses are responsible for providing good communication in all healthcare settings and facilities.

Key terms

communication: the sharing of ideas and thoughts among people
nonverbal communication: exchange of information without the use of words; with facial expressions, posture, eye contact, gestures, and physical touch
active listening: when someone listens by giving their full attention, listening to understand, and providing thoughtful input
engage: active listening, with nonverbal communication, asking for feedback when necessary
empathy: the ability for one person to understand and share the feelings of another person
listening: the ability to thoughtfully receive and interpret messages
verbal communication: the production of spoken language to send to a listener
small-group communication: exchange of information between three or more people

Chapter 3

Healthcare Delivery Systems

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Summary

When a patient needs a higher level of skill, knowledge, or diagnostic capability than what a primary care physician can provide, they move to the secondary health care level. Secondary health care occurs in hospitals, specialty clinics, and therapeutic facilities and is provided by medical, mental health, and allied healthcare professionals who have specialized education beyond the scope of… Patients move through primary, secondary, and tertiary levels in the healthcare system throughout their lifetimes. Most patients spend most of their lives seeing practitioners at the primary level.

Key terms

secondary health care: (acute or hospital care) when a patient’s condition requires specialty care or diagnosis
community hospitals: all hospitals that are not federal hospitals and offer both short-term and/or specialty care available to the general public
for-profit: hospitals and other healthcare organizations that are run as businesses and funded in part by investors who expect to receive a share of the profits from the business in return…
not-for-profit (NFP): organizations, such as hospitals and other healthcare groups, that are funded in part by donations and do not have to pay local, state, or federal taxes but are required to…
private: an institution that is run and funded by a group other than the government and can be either a for-profit or a not-for-profit institution
public health institutions: healthcare organization run and largely funded by the government for the good of the people they serve; provide direct patient care, set healthcare policy for all affiliated…
public: an institution that is run and largely funded by the government and is for the good of the people it serves

Chapter 4

Health, Wellness, and Community-Based Health Care

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Summary

The most used model for wellness is Dunn’s Theory of Wellness , including four processes: being , belonging , becoming , and befitting . Health and wellness are vital components of overall well-being. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Human dimensions of health include five aspects, encompassing physical, emotional, social, intellectual, and spiritual health .

Key terms

quality: the provision of evidence-based interventions and services that are effective, efficient, and responsive to the needs of the community
becoming: an individual’s pursuit of personal growth and self-improvement, as well as their openness to new experiences and perspectives
being: recognizing oneself as an individual and actively working to achieve a state of high-level wellness in all eight dimensions
belonging: the feeling of being accepted, valued, and supported by others, as well as the sense of belonging to a larger community or group
Dunn’s Theory of Wellness: also known as High-Level Wellness Model, defines wellness as an ongoing process of growth and development that encompasses all aspects of an individual’s life
human dimensions: facets of wellness that interrelate to demonstrate a comprehensive view of health; include emotional, physical, social, intellectual, and spiritual aspects of illness and wellness
Healthy People 2030 initiative: a nationwide endeavor in the United States that aims to improve public health and prevent diseases by setting core, developmental, and research objectives concerning diff
befitting: taking proactive self-care strategies and personal responsibility to make personal choices to benefit one’s well-being

Chapter 5

Cultural Competence

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Summary

Various cultures have their own traditional healing practices and beliefs, and many people still use these practices either alongside or in place of Western medicine. Culture is a set of beliefs, attitudes, and practices shared by a group of people or community that is accepted, followed, and passed down to other members of the group. Their culture informs how they view health and illness, how they view healthcare providers, and how receptive they are to treatment plans. Culture also determines who receives care and the quality of their care.

Key terms

cultural competence: ability to respect and understand one’s own beliefs and values as well as how these values and beliefs may differ between cultures
traditional healing: various medicines and healing practices around the world that differ from the modern, Western healthcare system
culture: the common beliefs, values, symbols, language, behaviors, and practices that unite a group
Ayurveda: a traditional Hindu form of medicine from India that is based on the idea that disease is caused by an imbalance in the body
racism: the belief that races are distinct from one another and that there is a hierarchy to race, implying that races are unequal
stereotyping: the assumption that a person has the attributes, traits, beliefs, and values of a cultural group because they are a member of that group
curanderismo: a holistic practice rooted in beliefs that health is achieved through the right balance of mind, body, and spirit
ethnocentrism: the belief that one’s culture (or race, ethnicity, country) is better than and preferable to another’s

Chapter 6

Promoting Individualized Care

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Summary

Nurses can provide multiple holistic interventions into patient care, such as aromatherapy , guided imagery , hydrotherapy , massage, and progressive relaxation . Nurses have the privilege of providing patient-centered care (PCC) in every setting. Patient-centered care includes working with the patient to ensure they are an equal partner in the healthcare process. Thoughtful practice is providing care in a way that reflects compassion and incorporates empathy for a patient’s unique situation.

Key terms

patient-centered care (PCC): the healthcare delivery model that aims to ensure the person is an equal partner in their health care; a framework for providing care to individuals
progressive relaxation: a holistic technique in which each part of the body is contracted and relaxed
thoughtful practice: care that reflects compassion and incorporates empathy for a patient’s unique situation
hydrotherapy: a holistic treatment that uses water to treat pain, swelling, and sore muscles
aromatherapy: the use of essential oils via inhalation or diluted application to the skin
patient to ensure they: an equal partner in the healthcare process
medical power of attorney: a person deemed in charge of medical decisions when the patient is unable or unwilling
holistic care: a care approach that considers the whole entity, encompassing the physical, psychological, emotional, and spiritual dimensions of an individual patient

Chapter 7

Vital Signs

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Summary

Vital signs in the normal range indicate the presence of homeostasis, or balance, in the body. Pulse is the direct measurement of a patient’s heart rate. Vital signs are arguably the most frequently used metrics by healthcare providers because they are important and interrelated indicators of the body’s homeostatic functioning. The number of beats per minute is a strong indicator of how hard the heart is working to perfuse the body; irregular beats or a rhythm that is too fast or too slow can indicate alterations in cardiovascular homeostatic…

Key terms

vital sign: five key metrics of homeostasis—temperature, pulse (heart rate), blood pressure, respirations, and oxygen saturation—that are used by nurses and other members of the medical…
number of beats per minute: a strong indicator of how hard the heart is working to perfuse the body; irregular beats or a rhythm that is too fast or too slow can indicate alterations in cardiovascul
pulse: the palpable way to assess the brief pressure increase in the arteries causing them to temporarily expand as the left ventricle pumps blood through them
homeostasis: the process by which the human body maintains balance by adjusting to internal and external stimuli
oxygen saturation: measurement of the arterial oxyhemoglobin saturation (SpO 2 ) of arterial blood
respiration: the action of breathing, including inhalation and exhalation
blood pressure: the pressure of blood as it presses against arterial walls
heart rate: the number of times the heart beats in one minute

Chapter 8

Admission, Transfer, and Discharge

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Summary

Acute care admissions are for patients who require inpatient monitoring and/or a professional level of care. There are many different types of patient admissions to healthcare facilities. It is important to ensure the patient is admitted to the correct level of care. Some come from an ambulatory care setting, while others arrive from home or via EMS

Key terms

acute care: a type of inpatient medical care for patients who require monitoring and medical assistance from professionally trained healthcare providers
ambulatory care: patient care given in outpatient settings, which includes doctor’s offices, clinics, and outpatient surgery centers
patient: admitted to the correct level of care
against medical advice (AMA): when a patient under inpatient medical care voluntarily leaves the hospital even though the medical team does not recommend it; also the name of the documentation form that is…
medical-surgical unit: an inpatient hospital unit for patients with medical needs that cannot be addressed in an ambulatory setting but are not severe enough to warrant critical care admission
percutaneous endoscopic gastrostomy (PEG) tube: a tube that is inserted into a patient’s abdomen to enable them to receive tube feedings; typically needed when a patient is unable to swallow food safely
step-down unit: a transitional inpatient unit, usually when the patient is well enough to leave the intensive care unit but still requires more monitoring than a patient on the medical-surgical…
triage: a method of evaluating patients according to the severity of their complaints and ensuring that patients with the most serious and potentially life-threatening symptoms that can…

Chapter 9

Safety and Security

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Summary

There are many aspects for the nurse to consider when maintaining individual safety including understanding a patient’s developmental stage of life, physical and psychosocial health risk factors, and any knowledge… Individual safety is an essential component of good health, and it should be prioritized above anything else. Environmental safety is also a major concern. Occupational safety is needed to prevent or reduce the risk of work-related injuries.

Key terms

environmental safety: practices and measures taken to protect and preserve the natural environment, ecosystems, and human health from potential hazards and harmful impacts to health
occupational safety: the practice of protecting workers from injury, particularly those who work in high-risk industries such as health care
psychosocial health: the psychological and social aspects of an individual’s overall health and well-being
individual safety: the state of being free from physical or psychological harm
personal safety: the act of keeping oneself free from injury
horizontal violence: (also called lateral violence) a form of workplace aggression that occurs between colleagues who are at the same level of authority or hierarchy within an organization
meaningful use: ensuring technology being utilized in healthcare settings is done so purposefully and with the intention of improving outcomes
never event: an adverse event that is clearly identifiable, measurable, serious (resulting in death or significant disability), and preventable

Chapter 10

Infection Control and Prevention

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Summary

These six pieces are causative agent, reservoir , portal of exit , mode of transmission , portal of entry , and susceptible host . By understanding the conditions that foster the spread of infection, nurses can implement evidence-based interventions to break the cycle and stop the chain of infection . Nurses must have a thorough understanding of how to protect themselves and their patients from exposure to harmful pathogens. The human body’s immune system provides a mechanism for staying healthy through protection against harmful pathogens.

Key terms

infection control: the discipline of stopping or preventing the spread of infectious agents
susceptible host: the organism that is susceptible to or at risk for infection
chain of infection: the six stages of infection that must be present for the transmission of a pathogen from one place or person to another
reservoir: the habitat or source of the pathogen that provides a place for survival and growth
transmission: the method that a pathogen uses to spread from one host to another
pathogen: any type of microorganism that causes disease to its host
portal of entry: the site at which a pathogen enters the susceptible host
portal of exit: the path by which the pathogen leaves the reservoir

Chapter 11

Medication Administration

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Summary

Different types of medication orders include routine orders, one-time orders, standing orders, STAT orders, PRN orders, and titration orders, each with specific indications for nursing practice. Routine orders are continuously followed until canceled, whereas one-time orders are for a single dose. Standing orders allow nurses to intervene promptly without waiting for provider orders, and STAT orders are administered urgently. PRN orders are used as needed for specific symptoms, and titration orders involve dose adjustments based on patient status

Key terms

titration order: a medication dose that is either progressively increased or decreased by the nurse in response to the patient’s status
routine order: a medication order that is continuously followed until canceled
STAT order: a medication order that is urgent or requires immediate action
PRN order: a medication order that is administered as needed
components of a medication order: crucial elements that ensure safe and effective medication administration
standing order: a standardized order that may be implemented under certain circumstances
medication order: a prescription ordered within clinical practice
one-time order: medication to be administered just one time

Chapter 12

Assessment: Recognizing Cues

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Summary

An accurate assessment is essential for a correct diagnosis and appropriate planning and emphasizes the significance of the data collected Nurses use clinical reasoning skills to perform focused assessments to address immediate concerns while covering all necessary health aspects using a systemic approach. Nursing assessment is a systematic process of gathering comprehensive and accurate information about a patient’s health status. A comprehensive nursing assessment includes physical signs as well as psychosocial, emotional, and spiritual factors to ensure holistic care

Key terms

assessment: the systematic and dynamic process of collecting and analyzing data about a patient’s health
clinical reasoning: the process by which a healthcare provider combines their own knowledge and experience with data obtained through various patient assessments to diagnose a medical problem and…
accurate assessment: essential for a correct diagnosis and appropriate planning and emphasizes the significance of the data collected
data: information that nurses gather about a patient’s health status
physiological crisis: a critical situation where the patient’s physiological functions are severely compromised, posing an immediate threat to life or health
potential problem: risk or condition that a patient is susceptible to but not currently manifesting symptoms of
actual problem: current health issues that are identifiable through symptoms or clinical evidence
ABC framework: a system that uses letters as reminders to establish three fundamental priorities during a nursing assessment: airway, breathing, and circulation

Chapter 13

Diagnosis and Planning: Analyzing, Prioritizing, and Generating Solutions

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Summary

NANDA-I supports nursing diagnosis through taxonomy and classification. Nursing diagnosis is a defining characteristic of the nursing profession. The ANA Standards of Practice and the ANA Competencies for Nursing Diagnosis both support the autonomy of the profession. The breadth and depth of patient problems that fall under the umbrella of this concept are the basis of nursing practice.

Key terms

NANDA-I: an organization whose purpose is to facilitate the development, modification, distribution, and use of standardized nursing diagnostic terminology
Standards of Practice: standards designed by the ANA and based on the nursing process that provides a problem-solving-focused approach to nursing practice
outcome: the desired result or goal after implementation of the patient’s individualized plan of care
defining characteristic: the actual sign or symptom being exhibited by the problem
nursing diagnosis: a method to provide and evaluate appropriate patient care
umbrella of this concept: the basis of nursing practice
taxonomy: a system of classification
risk diagnosis: a diagnosis behind the signs and symptoms the patient is experiencing; developed through clinical judgment based on the vulnerability of the patient’s individualized situation

Chapter 14

Implementation and Evaluation: Taking Action, Evaluating Outcomes, and Documentation

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Summary

The implementation phase is crucial in the nursing process, involving the active execution of planned interventions while adapting to the patient’s evolving needs. From beginning to end, the implementation phase calls on the nurse’s critical-thinking and clinical judgment skills, psychomotor abilities for performing interventions safely and effectively, interpersonal… The implementation phase of care highlights the complex and essential nature of nursing and involves applying various interventions tailored to each patient’s specific needs. Nurses apply their clinical knowledge to perform various tasks, from administering medications to assisting with rehabilitation exercises tailored to facilitate the patient’s recovery and well-being

Key terms

implementation: the step of the nursing process when the plan of care for a patient is put into action
evaluation: the systematic determination of a patient’s progress toward the achievement of outcomes and goals set during the care-planning process
implementation phase: crucial in the nursing process, involving the active execution of planned interventions while adapting to the patient’s evolving needs
clinical knowledge: a nurse’s understanding of health and disease processes, treatments, and interventions
intervention: an action intended to stop a harmful outcome or promote a healthful one
quality assurance (QA): oversight to ensure that current quality standards are being met across a department or agency and that staff are receiving the education and infrastructure support to maintain…
quality health care: the provision of health services that improve the chances of preferred outcomes, decrease the chances for error, and are consistent with current evidence and knowledge
source-oriented documentation: a traditional method of recording healthcare information, in which data is organized based on the person providing it

Chapter 15

Evidence-Based Research, Quality Improvement, and Collaborative Practice

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Summary

On larger scales, changes to implement EBP must be planned and negotiated with multiple stakeholders based as much on resources and institutional values as on the value of the research. Operationalizing EBP into EBDM involves the EBP triad of the patient’s preferences, the clinical expertise of the nurse, and the best available evidence. It is codified into our practice acts and ethical standards and has evolved over the decades into a vibrant field of nursing researchers. Research has been an essential component of nursing since the days of Florence Nightingale.

Key terms

collaborative practice: the process of healthcare workers from multiple professions working and communicating effectively together with patients and their families to provide patient care and improve…
clinical expertise: the combination of a nurse’s experience, critical thinking, and ability to recognize patterns and extrapolate alternatives based on similar experiences
references: sources used within the body of an article to provide background information and support for analysis and discussion of the findings
stakeholders: individual with an interest in the success of an organization, such as an investor in a business or a nurse in a hospital
resource: a tangible or intangible item used in patient care, including time, staff, supplies, and space
nursing research: structured inquiry to obtain and evaluate information related to a specific nursing question
assignment: the routine activities and procedures that are part of a staff member’s normal job and that they were taught in either a degree or certificate program or as part of on-the-job…
delegation: the act of requesting staff members to perform tasks or procedures that are outside of their normal job but within the limits of their job description

Chapter 16

Legal and Ethical Considerations

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Summary

Professional nursing values include altruism , autonomy , integrity , social justice, and human dignity . Ethics play many roles in nursing practice from the underpinning that nursing values give to the profession to the Code of Ethics for Nurses with which nurses govern themselves. Ethical concepts such as a belief in autonomy, justice, and veracity should be threaded through all decisions nurses make and the care they offer their patients. Values are the core convictions that underlie beliefs and behaviors.

Key terms

ethical consideration: an issue that causes a nurse to stop to think through the ethics of a situation
ethics: a branch of philosophy and a set of moral principles, virtues, or ideals that guide behavior and help determine what is right and wrong
integrity: being honest and morally constant, supporting what is right even when not popular, and meeting commitments
autonomy: an individual’s ability to make decisions and determine courses of actions based on being well informed, giving consent, and volunteering without coercion
social justice: a belief that all people deserve equal treatment and access to health care
justice: treating all people equally and judging them on the same criteria
human dignity: every individual has worth on account of being human
value: a central, guiding principle in an individual’s life

Chapter 17

Patient and Family Education

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Summary

Factors such as health literacy, feelings, and anxiety, and physical influences like pain or limitations influence patients’ adherence to and compliance with treatment and nursing care plans. The four purposes of health education were identified as health promotion, disease prevention, function restoration, and facilitation of coping and adjustments to health challenges and changes (the “new normal”). Health maintenance and promotion include considerations for an overall more actively involved population of healthcare consumers who have more interest in health promotion and illness prevention. Nurses play a role in promoting adherence to and compliance with health promotion and illness prevention even for patients who are not as invested in their healthcare decisions and actions

Key terms

health literacy: the ability of an individual to locate, comprehend, and use health-related material and make healthcare decisions
literacy: the ability to read and write
activities of daily living (ADLs): skills required to perform essential and routine tasks independently for oneself (e.g., bathing, toileting) without assistance
direct observation of actions: evaluation method of observing the learner in the normal setting for actions and behaviors illustrating learning acquisition
metacognition: an elevated level of thinking that allows comprehension and examination; higher-order thinking that enables understanding, analysis, and command of thoughts and the thinking…
return demonstration: evaluation method whereby the patient showcases the ability to complete the task by performing it back to the evaluator
psychomotor learning: the development of organized patterns of muscular activities guided by signals from the environment

Chapter 18

Leadership and Management in Nursing

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Summary

Laissez-faire leadership offers autonomy and independence, ideal for experienced teams, while servant leadership focuses on empowering and uplifting team members. Autocratic leadership is decisive and directive, suitable for emergency situations where quick action is required. Democratic leadership, in contrast, emphasizes collaboration and team input, fostering a participative and inclusive environment. Leadership is the practice of guiding, influencing, and motivating individuals or groups toward achieving a common goal.

Key terms

management: the practice of determining what tasks need to be completed to accomplish a particular goal and ensuring all team members complete those tasks
leadership: the practice of guiding, influencing, and motivating individuals or groups toward achieving a common goal
laissez-faire leadership: a leadership style in which team members receive a high level of autonomy to make decisions, solve problems, and manage their work independently
servant leadership: a leadership style that prioritizes the needs of team members and fosters a culture of care, empathy, and community
autocratic leadership: a leadership style characterized by individual control over decisions with little input from team members
democratic leadership: a leadership style that values the input of team members and stakeholders in the decision-making process
appreciative inquiry: a theory that builds from what is already working within an organization through four stages of change management: discovery, dream, design, destiny
board certification: considered an advanced nursing specialty certification where there are more eligibility requirements, such as a higher number of clinical experience hours, more education hours…

Chapter 19

Oxygenation and Perfusion

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Summary

Specifics as to the role this system plays in ventilation, how respiration and gas exchange transpire, and the role the lungs play in the renin-angiotensin-aldosterone system are presented. The functions of these structures have been categorized, relating specific components to the purpose relative to ventilation and perfusion . At the capillary-alveolar bed, the primary function of the respiratory system is gas exchange . This section has delved into the physiology of the respiratory system, and how it fits in the cardiopulmonary system .

Key terms

perfusion: vascular circulation powered by the pumping action of the heart that delivers oxygen and other nutrients to body tissues
cardiovascular system: structurally unique insofar as it contains the muscular four-chambered heart (the pump), fluid/blood volume (the tank), and the blood vessels (the pipes)
gas exchange: the transfer of oxygen and carbon dioxide; takes place at the alveolar-capillary bed
respiration: the action of breathing, including inhalation and exhalation
cardiopulmonary system: combination of cardiovascular and pulmonary systems
ventilation: the movement of air in and out of the lungs
crepitus: a popping or crackling sensation when the skin is palpated; it is a sign of air trapped under the subcutaneous tissues
bronchiectasis: a chronic condition where airways are dilated and the lung walls are thickened due to inflammation and infection

Chapter 20

Fluid, Electrolyte, and Acid-Base Balance

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Summary

When homeostasis is not maintained, the patient is at risk for organ system dysfunction and even death. One of the primary mechanisms by which homeostasis is maintained is through regulation of body fluid within the different fluid compartments. The human body regulates fluid and electrolyte balance by adjusting to internal and external stimuli to maintain homeostasis . The two fluid compartments in the human body are the extracellular and intracellular fluid compartments.

Key terms

base: a molecule that can donate a hydroxide ion (OH - ) in chemical reactions
acid: a molecule that can donate a hydrogen ion (H + ) in chemical reactions
total body fluid: found in the intracellular space and one-third is in the extracellular space
homeostasis: the process by which the human body maintains balance by adjusting to internal and external stimuli
pH: the concentration of hydrogen ions in a given solution
patient: at risk for organ system dysfunction and even death
intracellular fluid: the body fluids found inside the body’s cells

Chapter 21

Nutrition

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Summary

Good nutrition includes ingestion of quality macronutrients such as carbohydrates, proteins, and fats. Dietary patterns also need to include adequate water regulation to maintain hydration balance and sufficient quantities of micronutrients, like vitamins and minerals, to meet metabolic demands. Physiological factors also include environmental factors such as socioeconomic status, food insecurity , and lifestyle behaviors. These provide adequate calories to meet the body’s daily energy needs.

Key terms

mineral: essential to physiological processing; some are macronutrients, and some are micronutrients
micronutrient: nutrient found in small quantities within the body but still necessary for physiological functions
vitamin: essential micronutrient vital to biochemical regulation within the human body
macronutrient: nutrient consumed in large quantities to meet the body’s energy needs
carbohydrate: macronutrient used to fuel the immediate energy needs of the body
fat: large, complex molecule made up of fatty acids and glycerol
food insecurity: the state of having limited access to adequate food
protein: macronutrient made up of amino acids

Chapter 22

Activity

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Summary

These systems work together to improve cardiovascular circulation, balance, coordination, posture, and even postural reflexes, which work unconsciously The physiology of activity, movement, and alignment in the body is managed through the skeletal system. Functions of activity, movement, and alignment in the body are managed through an intertwined system of bones, muscles, and joints. Ergonomics in patient care can be accomplished through proper body mechanics such as safe lifting and transferring.

Key terms

activity: purposeful movement, such as walking
body mechanics: intentional movements and muscle use designed to maintain an individual’s posture and alignment, decreasing the chance of injury
ergonomics: the design and arrangement of workspaces, tools, equipment, and tasks to optimize comfort, efficiency, and safety for employees
postural reflex: an unconscious, involuntary correction that the nervous and musculoskeletal systems make together to keep postural alignment when something threatens to disrupt it
circulation: the continuous, controlled movement of blood throughout the body, facilitated by the heart, blood vessels, and blood
skeletal system: the bones, joints, and other structures that allow for movement, form the body, make blood cells, and shield organs
bone: hard, dense connective tissue that form most of the adult skeleton, the primary support structure of the body
balance: the ability to maintain an upright alignment that prevents an individual from falling

Chapter 23

Neuromuscular Function

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Summary

The musculoskeletal system is made up of bones, muscles, and various connective tissues. The neuromuscular system is the combination of the neurological system and the musculoskeletal system working together effectively. The neurological system is composed of the brain, spinal cord, and peripheral nerves. Signals from the neurological system send messages to the musculoskeletal system to cause responses and reactions to external and internal stimuli to maintain homeostasis and protect the body from injury.

Key terms

brain: contained within the cranial cavity of the skull is the central organ of the nervous system responsible for controlling bodily functions, processing sensory information, and…
spinal cord: a long, thin, tube-shaped bundle of nerves that extends from the base of the brain through the vertebral column; contained within the vertebral cavity of the vertebral column
skeletal system: the bones, joints, and other structures that allow for movement, form the body, make blood cells, and shield organs
bone: hard, dense connective tissue that form most of the adult skeleton, the primary support structure of the body
neuromuscular system: the combination of the neurological system and the musculoskeletal system working together effectively
electromyography (EMG): a diagnostic procedure involving small needles that record electrical activity in the muscles
connective tissue: cartilage, ligaments, and tendons that connect tissues and organs
patient: experiencing, all of which have varying clinical manifestations…

Chapter 24

Skin Integrity

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Summary

The epidermis, dermis , and hypodermis are the three distinct layers of the skin. The bottom layer, the hypodermis or subcutaneous tissue, anchors the skin to the underlying tissues. The epidermis is the outermost portion and is made up of stratified epithelial cells. The dermis is the second layer of skin that consists of elastic connective tissue made up of collagen .

Key terms

subcutaneous tissue: the subcutaneous fatty layer (hypodermis) beneath the dermis that separates the skin from the underlying tissue
hypodermis: the subcutaneous fatty layer beneath the dermis that anchors the dermis to the underlying tissues of the body
dermis: the layer of skin below the epidermis connected to the epidermis by dermal papillae
collagen: whitish protein substance that adds flexible strength to the wound
epidermis: the outermost layer of the skin consisting of epithelial cells
carbuncle: cluster of skin abscesses connected to one another below the surface of the skin; often form when one or more hair follicles are infected
squamous cell carcinoma: the second most common type of skin cancer that generally develops on sun-exposed areas but can grow where sun exposure is limited
superinfection: secondary infection that is unrelated to the original infection and results from opportunistic colonization after immunosuppression

Chapter 25

Hygiene

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Summary

The lack of adequate hygiene practices may lead to various hygiene-related diseases or infections such as lice (body, hair, and pubic), tooth decay, scabies , pinworm infection, ringworm , trachoma , swimmer’s ear … There are various factors that impact a person’s personal hygiene . Hygiene measures can support health and prevent disease. Hygiene practices include but are not limited to the care of the skin, hair, nails, oral cavity, and perineal areas.

Key terms

hygiene: the measures or practices conducive to preserving health and preventing disease, particularly through cleanliness
pinworm: an intestinal worm that usually spreads when an infected individual scratches the anal area
scabies: a contagious skin infestation caused by a burrowing mite accompanied by extreme itching
tooth decay: visible cavities or holes in the outer surface of a tooth or enamel
personal hygiene: self-care measures one performs to preserve their own health
ringworm: a fungal infection of the skin or scalp
trachoma: a bacterial infection of the eyes
skin breakdown: the damage or injury that occurs to the skin and underlying tissue due to prolonged pressure, friction, shear, or moisture

Chapter 26

Urinary Elimination

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Summary

The urinary system , composed of the kidneys, ureters, bladder, and urethra, is a vital component of the human anatomy, responsible for maintaining internal balance and waste elimination. The process of urine formation is orchestrated by the kidneys and involves glomerular filtration , tubular reabsorption, and tubular secretion. Ureters transport urine to the bladder, a muscular reservoir, while the urethra serves as the exit pathway Tubular reabsorption selectively reclaims vital substances from this filtrate, and tubular secretion actively eliminates specific substances into the renal tubules.

Key terms

tubular reabsorption: the physiological process in the kidneys by which essential substances, including water, glucose, ions, and other necessary molecules, are selectively reclaimed from the filtrate…
tubular secretion: the active transport process in the kidneys by which certain substances, including excess ions, drugs, and metabolic by-products, are selectively moved from the peritubular…
micturition reflex: an involuntary physiological response that initiates the contraction of the bladder’s detrusor muscle and relaxation of the internal urethral sphincter, facilitating the…
ureter: one of two muscular tubes that serve as conduits for transporting urine from the kidneys to the urinary bladder
nephron: a microscopic unit within the kidneys; a functional unit responsible for blood filtration and urine formation
process of urine formation: orchestrated by the kidneys and involves glomerular filtration , tubular reabsorption, and tubular secretion
urinary system: a sophisticated network of organs responsible for producing, storing, and eliminating urine from the body
urethra: a tubular structure that serves as the conduit for the expulsion of urine from the body

Chapter 27

Bowel Elimination

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Summary

The stomach further digests food using gastric juices and muscular contractions. The anus is the external opening through which waste is expelled during defecation. The mouth is where food is initially broken down through chewing and mixing with saliva. The small intestine is where nutrients are absorbed into the bloodstream.

Key terms

large intestine: is approximately 5 ft (1.5 m) long and consists of the cecum and colon; this vital component of the gastrointestinal tract is responsible for bowel elimination
mouth: the orifice at the beginning of the gastrointestinal tract into which food is introduced into the gastrointestinal system; the mouth consists of the lips, tongue, hard and soft…
anus: opening at the end of the digestive tract through which feces (solid waste) are expelled from the body
peristalsis: rhythmic, wavelike contraction and relaxation of the intestinal muscles that serves to mix food with gastric juices and propel food, water, and digestive juices forward through…
small intestine: a convoluted tube approximately 22 ft (6.7 m) long that stretches from the stomach to the large intestine
defecation: the process of eliminating solid waste, known as feces or stool, from the body through the anus
stomach: muscular organ located in the upper abdomen that plays a pivotal role in the digestive process
stoma: an opening surgically created in the body to allow the passage of bodily waste from the body

Chapter 28

Sleep and Rest

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Summary

Originating in the brain stem, and involving other regions of the neurological system, sleep is influenced by factors such as circadian rhythms. Although a person is unaware of much of what happens during sleep, there are four stages that occur in cycles throughout the hours of sleep There are also developmental alterations regarding the amount of sleep necessary at different life stages, with neonates experiencing a slightly different sleep before circadian rhythms are established, and spending… Like breathing, sleep seems simple and automatic, but the physiological processes involved in sleep involve coordination of multiple body systems and complicated neurological and physical responses.

Key terms

person: unaware of much of what happens during sleep, there are four stages that occur in cycles throughout the hours of sleep
circadian rhythm: the biological rhythm associated with metabolism, temperature, sleep, and wakefulness
theta wave: an EEG wave that is fast and has variable frequencies
delta wave: EEG brain wave that is slower with higher amplitude
parasomnia: an abnormal behavior while a person is asleep
glymphatic system: a body system involved in the regulation of interstitial fluid movement and subsequent removal of waste from the brain and CSF
reticular activating system (RAS): a crucial neural network in the brainstem responsible for regulating arousal, attention, and consciousness
hypersomnolence: excessive feelings of fatigue and sleepiness, or episodes of sleep during normal times to be awake

Chapter 29

Sensory Alterations

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Summary

Identifying the different states of arousal of the brain involves recognizing variations in consciousness, ranging from alertness and wakefulness to drowsiness, sleep, and coma , each influenced by complex interactions… Sensory perception is the process through which individuals gather information from the environment via senses like sight, hearing, touch, taste, and smell, interpreting it to understand and interact with surroundings. Complementing the primary senses, kinesthetic sense s provide feedback about body movement and position, while visceral senses monitor internal bodily sensations, collectively enriching the sensory experience and… The reticular activating system (RAS) plays a crucial role in regulating wakefulness and maintaining consciousness by filtering sensory stimuli and modulating arousal levels in the brain.

Key terms

alert: a state of heightened wakefulness, attentiveness, and responsiveness in which an individual is fully awake, aware of their surroundings, and capable of actively engaging with…
coma: a profound state of unconsciousness characterized by a complete loss of consciousness, absence of wakefulness, and lack of response to external stimuli
sensory perception: process by which organisms gather information from the environment through the senses (such as sight, hearing, touch, taste, and smell) and interpret and make sense of that…
reticular activating system (RAS): a crucial neural network in the brainstem responsible for regulating arousal, attention, and consciousness
senses: physiological mechanisms by which organisms perceive and respond to stimuli from their environment
states of arousal: levels of physiological and psychological alertness and responsiveness exhibited by an individual
sensory overload: occurs when an individual is exposed to an excessive amount of sensory stimuli that overwhelms their ability to process and integrate information effectively
altered consciousness: any deviation from the normal waking state of consciousness, characterized by changes in perception, cognition, or awareness

Chapter 30

Pain Assessment

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Summary

The physiologic process of pain describes how the brain is alerted to painful stimuli and how it can modify and adjust the amount of pain that is felt in the body. The central nervous system can also determine which pain signals are allowed through to the brain. Pain can be classified and described in many different ways. The duration, location, and cause are all important factors when assessing and treating pain.

Key terms

brain: alerted to painful stimuli and how it can modify and adjust the amount of pain that is felt in the body
nociception: the process by which painful stimuli are detected by nociceptors and send the pain signals from the peripheral nervous system to the brain
first line therapy: medical treatment that is recommended as the best option for the initial treatment of a disease or medical condition
transmission of pain: the second step of the pain process when the pain signal is sent from the peripheral to the central nervous system
adjuvant analgesic: medication that is not classified as an analgesic but has been found to have an analgesic effect with opioids
cutaneous pain: pain that is perceived from the skin and caused by heat, cold, or mechanical or chemical stimuli
visceral pain: pain that is activated when internal organs such as the stomach and kidneys are damaged
affective response: the emotional interpretation of pain, such as how uncomfortable the pain is

Chapter 31

Perioperative Nursing Care

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Summary

During the last couple of decades, surgical advancements have been made exponentially to include robotic surgery, telesurgery, surgical uses of AI, Multi-Angle Rear-Viewing Endoscopic tooL (MARVEL), and 3-D printing. Expedited surgeries are when a patient is stable but requires early intervention for a condition. Surgical procedures are classified as emergent, urgent, expedited (scheduled), and elective. Emergent surgeries are performed immediately to save a life, limb, or an organ.

Key terms

telesurgery: remotely performing surgical procedures from a distance using robotic systems and telecommunication technology
3-D printing: manufacturing process that creates three-dimensional (3-D) objects from digital files
patient: stable but requires early intervention for a condition
anesthesia provider: a physician (anesthesiologist) or advanced practice RN (certified RN anesthetist [CRNA]) who is specialized in administering anesthesia and managing perioperative care
emergent surgery: surgery that is performed without delay to address critical situations such as potentially life-, limb-, or organ-threatening conditions
haptic interface: a type of human-computer interaction technology that is created by using force feedback via movement of a limb or the head to simulate bodily tactile sensations and movements…
medication reconciliation: a comprehensive review of the patient’s medication history: medications being taken at home, including ones that the patient should have been taking but may not be, and any…

Chapter 32

Self-Concept

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Summary

The primary components of self-concept are fundamental in developing personal identity, body image, self-esteem, and role performance Our personal identity and self-concept, according to Rogers, develops throughout the life span beginning in childhood and is molded by experiences, perceptions, and evaluation of others. To do this well, it is suggested to use different methods, consider how the study relates to real-life situations, and make sure the study is as close to a natural setting as possible. Just as forming strong connections is a crucial milestone in infancy, a significant step in childhood is developing a positive sense of self.

Key terms

self-concept: the organized and consistent set of perceptions and beliefs an individual holds about themselves; includes an individual’s self-esteem, self-image, self-identity, and social…
body image: a component of self-concept that reflects an individual’s perception and evaluation of their physical appearance, based on societal standards, cultural norms, and personal…
personal identity: a component of self-concept that involves the sense of individuality, including personal traits and beliefs, that distinguishes a person from others
self-esteem: the overall positive or negative evaluation of oneself that reflects an individual’s feelings of self-worth and confidence
role performance: how individuals perceive and execute their roles in different contexts within the family, work, or social environment
primary components of self-concept: fundamental in developing personal identity, body image, self-esteem, and role performance
study: as close to a natural setting as possible
significant step in childhood: developing a positive sense of self

Chapter 33

Sexuality

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Summary

Society has long dictated that individuals should act according to their biological sex, adhering to the appropriate gender role expression; however, there has been an increase in awareness and understanding of gender… Nurses are tasked with remaining knowledgeable and open-minded about these variations in gender identity and sexual orientation to provide high-quality, patient-centered care. Biological sex refers to the sex assigned to an individual at birth, either male or female. However, there are several gender variations because the sex assigned at birth does not always correlate with an individual’s feelings about their gender.

Key terms

sexual orientation: who an individual is attracted to sexually, emotionally, and/or romantically
gender identity: a person’s deeply felt, internal and individual experience of gender, which may or may not correspond to the person’s physiology of designated sex at birth
gender role expression: the way a person communicates their gender to others, such as by clothing, appearance, and mannerisms
sexual fulfillment: the state of experiencing satisfaction, pleasure, and contentment in one’s sexual relationships
gender: a social construct that includes norms and behaviors associated with being a man or a woman
biological sex: sex assigned to an individual at birth
gay: a term used to describe men who are romantically or sexually attracted to other men; also used more broadly to describe individuals of any gender that are attracted to…
gender dysphoria: distress experienced by some people when their sex assigned at birth and assumed gender is not the one with which they identify

Chapter 34

Stress, Adaptation, and Homeostasis

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Summary

Adaptive, or coping, responses support the body’s resistance to stress and ideally its resolution and return to a condition of homeostasis Stress is integral in some aspects of growth and development, especially through adaptation. Resistance to stress involves adaptive responses, which when effective assist the body in its return to equilibrium, when the SNS effects diminish and homeostasis is restored. Unfortunately, coping does not always involve positive techniques, and maladaptive results may also occur, preventing or slowing the return to homeostasis.

Key terms

homeostasis: the process by which the human body maintains balance by adjusting to internal and external stimuli
stress: the physiological response by the body to a stimulus, or stressor
adaptation: the ongoing changes within the body in response to stress
coping: an adaptive mechanism for managing stress
anxiety: an overwhelming feeling of apprehensiveness, nervousness, and worry about real or perceived events that have an uncertain outcome
Roy’s adaptation model (RAM): holistic approach to the art and science of nursing structured as a science, model, and practice discipline containing various elements
general adaptation syndrome (GAS): theory involving stress as the cause of a three-stage syndrome of events resulting in either adaptation or exhaustion
psychophysiological stress model (PSM): the relationship between the mental and physical reactions and adaptations to stress

Chapter 35

Spirituality

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Summary

Spirituality encompasses a connection beyond oneself and a pursuit of meaning, distinct from religion yet often intersecting with faith based on shared aspects such as hope, love, conflict, and healing. Hope emerges as a guiding force, assisting patients in navigating challenges, whereas love is depicted as a profound connection rooted in spirituality, influencing the meaning individuals find in life Spirituality assumes a crucial role in the healthcare setting, with its profound influence on patients’ well-being. Faith is examined as an acceptance of religious doctrines or an attitude facilitating a gateway to spiritual practice.

Key terms

spirituality: a profound feeling of connection to a greater power than oneself, as well as the practices used to explore this feeling
ritual: a defined practice that individuals or groups use to commemorate or cope with something
religion: a unified system of beliefs, values, and practices that a person holds sacred or considers to be spiritually significant
hope: the desire for a certain outcome and the belief that it will happen
faith: a belief in something without proof
love: a strong feeling of affection
karma: the notion that one’s future happiness is caused by present actions; actions performed with good intent lead to future happiness, whereas actions performed with bad intent lead…
kosher diet: a diet that adheres to Jewish dietary laws (kashrut), governing which foods are permissible based on specific religious guidelines such as the separation of meat and dairy…

Chapter 36

Grief, Loss, Death, and Dying

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Summary

In all areas of care, nurses will encounter patients experiencing death, dying, loss, or grief. Understanding the concepts of loss and grief, particularly in relation to death and dying, prepares the nurse to support patients physically and emotionally. Grief, bereavement, and mourning are unique experiences for each individual and are affected by personal values and specific cultural beliefs. Physical symptoms associated with grief, such as heart palpitations, dizziness, fatigue, and muscle tension, often overlap with emotional dysregulation, such as depression, anxiety, and anger.

Key terms

loss: a real or perceived absence of a possession, circumstance, or individual
death: the cessation of biological life functions
grief: the emotional response to loss
depression: a grief stage marked by prolonged sadness that affects an individual’s ability to perform everyday tasks
anger: a grief stage marked by an intense feeling of displeasure and hostility
bereavement: the feeling of grief and the outward expression of mourning
mourning: the outward, personal expression of grief
autopsy: a medical procedure in which a deceased person's body is systematically examined to determine the cause of death and to gain additional insights into the person's health and…

Chapter 37

Family Dynamics

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Summary

Defining family is a complex and culturally sensitive topic. Nurses must understand the interactions among family members and how the family interacts with their environment and community. In particular, understanding the health beliefs of the family will contribute to better care planning. Considering family habits and lifestyle factors is as important in promoting family health as heredity, familial illness, and genetic factors

Key terms

family: socially recognized group, usually joined by blood, marriage, cohabitation, or adoption, that forms an emotional connection and serves as an economic unit of society
conversation: communication patterns in which family members are encouraged to evaluate topics independently and discuss them with the family
conformity: communication patterns in which family members are expected to follow hierarchical family values
hereditary: when a disorder is passed naturally from parent to offspring through their genes
congruence: an individual’s perception and the other person’s perception are similar
family of procreation: the family that is formed with the intention of bearing children
family of orientation: the family into which a person is born
co-orientation: when two or more people experience the same physical or emotional input and develop a corresponding perception or response

Chapter 38

Growth and Development

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Summary

From birth to end of life, patients are categorized into the following developmental stages: newborn (0-28 days), infant (0-12 months), toddler (1-3 years), preschool (3-5 years), middle childhood (6-11 years)… Considered the “work” of children, play is a crucial component of development throughout the life span. One of the first steps in providing care across the life span is understanding how a patient population grows and develops over that time frame. Physical growth may be easier to assess, but this assessment must be coupled with all forms of development—cognitive, psychosocial, personality, communication, sexuality, and motor function—to fully understand a…

Key terms

development: the process by which a person gains various skills and functions
id: the primitive or unconscious part of the mind, which seeks gratification through physical needs
life span: understanding how a patient population grows and develops over that time frame
play: considered the work of children; a crucial aspect in growth and development
ego: the regulator between the id and the superego
middle childhood: the life stage from 6 to 11 years
toddler: the life stage from 1 to 3 years

Chapter 39

Conception Through Adolescence

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Summary

Growth and development start at conception and continue through adolescence. During conception and the prenatal stage, the genetic makeup and the basic physical structure of the child are determined. When children enter the toddler years, their physical growth starts to slow down, and they rapidly develop gross motor and language skills. The toddler years are also characterized by the child’s need for autonomy.

Key terms

conception: the biological process of a sperm fertilizing an egg
toddler years: also characterized by the child’s need for autonomy
phenylketonuria (PKU): a rare metabolic disorder that can cause intellectual disabilities but is highly treatable with diet modification
high-risk pregnancy: any pregnancy in which there are increased health risks for the pregnant person, the developing fetus, or both
congenital malformation: any health problem or physical abnormality that is present at birth, otherwise known as a birth defect
puberty: the stage of development during which physical and sexual maturity occurs and individuals become capable of reproduction
teratogen: any external force, such as a medication, chemical, alcohol, drug, or maternal infection, that can cause fetal abnormalities
abstract thinking: the ability to think through scenarios with different possible outcomes and evaluate which outcome would be best

Chapter 40

Young and Middle-Aged Adults

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Summary

While many developmental changes follow a timeline, the challenges are not universal. Prominent growth and development patterns in the young adult years include psychological changes associated with increased independence, changing social networks, and continued brain development. The adult life span stage encompasses adults aged 18 to 64 years. Adults experience many significant changes over that period but with great variation that the nurse must be aware of.

Key terms

psychological change: relating to the mind and emotions
prediabetes: a chronic abnormal elevation in blood sugar levels; however, the level is not elevated enough to be considered diabetes
obesity: a disorder in which an individual’s weight is greater than the healthy maximum for their age and height
achlorhydria: condition in which not enough acid is produced in the stomach
burnout: a state of emotional, physical, and mental exhaustion caused by prolonged stress and excessive workload, often associated with work-related responsibilities and caregiving roles
Erickson’s psychosocial development theory: theory explaining social aspects of human development from infancy through adulthood, including personality development through the life span
executive functioning: the ability to develop plans, focus attention, perform from working memory, maintain self-awareness, initiate and execute complicated tasks, control impulses, and manage emotions

Chapter 41

Older Adults

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Summary

Physical changes in older adulthood affect all organ systems. When providing care for older adults, it is crucial to understand how your patients develop and change over time. Older adults experience many challenges with their physiological, psychological , and psychosocial environment. Nurses across all specialties must provide compassionate and individualized care for older adults

Key terms

older adult: adults 65 years of age or older
physical changes: relating to outward expressions of changes in the body
age stratification theory: a theory suggesting that members of society might be stratified by age, just as they are stratified by race, class, and gender
complicated grief: a state of grief that is prolonged, delayed, or exaggerated in which individuals have trouble coping and progressing through the normal grief process
delayed grief: normal grief reaction that is suppressed or postponed by the survivor consciously or unconsciously to avoid the pain of the loss
respite: refers to a short period of rest or relief, typically provided to caregivers who are responsible for the continuous care of individuals with special needs, disabilities, or…
masked grief: grief that occurs when the survivor is unaware of behaviors that interfere with normal functioning due to the loss
activity theory: a theory on aging that suggests that the more active and involved an older person is, the happier they will be

Chapter 42

Caring for Patients with Disability and Chronic Illness

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Summary

The terms disability and impairment are often used interchangeably. Disability relates to how impairments affect an individual’s ability to function in their home and community environment. Physical, cognitive, and congenital impairments often result in disabilities. However, most definitions explain impairments as physical or mental deficits or differences that can be seen or perceived.

Key terms

disability: a mental or physical condition that limits an individual’s ability to engage in daily activities in a typical way
chronic illness: a condition requiring medical attention or limiting usual daily activities for greater than one year
illness: the perceived experience of a disorder within the body
impairment: loss of one’s physical or mental ability that inhibits usual or expected functioning Individuals with Disabilities Education Act (IDEA) enacted in 1975, requires that all…
congenital: a condition present at birth
terms disability and impairment: often used interchangeably
medical model of disability: disability as a consequence of a trauma, illness, or congenital health condition that is out of the control of the individual
disease: a disorder within the body that is identifiable as a medical condition

Chapter 43

Clinical Judgment and Critical Thinking

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Summary

Some of this growth was due to the development of the CJMM, a tool designed to measure critical thinking and clinical judgment in nursing students. Nursing involves several types of thinking, of which one of the most important is critical thinking. Historically, nursing was often viewed as a task-oriented career, but in recent years, the profession has grown in terms of autonomy and clinical judgment. This tool allows educators to assess the development of nursing student’s critical thinking skills to help ensure they are ready to practice as a nurse after graduation.

Key terms

clinical judgment: thought process that allows nurses to arrive at a conclusion based on objective and subjective information about a patient
critical thinking: reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow
clinical judgment measurement model (CJMM): a model allowing nurse educators to teach, assess, and measure the development of clinical judgment skills of nursing students
clinical reasoning: a complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh…
cognitive thinking: mental processes and abilities a nurse uses to interpret, analyze, and evaluate information in their practice
critical thinking indicators (CTIs): certain behaviors that demonstrate the knowledge, skills, and attitudes that promote critical thinking
inductive reasoning: type of thinking that involves noticing cues, making generalizations, and creating hypotheses