Standards & Conceptual Approach

Open Resources for Nursing (Open RN)

The Open RN Nursing Skills textbook is based on several external standards and uses a conceptual approach.

External Standards

American Nurses Association (ANA):

The ANA provides standards for professional nursing practice including nursing standards and a code of ethics for nurses

The National Council Licensure Examination for Registered Nurses: NCLEX-PN and NCLEX-RN Test Plans

The NCLEX-RN and NCLEX-PN test plans are updated every three years to reflect fair, comprehensive, current, and entry-level nursing competency.

The National League of Nursing (NLN): Competencies for Graduates of Nursing Programs

NLN competencies guide nursing curricula to position graduates in a dynamic health care arena with practice that is informed by a body of knowledge and ensures that all members of the public receive safe, quality care.

Quality and Safety Education for Nurses (QSEN) Institute: Pre-licensure Competencies 

Quality and safety competencies include knowledge, skills, and attitudes to be developed in nursing pre-licensure programs. QSEN competencies include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

Wisconsin State Legislature, Administrative Code Chapter N6

The Wisconsin Administrative Code governs the Registered Nursing and Practical Nursing professions in Wisconsin.

Healthy People 2030

Healthy People 2030 envisions a society in which all people can achieve their full potential for health and well-being across the life span. Healthy People provides objectives based on national data and includes social determinants of health.

Conceptual Approach

The Open RN Nursing Skills textbook incorporates the following concepts across all chapters.

  • Holism. Florence Nightingale taught nurses to focus on the principles of holism including wellness and the interrelationship of human beings and their environment. This textbook encourages the application of holism by assessing the impact of developmental, emotional, cultural, religious, and spiritual influences on a patient’s health status.
  • Evidence Based Practice (EBP). Textbook content is based on current, evidence-based practices that are referenced by footnotes. To promote digital literacy, hyperlinks are provided to credible, free, online resources that supplement content. The Open RN textbooks will be updated as new EBP is established and with the release of updated NCLEX Test Plans every three years.
  • Cultural Competency. Nurses have an ethical and moral obligation to provide culturally competent care to the patients they serve based on the ANA Code of Ethics.[1] Cultural considerations are included throughout this textbook.
  • Care Across the Life Span.  Developmental stages are addressed regarding patient assessments and procedures.
  • Health Promotion. Focused interview questions and patient education topics are included to promote patient well-being and encourage self-care behaviors.
  • Scope of Practice. Assessment techniques are included that have been identified as frequently performed by entry-level nurse generalists.[2], [3], [4], [5]
  • Patient Safety.  Expected and unexpected findings on assessment are highlighted in tables to promote patient safety by encouraging notification of health care providers when changes in condition occur.
  • Clear and Inclusive Language. Content is written using clear language preferred by entry-level pre-licensure nursing students to enhance understanding of complex concepts.[6] “They” is used as a singular pronoun to refer to a person whose gender is unknown or irrelevant to the context of the usage, as endorsed by APA style. It is inclusive of all people and helps writers avoid making assumptions about gender.[7] 
  • Open Source Images and Fair Use. Images are included to promote visual learning. Students and faculty can reuse open source images by following the terms of their associated Creative Commons licensing. Some images are included based on Fair Use as described in the “Code of Best Practices for Fair Use and Fair Dealing in Open Education” presented at the OpenEd20 conference. Refer to the footnotes of images for source and licensing information throughout the text.
  • Open Pedagogy. Students are encouraged to contribute to the Open RN textbooks in meaningful ways. In this textbook, students assisted in reviewing content for clarity for an entry-level learner and also assisted in creating open source images.[8]

Supplementary Material Provided

Several supplementary resources are provided with this textbook.

  • Supplementary, free videos to promote student understanding of concepts and procedures
  • Sample documentation for assessments and procedures
  • Online learning activities with formative feedback
  • Critical thinking questions that encourage application of content to patient scenarios
  • Free downloadable versions for offline use

An affordable print version of this textbook is published by XanEdu and is available on Amazon and in college bookstores. It has been reported that over 65% of students prefer a print version of their textbooks.[9]


  1. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
  2. Anderson, B., Nix, E., Norman, B., & McPike, H. D. (2014). An evidence based approach to undergraduate physical assessment practicum course development. Nurse Education in Practice, 14(3), 242–246. https://doi.org/10.1016/j.nepr.2013.08.007
  3. Giddens, J., & Eddy, L. (2009). A survey of physical examination skills taught in undergraduate nursing programs: Are we teaching too much? Journal of Nursing Education, 48(1), 24–29. https://doi.org/10.3928/01484834-20090101-05
  4. Giddens, J. (2007). A survey of physical assessment techniques performed by RNs: Lessons for nursing education. Journal of Nursing Education, 46(2), 83–87. https://doi.org/10.3928/01484834-20070201-09
  5. Morrell, S., Ralph, J., Giannotti, N., Dayus, D., Dennison, S., & Bornais, J.(2019). Physical assessment skills in nursing curricula: A scoping review protocol. JBI Database System Rev Implement Rep., 17(6), 1086-1091. https://doi.org/10.11124/jbisrir-2017-003981.
  6. Verkuyl, M., Lapum, J., St-Amant, O., Bregstein, J., & Hughes, M. (2020). Healthcare students’ use of an e-textbook open educational resource on vital sign measurement: A qualitative study. Open Learning: The Journal of Open, Distance and e-Learning. https://doi.org/10.1080/02680513.2020.1835623
  7. American Psychological Association (2021). Singular "They". https://apastyle.apa.org/style-grammar-guidelines/grammar/singular-they
  8. The Open Pedagogy Notebook by Steel Wagstaff is licensed under CC BY 4.0.
  9. Verkuyl, M., Lapum, J., St-Amant, O., Bregstein, J., & Hughes, M. (2020). Healthcare students’ use of an e-textbook open educational resource on vital sign measurement: A qualitative study. Open Learning: The Journal of Open, Distance and e-Learning. https://doi.org/10.1080/02680513.2020.1835623

License

Icon for the Creative Commons Attribution 4.0 International License

Nursing Skills by Open Resources for Nursing (Open RN) is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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