The nursing profession is constantly evolving and we, as nurses, are asked to assist with many health challenges that develop in our society (a statement perhaps never more true than during a pandemic). A core foundation of knowledge is required to prepare nurses for diverse roles within such a context and for contributing to the overall health of the individuals, communities, and society this profession serves. For these reasons, I was shocked and disappointed when a testing provider recently advised educators to “toss the textbook” and forego the use of expert-authored fundamental content in their programs.
I have been fortunate to have the opportunity to write fundamentals texts for more than 30 years. I have searched and read the literature and can say unequivocally that current, evidence-based fundamentals content cannot be found on YouTube or even on academic internet sites. Reliable fundamentals content is still primarily found in textbooks.
The single most important role we have as educators is to enable today’s students to become tomorrow’s best nurses. I strongly encourage, fellow educators, that we not cut corners in the learning process and eliminate an invaluable source of knowledge.
As the author of a nursing fundamentals textbook, I may have a bias here. At the same time, this is a topic I feel passionate about, and so should you.
The foundational knowledge that textbooks provide is vital in preparing students for the varied roles they will assume and the skills they will need to care for a diverse population of patients. I have spoken over the years with numerous practicing nurses who continue to value the knowledge gained from their texts. Today, students can pair this knowledge with the added benefits of interactive digital learning solutions, like Sherpath with EAQ (Elsevier Adaptive Quizzing), to further enhance retention by video engagement, application exercises, cases to problem-solve, and adaptive learning methods.
Our profession requires aspiring and practicing nurses alike to be knowledgeable, observant, analytical, skillful, ethical, and compassionate. How does one truly gain these competencies without sound contextual reading for reference, modeling, application, and practice?
Another aspect of what makes nursing unique is the holistic view nurses must take with every patient seeking health care. I have long valued the research of author Dr. Christine Tanner who developed the concept of “knowing” the patient. Co-author of Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics (Springer) and the research article “Thinking like a nurse: A research-based model of clinical judgment in Nursing” (Journal of Nursing Education), Dr. Tanner recognized that expertise in nursing requires repeated patient care experiences in their specialty to: a) allow development of a nurse’s in-depth knowledge of various patterns of responses; b) recognize when that knowledge may apply across patient cases; and c) learn to “know” each patient being cared for as an individual person. The ability to build this expertise of “knowing” patients has become increasingly challenging to teach with students experiencing less clinical time or having hands-on clinical care substituted with observational experiences. It is even more challenging when we consider the diversity of our patients and families. A lack of strong clinical mentors also plays a role.
With these challenges at hand, educators are responsible for ensuring future nurses have the knowledge, technical skills, and experiences to be advocates for patients, while confidently making informed clinical decisions under pressure or during changing circumstances. This foundation of knowledge presented in our textbook, for example, was designed to prepare nurses for their future careers. Textbooks offer an irreplaceable common scientific thread that all students can apply in theory, practice, or simulated environments. This consistent voice of the expert, along with digital companions like Sherpath with EAQ, are the best weapons we can arm our nursing students with as they journey through their nursing programs.
Clinical judgment is defined by the National Council of State Boards of Nursing (2019) as the observed outcome of critical thinking and decision making. Fundamentals textbooks like ours serve nursing students with a strong foundational knowledge base and also explains how to apply that knowledge to individual clinical presentations of patients so that they consistently make informed, clinically sound decisions.
Nurses constantly observe and gather information about their patients. They then must be able to assimilate this information, anticipate patient responses while comparing actual responses, recognize health problems, and select evidence-based interventions. The core of our book offers a model that facilitates this —empowering student’s understanding of clinical judgment and the interrelationships between critical thinking, the Nursing Process, and clinical decision making.
With each new edition, we incorporate the latest scientific evidence available as it pertains to nursing, general health concepts, and nursing interventions. This means the research we apply in our text is the most current and imperative for student learning at that time. Cutting this from the curriculum over-simplifies and undervalues the Fundamentals course, which is designed to set the stage for a strong foundation of knowledge and, by association, a strong program.
Students learn to recognize the value of research when they can see it represented in the scientific rationale for techniques they need to be able to perform for patients. Irish writer and magazine founder Sir Richard Steele said, “Reading is to the mind what exercise is to the body.” If we shield students from more difficult parts of learning (in this case, reading and comprehending), how are we better training future nurses to absorb and apply written information later in their careers?
Finally, in addition to enabling critical thinking, a Nurse’s foundation of knowledge should encompass an awareness of our diverse humanity and the multidimensional nature of each patient encounter. The application of concepts such as culture, spirituality, psychology, and family health into the clinical context of a patient situation is key, and covered in books across the curriculum. Such knowledge enables aspiring nurses to see themselves more clearly and to accept and address the healthcare needs of each individual patient.
So, I’ll say it again: our profession is constantly evolving, and we, as nurses, must assist with endless health challenges across the world. The most important role we have as educators is to ensure that our society’s future nurses gain the foundational knowledge that textbooks, their digital components, and your lessons provide, and then apply it in practice for strong clinical judgment.
Lifelong learning is a non-negotiable responsibility of the nursing profession — there’s going to be some reading involved. Make sure it’s a skill you don’t take off the table for your first-year students — they’re going to need it.
Patricia A. Potter, RN, MSN, PhD, FAAN, is the former Director of Research & Patient Care Services at Barnes-Jewish Hospital in St. Louis, Missouri. You can view her Fundamentals of Nursing, 10e textbook here, which features more than 50 nursing skills with illustrated, step-by-step instructions, over 30 procedural guidelines, 50 in-text case studies, and important current issues such as gun violence, cultural diversity, the opioid epidemic, and chronic illness care. Additional resources that accompany this title include a wealth of online modules with video content and adaptive practice.