Textbook Fundamentals of Canadian Nursing Concepts Process and Practice Fourth Canadian Edition Barbara J Kozier Ebook All Chapter PDF

Fundamentals of Canadian Nursing:
Concepts, Process, and Practice,

Fourth Canadian Edition Barbara J.
Kozier
Visit to download the full and correct content document:
https://textbookfull.com/product/fundamentals-of-canadian-nursing-concepts-process-
and-practice-fourth-canadian-edition-barbara-j-kozier/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Biota Grow 2C gather 2C cook Loucas
https://textbookfull.com/product/biota-grow-2c-gather-2c-cook-
loucas/
Psychiatric Mental Health Nursing for Canadian Practice

Wendy Austin
https://textbookfull.com/product/psychiatric-mental-health-
nursing-for-canadian-practice-wendy-austin/
Fundamentals of Social Research Fourth Canadian Edition

Earl Babbie And Lance W. Roberts
https://textbookfull.com/product/fundamentals-of-social-research-
fourth-canadian-edition-earl-babbie-and-lance-w-roberts/
Engineering Economic Analysis Fourth Canadian Edition

Donald G. Newnan
https://textbookfull.com/product/engineering-economic-analysis-
fourth-canadian-edition-donald-g-newnan/
Fundamentals of Corporate Finance, 3rd Canadian Edition
Jonathan B. Berk
https://textbookfull.com/product/fundamentals-of-corporate-
finance-3rd-canadian-edition-jonathan-b-berk/
Business Communication: Process & Product: Brief Sixth

Brief Canadian Edition Griffin
https://textbookfull.com/product/business-communication-process-
product-brief-sixth-brief-canadian-edition-griffin/
Financial management theory and practice Third Canadian

Edition Brigham
https://textbookfull.com/product/financial-management-theory-and-
practice-third-canadian-edition-brigham/
Interplay The Process of Interpersonal Communication

Fifth Canadian Edition Ronald B. Adler
https://textbookfull.com/product/interplay-the-process-of-
interpersonal-communication-fifth-canadian-edition-ronald-b-
adler/
Concepts and Cases in Nursing Ethics - Fourth Edition

Yeo
https://textbookfull.com/product/concepts-and-cases-in-nursing-
ethics-fourth-edition-yeo/
KOZIER ERB BERMAN SNYDER FRANDSEN
BUCK FERGUSON YIU STAMLER
FUNDAMENTALS OF
KOZIER ERB
BERMAN SNYDER
CANADIAN NURSING
FRANDSEN BUCK CONCEPTS, PROCESS, AND PRACTICE 4TH ED I TI ON
FERGUSON YIU
STAMLER
FUNDAMENTALS OF
CANADIAN NURSING
CONCEPTS, PROCESS, AND PRACTICE
4TH EDITION
www.pearsoncanada.ca
ISBN 978-0-13-419270-3
9 0 0 0 0
9 780134 192703
Fundamentals of Canadian Nursing
Concepts, Process, and Practice
Fourth Canadian Edition
A01_KOZI2703_04_SE_FM.indd 1 03/03/17 3:30 PM

Fundamentals of Canadian Nursing
Concepts, Process, and Practice
Fourth Canadian Edition
Barbara Kozier, MN, RN
Glenora Erb, BScN, RN
Audrey Berman, PhD, RN

Professor
Dean, Nursing
Samuel Merritt University
Oakland, California
Shirlee J. Snyder, EdD, RN

Former Dean and Professor, Nursing
Nevada State College
Henderson, Nevada
Geralyn Frandsen, EdD, RN

Professor of Nursing
Maryville University
St. Louis, Missouri
Madeleine Buck, RN, BScN, MSc(A)

Assistant Professor
Ingram School of Nursing
McGill University
Clinical Associate
McGill University Health Centre
Linda Ferguson, RN, BSN, MN, PhD

Professor
College of Nursing
University of Saskatchewan
Lucia Yiu, RN, BSc, BA, MScN

Associate Professor
Faculty of Nursing
University of Windsor
Lynnette Leeseberg Stamler, PhD, RN, FAAN

Professor and Associate Dean for Academic Programs
College of Nursing
University of Nebraska Medical Center
(formerly of University of Saskatchewan)

Editorial Director: Claudine O’Donnell Production Services: Cenveo® Publisher Services
Acquisitions Editor: Kimberley Veevers Permissions Project Manager: Erica Mojzes, Joanne Tang
Marketing Manager: Michelle Bish Photo Permissions Research: Aptara
Program Manager: John Polanszky Text Permissions Research: Aptara
Project Manager: Jessica Mifsud Art Director: Alex Li
Manager of Content Development: Suzanne Schaan Interior and Cover Designer: Anthony Leung
Developmental Editor: Daniella Balabuk Cover Image: Terry Vine/Blend Images/Getty Images
Media Editor: Charlotte Morrison-Reed VP, Cross Media and Publishing Services: Gary Bennett
Media Developer: Tiffany Palmer
Pearson Canada Inc., 26 Prince Andrew Place, Don Mills, Ontario M3C 2T8.
Copyright © 2018, 2014, 2010 Pearson Canada Inc. All rights reserved.
Printed in the United States of America. This publication is protected by copyright, and permission should be obtained from the
publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate con-
tacts, please contact Pearson Canada’s Rights and Permissions Department by visiting www.pearsoncanada.ca/contact-information/
permissions-requests.
Authorized adaptation from Kozier & Erb’s Fundamentals of Nursing, Tenth Edition, Copyright © 2016, Pearson Education, Inc.,
Hoboken, New Jersey, USA. Used by permission. All rights reserved. This edition is authorized for sale only in Canada.
Attributions of third-party content appear on the appropriate page within the text.
PEARSON is an exclusive trademark owned by Pearson Canada Inc. or its affiliates in Canada and/or other countries.
Unless otherwise indicated herein, any third party trademarks that may appear in this work are the property of their respective owners
and any references to third party trademarks, logos, or other trade dress are for demonstrative or descriptive purposes only. Such
references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson Canada products by the
owners of such marks, or any relationship between the owner and Pearson Canada or its affiliates, authors, licensees, or distributors.
If you purchased this book outside the United States or Canada, you should be aware that it has been imported without the approval
of the publisher or the author.
ISBN-13: 978-0-13-419270-3
10 9 8 7 6 5 4 3 2
Library and Archives Canada Cataloguing in Publication
Kozier, Barbara, author
Fundamentals of Canadian nursing : concepts, process,
and practice / Barbara Kozier [and eight others].—Fourth
Canadian edition.
Originally published under title: Fundamentals of nursing, the

nature of nursing practice in Canada.
Includes bibliographical references and index.
ISBN 978-0-13-419270-3 (hardback)
1. Nursing—Canada—Textbooks. 2. Nursing—Textbooks.
I. Title.
RT41.K69 2017 610.73 C2016-904384-3
A01_KOZI2703_04_SE_FM.indd 4 16/06/17 9:32 AM

Contents
Preface xiv
Canadian Reviewers xviii
UNIT 1 T H E F O U N D AT I O N O F N U R S I N G I N C A N A D A 1
Chapter 1 Chapter 4 Chapter 6

Historical and Nursing Philosophies, Accountability and Legal
Contemporary Nursing Theories, Concepts, Aspects of Nursing 85
Practice 1 Frameworks, and Relationship between Nurses
Historical Nursing Practice 2 Models 51 and the Law 86
Contemporary Nursing Practice 7 Contractual Arrangements
What Is Philosophy? 52
Roles and Functions of the Nurse 12 in Nursing 89
Philosophy’s Three Primary
Nursing as a Profession 14 Areas of Potential Tort Liability
Areas of Inquiry 52
Factors Influencing Contemporary in Nursing 90
World Views and Paradigms 53
Nursing Practice 16 Selected Legal Aspects of Nursing
Philosophy in Nursing 53
Nursing Organizations 17 Practice 97
Concepts and Theories 54
Legal Protections in Nursing
Overview of Selected Nursing
Chapter 2 Theories 56
Practice 99
Nursing Education Reporting Crimes, Torts, and Unsafe
Practices 101
in Canada 23 Chapter 5
Legal Responsibilities of Nursing
Nursing Education 24 Values, Ethics, and Students 102
Types of Educational Programs 25 Advocacy 66
Nursing Associations and Their Influence Values 67
on Education 27 Ethics 72
Issues Facing Nursing Education 29 Ethical Decision Making 75
Selected Ethical Issues
Chapter 3 in Nursing 76
Nursing Research in Nursing and Advocacy 79
Canada 35 Enhancing Ethical Practice 80
Nursing Research 36
UNIT 2 C O N T E M P O R A R Y H E A LT H C A R E I N C A N A D A 106
Chapter 7 Chapter 8 The Nurse’s Role in Health

Promotion 130
Health, Wellness, Health Promotion 120 The Nursing Process and Health
and Illness 106 Development of Health-Promotion Promotion 131
Concepts of Health, Wellness, Initiatives in Canada 121 Promoting Canadians’ Health 135
and Well-Being 107 Strategies for Population Health
Models of Health and Wellness 108 (1994) 123 Chapter 9
Health-Promotion Models 111 Defining Health Promotion 125 The Canadian Health Care
Sites for Health-Promotion
Health Care Adherence 113
Activities 126
System 140
Illness and Disease 113
Pender’s Health-Promotion Model 126 History 141
What Makes Canadians
The Transtheoretical Model: Stages of Rights and Health Care 142
Healthy? 114
Health Behaviour Change 128 Categories of Health Care 143
Summary 116

vi Contents
Types of Health Care Organizations Chapter 12 Community Health Nursing Practice 249
and Care Settings 146 The Community Health Nurse as a
Factors Impacting the Health Care
Individual Care 203 Collaborator 252
System 151 Concept of Individuality 204 Community Health Nursing
Contemporary Frameworks for Self-Concept 205 Competencies 254
Care 155 Concept of Holism 212 Focus on Trends in Community
Models for the Delivery Applying Theoretical Frameworks Health Nursing 256
of Nursing 156 to Individuals 216
Chapter 15
Chapter 10 Chapter 13 Rural and Remote
Environmental and Global Nursing Care of Health Care 262
Health Nursing 160 Families 223 Definition of Rural 263
Environment and Health 161 What Is “Family?” 224 Rural Health: Place, Space,
Global Health versus International Family Nursing 224 and Time 263
Health: What Is the Development of Family Elements of a Rural Health
Difference? 164 Nursing 226 Framework 263
Theories of Development 167 Canadian Families: A Demographic Health of Rural Residents 265
Globalization 168 Snapshot 227 Special Concerns in Rural and Remote
Sustainable Development Understanding Families 231 Aboriginal Communities 269
Goals 168 How Does the Family Affect Health Care Delivery 270
Major Issues in Global the Illness? 234
Health 170 Nursing Care of Families 234 Chapter 16
Nurses and Global Health 174 Evaluating Nursing Care of Complementary and
Families 240
Chapter 11 Alternative Health
Safe Cultural Caring 181 Chapter 14 Modalities 279
Canada’s Cultural Mosaic 182
Community Health Basic Concepts 280
Definitions and Concepts Related to Nursing 246 Complementary and Alternative Health
Modalities 281
Culture 187 What Is Community Health
Nursing Role in Complementary and
Considerations for Culturally Safe Nursing? 247
Alternative Health Modalities 290
Nursing Practice 187 Community Health Nursing in the
Providing Culturally Safe Context of Canadian Health
Care 194 Care 248
UNIT 3 L I F E S PA N A N D D E V E L O P M E N TA L S TA G E S 294
Chapter 17 Preschoolers (4 to 5 Years) 318 Moral Development 355

School-Age Children (6 to 12 Years) 321 Spirituality and Religion 355
Concepts of Growth and Adolescence (12 to 18 Years) 323 Promoting Healthy Aging 355
Development 294 Planning for Health Promotion 358
Factors Influencing Growth and Chapter 19
Development 295 Young and Middle
Stages of Growth and Development 296 Adulthood 331
Growth and Development Theories 296
Young Adults (20–40 Years) 332
Applying Growth and Development
Middle-Aged Adults (40 to 65 Years) 337
Concepts to Nursing Practice 305
Chapter 18 Chapter 20
Development from Older Adults 344
Characteristics of Older Adults in
Conception through Canada 345
Adolescence 308 Attitudes toward Aging 346
Conception and Prenatal Gerontological Nursing in Canada 346
Development 309 Care Settings for Older Adults 347
Neonates and Infants Theories of Aging 347
(Birth to 1 Year) 310 Psychosocial Aging 352
Toddlers (1 to 3 Years) 315 Cognitive Abilities and Aging 354

Contents vii
UNIT 4 INTEGRAL ASPECTS OF NURSING 364
Chapter 21 Chapter 23 Computer Technology and Informatics

in Nursing 485
Clinical Reasoning and The Nursing Process 411 How Nurses Are Currently Using
Critical Thinking 364 Overview of the Nursing Process 412 Technology 489
Critical Thinking 365 Assessing 412 Using Evidence-Informed Nursing
Critical Thinking: Definitions and Diagnosing/Analyzing 428 Practice in ICT 491
Purposes 365 Planning 436 Roles in Nursing Informatics 491
Techniques in Critical Thinking 367 Implementing 448 How Technology Influences Humans
Clinical Reasoning 369 Evaluating 450 and How Humans Influence
Attitudes That Foster Critical Thinking 369 Nursing Process Summarized 456 Technology 492
Standards of Critical Thinking 371 Workflow or Nursing Practice
Applying Critical Thinking to Nursing
Chapter 24 Process 493
Practice 371 Documenting and Consumers’ Health Informatics and
Developing Critical Thinking Attitudes Reporting 460 Online Information Access 494
and Skills 374 Professional Issues 495
Ethical and Legal Considerations 461
Conclusion 496
Purposes of Client Records and
Chapter 22
Documentation 462 Chapter 26
Caring and Documentation Systems 462
Communicating 381 Documenting Nursing Activities 470 Teaching and
Professionalization of Caring 382 General Guidelines for Learning 500
Nursing Theories on Caring 382 Documentation 472 Teaching 501
Types of Knowledge in Nursing 384 Reporting 476 Learning 502
Caring in Practice 385 Conferring 478 Nurse as Educator 506
Communicating 385
The Helping Relationship 396
Chapter 25 Chapter 27
Group Communication 398 Nursing Informatics Leading, Managing,
Communication and the Nursing and Technology 482 and Delegating 522
Process 400 Definition of Nursing Informatics 483 Nurse as Leader 523
Communication among Health Care Informatics Fundamentals: Data, Nurse as Manager 526
Professionals 405 Information, and Knowledge 484 Nurse as Delegator 529
Nurse and Physician Standardized Languages 485 Change 531
Communication 406
UNIT 5 N U R S I N G A S S E S S M E N T A N D C L I N I CA L ST U D I E S 537
Chapter 28 Male Genitals and Inguinal Area 621 Implementing 689

The Anus 625 Pharmacological Pain
Health Assessment 537 Management 691
Physical Health Assessment 538 Chapter 29 Nonpharmacological Pain
General Survey 545 Vital Signs 629 Management 700
The Integument 547 Evaluating 703
Body Temperature 630
Head 555
Pulse 637
Eyes and Vision 555 Chapter 31
Respirations 648
Ears and Hearing 558
Blood Pressure 651 Hygiene 710
Nose and Sinuses 567
Oxygen Saturation 662 Skin 711
Mouth and Oropharynx 567
Feet 725
The Neck 572 Chapter 30 Nails 729
Thorax and Lungs 574
Cardiovascular and Peripheral Vascular Pain Assessment and Mouth 730
Systems 586 Management 668 Hair Care 738
Eyes 744
Breasts and Axillae 594 The Nature of Pain 670 Ears 747
Abdomen 598 Physiology of Pain: Nociception 673 Nose 748
Musculoskeletal System 599 Factors Affecting the Pain Supporting a Hygienic
Neurological System 605 Experience 676 Environment 748
Female Genitals and Inguinal Lymph Pain Assessment 679
Nodes 610 Planning 686

viii Contents
Chapter 32 Chapter 34 Chapter 35

Safety 761 Infection Prevention Skin Integrity and
Factors Affecting Safety 762 and Control 875 Wound Care 930
Assessing 764
Health Care–Associated Infections 877 Skin Function and Integrity 931
Diagnosing 766
Types of Microorganisms Causing Wounds or Altered Skin Integrity 932
Planning 767
Infections 877 Wound Healing 933
Implementing 767
Body Defences against Infection 878 Heat and Cold Applications 961
Evaluating 785
Pathophysiology of Infection 882 Care of Specific Common Wound
Chapter 33 The Clinical Spectrum of Infection 882 Etiologies 966
Infection: An Imbalance between Pressure Injury 966
Medications 792 Microorganisms and Defences 882 Skin Tears 972
Key Concepts in Pharmacology 793 The Chain of Infection 883 Moisture-Associated Skin Damage 976
Effects of Drugs 795 Breaking the Chain: Prevention and Lower Extremity Ulcers 977
Drug Misuse 797 Control of Health Care–Associated
Actions of Drugs in the Body 797 Infections 887 Chapter 36
Factors Affecting Medication Action 799 Routine Practices and Additional Caring for Perioperative
Routes of Administration 800
Medication Order 802
Precautions 910 Clients 983
Practical Considerations for
Systems of Measurement 806 Implementation of Precautions 918 Types of Surgery 984
Methods of Calculating Dosages 807 Nursing Responsibility for Infection Preoperative Phase 986
Administering Medications Safely 811 Prevention and Control 919 Intraoperative Phase 998
System Factors Related to Medication Occupational Health Issues Related Postoperative Phase 1000
Safety 811 to Infection 922
Enteral Medications 819 Roles of the Infection Control
Parenteral Medications 824 Practitioner 924
Topical Medications 858 Infection Prevention and Control Is a
Inhaled Medications 867 Shared Responsibility 925
UNIT 6 P R O M O T I N G P H Y S I O L O G I C A L H E A LT H 1021
Chapter 37 Chapter 39 Vegetarian Diets 1143

Altered Nutrition 1144
Sensory Perception 1021 Activity and Assessing 1145
Components of the Sensory-Perceptual Exercise 1057 Diagnosing 1155
Process 1022 Normal Movement 1059 Implementing 1158
Sensory Alterations 1022 Factors Affecting Body Alignment Evaluating 1176
Factors Affecting Sensory and Activity 1067
Function 1024 Exercise 1069 Chapter 41
Assessing 1025 Effects of Immobility 1073 Fecal Elimination 1183
Diagnosing 1027 Assessing 1079 Physiology of Defecation 1184
Planning 1027 Diagnosing 1082 Factors that Affect Defecation 1186
Implementing 1027 Planning 1082 Fecal Elimination Problems 1189
Evaluating 1032 Implementing 1084 Bowel Diversion Ostomies 1192
Using Body Mechanics 1084 Assessing 1194
Chapter 38 Evaluating 1118 Diagnosing 1197
Sleep 1038 Planning 1197
Physiology of Sleep 1039 Chapter 40 Implementing 1200
Normal Sleep Patterns and Nutrition 1123 Evaluating 1214
Requirements 1041 Essential Nutrients: Macronutrients 1124
Factors Affecting Sleep 1043 Essential Nutrients: Micronutrients 1127 Chapter 42
Common Sleep Disorders 1044 Energy Balance 1128 Urinary Elimination 1219
Assessing 1047 Factors Affecting Nutrition 1130 Physiology of Urinary Elimination 1220
Diagnosing 1048 Nutritional Variations Throughout the Factors Affecting Voiding 1222
Planning 1049 Lifespan 1133 Altered Urine Production 1224
Implementing 1050 Standards for a Healthy Diet 1140 Altered Urinary Elimination 1225
Evaluating 1053

Contents ix
Assessing 1227 Factors Affecting Respiratory and Factors Affecting Body Fluid, Electrolytes,
Diagnosing 1236 Cardiovascular Functions 1274 and the Acid–Base Balance 1335
Planning 1236 Alterations in Function 1278 Disturbances in Fluid, Electrolyte, and
Implementing 1241 Assessing 1281 Acid–Base Balance 1337
Evaluating 1260 Diagnosing 1287 Assessing 1346
Implementing 1290 Diagnosing 1352
Chapter 43 Evaluating 1320 Planning 1352
Oxygenation and Implementing 1354
Chapter 44
Circulation 1265 Evaluating 1383
Physiology of the Respiratory

Fluid, Electrolyte, and
System 1266 Acid–Base Balance 1325
Physiology of the Cardiovascular Body Fluids and Electrolytes 1326
System 1270 Acid–Base Balance 1334
UNIT 7 P R O M O T I N G P S Y C H O S O C I A L H E A LT H 1391
Chapter 45 Spiritual, Religious, and Faith Coping 1443

Development 1419 Assessing 1444
Sexuality 1391 Spiritual and Religious Care in Diagnosing 1445
Development of Sexuality 1392 Contemporary Context 1420 Planning 1445
Sexual Health 1397 Spiritual and Religious Practices Affecting Implementing 1447
Factors Influencing Sexuality 1401 Nursing Care 1422 Evaluating 1451
Sexual Response Cycle 1402 Spiritual Health and the Nursing
Altered Sexual Function 1404 Process 1425 Chapter 48
Effects of Medications on Sexual Assessing 1426 Loss, Grieving, and
Function 1406
Assessing 1406
Diagnosing 1427 Death 1456
Planning 1427
Diagnosing 1408 Implementing 1428 Loss and Grief 1457
Planning 1408 Evaluating 1429 Assessing 1460
Implementing 1408 Implementing 1461
Evaluating 1412 Chapter 47 Dying and Death 1462
Chapter 46
Stress and Coping 1435
Concept of Stress 1436
Spirituality 1417 Models of Stress 1438
Spirituality and Related Concepts 1418 Indicators of Stress 1441
Glossary 1484
Answers and Explanations for NCLEX-Style Practice Quizzes 1524
Appendix A
Laboratory Values 1587
Appendix B
Vital Signs 1594
Index 1595

About the Canadian
Editors
Madeleine Buck
Madeleine Buck is an Assistant Professor and Director of the Bachelor of Science (Nursing) pro-
gram at the McGill University Ingram School of Nursing. She is also a clinical associate at the McGill
University Health Centre and consultant at the TANWAT Hospital in Njombe, Tanzania. Her 38-year
career in nursing has provided her with opportunities to work in acute and critical care, community
health, and educational settings. She teaches in the undergraduate and graduate nursing programs at
McGill, principally in the areas of acute care and illness management. She is involved in international
work and leads McGill Nurses for Highlands Hope, which works with a group of Tanzanian nurses
and peer health educators in dealing with the HIV/AIDS pandemic in the Highlands of Tanzania.
With her nursing students in the McGill Global Health Masters stream, she works to foster collab-
oration and development of nursing education and practice relationships, including implementing
nursing best practices in low-resourced settings in Tanzania. As with previous editions, half of her
royalties from the publication of this book will go toward supporting sustainable nursing projects ori-
ginating from the Tanzanian Highlands Hope Nurse network.
Linda Ferguson
Linda Ferguson, RN, BSN, MN, PhD (Alberta), is Full Professor at the College of Nursing,
University of Saskatchewan. Her undergraduate, master’s, and PhD studies were in the field of nurs-
ing, and she has a postgraduate diploma in Continuing Education. She has worked extensively in
the field of faculty development in the College of Nursing and the University of Saskatchewan. At
the University of Saskatchewan, she has taught educational methods courses at the undergraduate
(nursing and physical therapy), post-registration, and master’s levels for the past 25 years, and nursing
theory and philosophy in the master’s and PhD programs. Her research expertise is in the area of
qualitative research, with a particular focus on nursing education and workplace learning in profes-
sional practice. Her research has focused on mentorship and preceptorship, continuing education
needs of precepting nurses, teaching excellence, interprofessional education, and the process of devel-
oping clinical judgment in nursing practice and mentorship. She is past president of the Canadian
Association of Schools of Nursing and currently serves as a member of the Board of Governors of
the University of Saskatchewan.
Lucia Yiu
Lucia Yiu, RN, BScN, BA (Psychology, Windsor), BSc (Physiology, Toronto), MScN (Administration,
Western Ontario), is an Associate Professor in the Faculty of Nursing, University of Windsor, and an
Educational and Training Consultant in community nursing. She has authored various publications
on family and public health nursing. Her practice and research interests include multicultural health,
international health, experiential learning, community development, breast health, and program plan-
ning and evaluation. She has worked overseas and served on various community and social services
committees involving local and district health planning. Lucia was a board member for various com-
munity boards related to children’s mental health; community health centres; quality assurance; status
of women, equity, and diversity; occupational health, employment equity, and breast cancer. She is
currently a board member with CARE working with international educated nurses.

xii About the Canadian Editors
Lynnette Leeseberg Stamler

Lynnette Leeseberg Stamler began her nursing career with a BSN from St. Olaf College,
Northfield, Minnesota, USA. Her interest in patient teaching began within that program and inspired
her to complete an MEd degree from the University of Manitoba. Although she has worked in many
areas of nursing, she has always gravitated toward clinical areas where the relationship with patients
and families is essential—such as rehabilitation, long-term care, dialysis, and VON (visiting nursing).
After teaching in a diploma program at Red River College in Winnipeg, she completed her PhD in
nursing from the University of Cincinnati, where she was their third graduate. She has since taught
at the University of Windsor, Nipissing University/Canadore College Collaborative BSN program,
the University of Saskatchewan, South Dakota State University, and, currently, the University of
Nebraska Medical Center. She has been very active in the Canadian Association of Schools of Nursing
(CASN), serving as Treasurer and the first elected President who was not a Dean or Director. She is
also active in Sigma Theta Tau International. Her research and international work have focused on
aspects of education, from patient to health to nursing. In this spirit, she began work on Canadian
nursing textbooks, recognizing that this is one way to influence the next generation of nurses. She has
served as an accreditation site visitor. In 2011, her work was recognized when she was inducted as an
International Fellow in the American Academy of Nursing, one of eight Canadian nurses to hold that
distinction at that time.

Dedication
Madeleine Buck dedicates this edition to the Highlands Hope Umbrella,
an organization that brings together community, professional, and volunteer networks to
address the challenge of HIV-AIDS and related social problems in the Njombe region of
the Southern Highlands of Tanzania. The knowledge, skill, creativity, and dedication of
nurses, nursing students, and other members within the “umbrella” are truly commendable.
Linda Ferguson dedicates this edition to those nurses in professional practice

who contribute their knowledge and expertise to nursing students in teacher-led groups and
preceptored relationships across Canada. Their substantive and tacit knowledge of nursing
and their enthusiasm for the profession are inspiring to students, faculty, clients, and their
nursing colleagues.
Lucia Yiu dedicates this edition to her daughters, Tamara, Camillia, and Tiffany;
and especially to her students and nursing colleagues who have inspired her to strive for
excellence in nursing.
Lynnette Leeseberg Stamler dedicates this edition to the many

nurses who have taught and inspired her throughout her life to “pay it forward” to the nurses
of tomorrow. Together, we daily move mountains.
Audrey Berman dedicates this tenth edition to everyone who ever played a
part in its creation: to Barbara Kozier and Glenora Erb who started it all and taught me
the ropes; to the publishers, editors, faculty authors, contributors, reviewers, and adopters
who improved every edition; to the students and their clients who made all the hard work
worthwhile; and to all my family and colleagues who allowed me the time and space to make
these books my scholarly contribution to the profession.
Shirlee Snyder dedicates this edition to her husband, Terry J. Schnitter, for his
unconditional love and support; and to all of the nursing students and nurse educators she
has worked with and learned from during her nursing career.
Geralyn Frandsen dedicates this edition to her husband and fellow nursing
colleague Gary. He is always willing to answer questions and provide editorial support. She
also dedicates this edition to her children Claire and Joe and future son-in-law, John Conroy.

Preface
As the scope and pace of nursing and allied health know-
ledge continue to grow exponentially, one must ask what is
Organization
truly “fundamental” for a nurse to know and understand in For this fourth edition, we present seven units containing in
order to practice knowledgeably, morally, ethically, accurately, total 48 chapters—one less than our last edition, as we have
sensitively, and compassionately in both today’s and tomor- merged the chapter on “Self-Concept” (Chapter 45 in the
row’s health care delivery system. Within the context of the 3rd edition) with “Individual Care” (Chapter 12 in this edi-
current and future health care system, the fourth edition of tion). The material presented in this publication addresses
Fundamentals of Canadian Nursing: Concept, Process, and Practice foundational and fundamental knowledge and skills required
provides undergraduate nursing students with the fundamentals for a person entering the nursing profession. Building on the
strengths of our previous editions, we enhanced many features
they will require as they embark on their nursing careers. This
to ensure that our textbook is relevant and informative to
textbook aims to provide students with a broad and solid foun-
nurses across the country.
dation of knowledge about the health of individuals, families,
communities, and populations. Also included are the issues Unit 1—The Foundation of Nursing in Canada
that client populations face at varying points in time, as well (Chapters 1–6) introduces the nature of the nursing pro-
as the nursing care that is possible in health and illness situa- fession, from the history of nursing to its current practice,
tions, whether clients are situated at home, in the community, education, and research. Each chapter has been updated since
at a clinic, at an extended or palliative care facility, or in an our previous edition to reflect evolving trends and emer-
acute care setting. We hope that this text will serve as a “go to” ging issues, such as changes to nursing practice standards, the
increasing role of nurses as research consumers, the influx of
resource for students and practising nurses working in a wide
internationally educated nurses, moral distress in the work of
range of settings.
nurses, and the role of social media in nursing and health care,
With the goal of providing a fundamental understanding
among many other topics.
of what is required for contemporary professional nursing
practice in Canada, we built on the first three editions to Unit 2—Contemporary Health Care in Canada
ensure that we thoroughly addressed needed skills, such as (Chapters 7–16) includes discussions on health care practice
communication, critical thinking, clinical reasoning, decision in today’s multicultural environments. Concepts of health,
making, use of the nursing process, development of inter- illness, and wellness are addressed as well as the role nurses
personal and interprofessional relationships, teaching, leading can play in health promotion from an individual, family,
community and global perspective. This unit addresses foun-
and managing change, use of technology, and application
dational concepts related to Canada’s health care system and
of primary health care principles. We placed high import-
specific issues related to rural and remote health care, includ-
ance on such concepts as caring, wellness, health promotion,
ing Northern nursing.
disease prevention, complementary and alternative health
modalities, rural health, environmental and global health, Unit 3—Lifespan and Developmental Stages
multiculturalism, growth and development, nursing theories, (Chapters 17–20) describes concepts of growth and develop-
nursing informatics, nursing research and education, ethics, ment and outlines the various developmental stages and their
accountability, and advocacy. Furthermore, we highlighted specific health needs throughout the lifespan. Particular atten-
tion has been given to the issues facing the very young and
basic nursing care for clients across the lifespan from hospi-
older adults.
tal to community settings in the culturally diverse Canadian
health care system throughout. In all areas, we integrated the Unit 4—Integral Aspects of Nursing (Chapters
most recent literature and clinical best-practice guidelines. 21–27) describes the fundamental nursing tools required for
To ensure that our text reflects “pan-Canadian” issues practice, including critical thinking, clinical reasoning and
and practices, we enlisted reviewers and contributors from decision making, caring and communicating, the nursing pro-
across the country, representing different geographical per- cess, documenting and reporting, teaching and learning, and
spectives. We expended every effort to ensure that the level of leading and managing change. These tools provide a founda-
specificity and readability is appropriate for beginning nursing tion for competent nursing care.
students. We believe that this text will also provide a strong Unit 5—Nursing Assessment and Clinical
foundation for advanced nursing studies. Enjoy! STUDIES (Chapters 28–36) provides fundamental knowledge

Preface xv
to guide comprehensive health assessment, including vital ●● An emphasis on Clinical Reasoning—A discussion about
signs, and addresses integral components of care in relation the importance of clinical reasoning and the similarities
to pain assessment and management, hygiene, safety, medi- and differences between clinical reasoning and critical
cations, infection prevention and control, skin integrity and thinking now appear. “Clinical Reasoning” questions
wound care, and caring for perioperative clients. appear in several chapters to encourage readers to consider
Unit 6—Promoting Physiological Health the clinical context as a major factor in determining the
(Chapters 37–44) discusses such physiologic concepts as sen- specific priorities and approach to nursing care.
sory perception; sleep; activity and exercise; nutrition; fecal ●● REINSTATED Glossary of Key Terms—Previously, our
elimination; urinary elimination; fluid, electrolytes, and acid– glossary of key terms was available online; based on feed-
base balance; and oxygenation and circulation. back from users, we have reinstated the glossary as part of
Unit 7—Promoting Psychosocial Health the text so that users have ready access to such an import-
(Chapters 45–48) covers a wide range of areas that affect ant feature.
one’s health. Sexuality, spirituality, stress and coping, and loss, ●● The latest evidence in the “Evidence-Informed Practice”
grieving, and death are all areas that a nurse should consider (EIP) boxes—A thorough review of the literature was con-
to care effectively for a client. ducted for each chapter. Emphasis was placed on including
Following the book chapters is a Glossary in which key the results of systematic reviews and meta-analyses to
terms are defined. Two Appendices are provided near the ensure the highest level of evidence is contained in the
end of the book. They summarize important information chapters. The EIP boxes highlight Canadian studies.
about laboratory values, formulae, and vital signs.
●● A focus on the role of all Registered Nurses in clinical
leadership as a means of providing high-quality and safe
patient care.
What’s New in the 4th Edition ●● A focus on changes in the regulation of nurses in Canada,
including reference to the NCLEX-RN examinations for
●● NEW approach with adoption of a broader, less pre- licensure.
scriptive approach to nursing diagnoses. This new edition
●● UPDATED all relevant national consensus guidelines relat-
encourages students and nurses to use their knowledge,
ed to nursing care are included in the relevant chapters.
experience, and critical thinking skills to generate diagnoses
or analyses. ●● ENHANCED Rationales for Nursing Care—All Skill
instructions and Clinical Guidelines were reviewed and
●● Inclusion of the Canadian Association of Schools of
revised to ensure that a rationale is provided for each rec-
Nursing Competencies Domains from the Nursing
ommendation to promote clarity and understanding.
Education Competencies Framework (CASN, 2014).
●● ENHANCED Pan-Canadian Perspective—Reviewers and
●● A stronger focus on the roles of nurses in interprofessional
contributors were selected from across Canada to ensure
collaboration in patient care.
that the textbook provides a relevant and comprehensive
●● A focus on “Environmental and Global Health Nursing”—A perspective on nursing care and issues facing nurses across
whole chapter is devoted to this important and fascinating the country.
topic.
●● ENHANCED Level of foundational knowledge—We took
●● All national patient safety consensus recommendations care to sustain the broad knowledge base provided by this
from Safer HealthCare NOW!, the Canadian Patient foundational “fundamentals” text; however, the depth and
Safety Institute, and Accreditation Canada have been inte- specificity of certain topics were updated and augmented
grated into relevant chapters. where required throughout the text.
●● Emphasis on continuity of care—To ensure that continu- ●● ENHANCED images and photos—Over 50 new colour
ity of care and home care considerations are addressed we photos have been added, mostly in the Skill boxes, to
have featured “Continuity of Care” segments in relevant enhance clarity and ensure that the most up-to-date equip-
chapters. ment appears.
●● Inclusion of Strength-Based Nursing model (Gottlieb,
2013) as a way to address patient care as well as nursing
leadership.

xvi Preface
Resources and Supplements

Student Resources CPRNE and NCLEX style. TestGen also allows for the
administration of tests on a local area network, to have the
Clinical Reference Cards
tests graded electronically, and to have the results prepared in
Each copy of the book is accompanied by a series of Clinical electronic or printed form.
Reference Cards, which are intended to serve as a handy refer-
PowerPoint Slides illuminate and build upon key concepts in
ence when engaged in clinical work. The contents include brief
the text.
summaries of such topics as the normal ranges of vital signs for
An Image Library provides electronic files of all the fig-
various age groups, common laboratory values, the Glasgow
ures, photos, and tables in the book.
Coma Scale, and the “10 Rights” of medication administration.
Online Resources Learning Catalytics
MyNursingLab Learning Catalytics is a “bring your own device” assessment

and classroom activity system that expands the possibilities
for student engagement. Using Learning Catalytics, you can
A revised MyNursingLab accompanies the new edition
deliver a wide range of auto-gradable or open-ended questions
of the text. MyNursingLab features a wealth of self-study
that test content knowledge and build critical thinking skills.
material and practice questions, including NCLEX-style quiz-
You can also manage student interactions by using
zes. Additional resources, such as Procedure Reviews and
Learning Catalytics to automatically group students for dis-
Skills Checklists, have been thoroughly reviewed and updated
cussion, teamwork, and peer-to-peer learning. Throughout
for the new edition.
the course, Learning Catalytics complements your instruction
by capturing student feedback and offering a range of data to
assess student understanding.
Instructor Resources Over 200 Canadian NCLEX-style questions are currently
The following instructor supplements are available for down- available through Learning Catalytics, including selected end-
load from a password protected section of Pearson’s online of-chapter questions from the new edition of Fundamentals of
catalogue: catalogue.pearsoned.ca. Navigate to your book’s Canadian Nursing.
catalogue page to view the complete list of available supple-
ments. See your local sales representative for details and
access. Learning Solutions Managers
The Instructor’s Manual includes lecture outlines and
Pearson’s Learning Solutions Managers work with faculty and
additional material to help instructors design effective classes
campus course designers to ensure that Pearson technology
for their students. The Instructor’s Manual includes unique
products, assessment tools, and online course materials are
Classroom and Clinical Activities geared towards students in
tailored to meet your specific needs. This highly qualified team
both degree (BScN) and diploma (PN) programs.
is dedicated to helping schools take full advantage of a wide
A Testbank is available in both Word and TestGen for-
range of educational resources, by assisting in the integration
mats. Pearson’s TestGen computerized Testbank is a powerful
of a variety of instructional materials and media formats.
program that enables instructors to view and edit existing
Your local Pearson Education sales representative can provide
questions, create new questions, and generate quizzes, tests,
you with more details on this service program.
examinations, or homework by searching and selecting ques-
tions in each chapter by a number of attributes including

Preface xvii
Acknowledgments
We wish to extend our sincere thanks to the many talented and ●● The two people who revised the end-of-chapter test ques-
committed people involved in the development of this fourth tions to make them NCLEX compliant: Joanne Jones,
edition. We are especially grateful to: Thompson Rivers University; and Elizabeth Brownlee,
●● The students and colleagues who provided valuable sug-
Northern College of Applied Arts and Technology.
gestions for developing this edition, in particular users who ●● The expert guidance and ongoing support from the editor-
alerted us to new practices or region-specific variations in ial and production teams at Pearson Canada: Kimberley
practice. Veevers, Daniella Balabuk, John Polanszky, Jessica Mifsud,
●● The Canadian contributors, who worked diligently to pro-
Avinash Chandra, Rohini Herbert, and many others who
vide content in their areas of expertise. worked scrupulously behind the scenes to help realize this
project.
●● The Canadian reviewers, who provided critical appraisal to
strengthen this text (listed on pages xviii). Madeleine Buck
●● The editors and contributors of the U.S. tenth edition for
Linda Ferguson
setting high standards for the book.

Canadian Reviewers
Catherine Linner Christine Castagne Ken Kustiak
St Clair College Memorial University of Grant MacEwan
Newfoundland
Manon Lemonde Jane Tyerman
University of Ontario Institute of Jacquie Bouchard Trent University
Technology Northern Lakes College
Paula Crawford
Katharine Hungerford Sharon Cassar George Brown
Lambton College Seneca College
Sandy Madorin
Joanne Gullison Crystal O’Connell-Schauerte Georgian College
New Brunswick Community Algonquin College
Amy Horton
College
Deborah Van Wyck Western University
Chris Sanders Dawson College
Monica Gola
Western University
Mary Anne Vanos York University
Shari Cherney Sheridan College
Diane Browman
George Brown College
Sharon Chin John Abbott College
Gail Orr Nipissing University
Kimberly Morency
Loyalist College
Margaret Verkuyl University of Manitoba
Heidi Holmes Centennial College
Dawn Inman-Flynn
Conestoga College
Nancy Flemming University of Prince Edward Island
Dwayne Pettyjohn Confederation College
Andrea Leatherdale
Camosun College
Jackie Bishop Centennial College
Karla Wolsky Centennial College
Lethbridge College

1
UNIT 1
Chapter The Foundation of

Nursing in Canada
Historical and
Contemporary
Nursing Practice*
Updated by
Lynnette Leeseberg Stamler, PhD, RN, FAAN
Professor and Associate Dean for Academic Programs
College of Nursing, University of Nebraska Medical Center
N
LEARNING OUTCOMES
After studying this chapter, you will be able to urses have traditionally
1. Discuss the range of people who provided nursing care in different composed the largest por-
periods in Canadian history. tion of health care workers
2. Compare different settings in which nursing care has been in Canada. As such, they have enabled
provided by Canadian nurses. and participated in shaping the Canadian
3. Explain the usefulness of nursing history for understanding current health care system and have made a sig-
practice issues. nificant impact on the health of individu-
4. Analyze the influence of changing social, political, and economic als, families, and communities. Although
conditions over time. public surveys identify nurses as the most
5. Describe the scope and standards of nursing practice. trusted of health care providers, gloomy
forecasts of massive nursing shortfalls
6. Outline the expanded nursing career goals and their functions.
persist. Nurses perceive their work as
7. Examine the criteria of a profession and the professionalization
being undervalued, while others deem
of nursing.
it too expensive in the face of persistent
8. Explain the functions of national and international nurses’
cost-cutting measures and concerns over
associations.
the viability of government-supported
health care and medical care. At the same
time, nurses struggle to articulate what
they actually do (Nelson & Gordon, 2006).
Nursing policymakers, educators, and
union leaders are challenged with defin-
ing and defending a unique role for nurses
among other health care professionals
and within a rapidly changing health care
*The author acknowledges the work of Drs. Jayne Elliott and Cynthia Toman in the
historical section. system (Villeneuve & MacDonald, 2006).
M01_KOZI2703_04_SE_C01.indd 1 17/03/17 10:37 AM

2 UNIT ONE The Foundation of Nursing in Canada
Historical Nursing Practice with other female workers. Analyzing nurses as agents
of the state allows us to ask in what ways they did (and
do) enable and influence larger social, political, and
In the past, Canadian nurses were on the front lines economic agendas through their participation in systems
during cholera, influenza, and polio epidemics, as they of health care. Knowledge of how nursing developed in
were for more recent outbreaks of contagious diseases, specific contexts or sets of circumstances permits nurses
such as the severe acute respiratory syndrome (SARS) to better understand their present situation and, particu-
outbreak in 2003 (MacDougall, 2007). They served in larly, to see how contemporary concerns might relate to
military medical units during the South African War, larger social-structural conditions.
World Wars I and II, the Korean War, and the Gulf War, Before the establishment of training schools in
leaving a rich heritage for Canadian nurses who continue Canada, women provided most of the nursing care either
to play important roles in international conflicts. Nurses for family members and acquaintances or for strangers in
and their work were critical to the rapid expansion in their communities. Some took on these roles as charitable
the number and size of hospitals, and nurses continue acts of kindness; others, self-identifying as nurses in the
to facilitate the spread and acceptance of medical tech- pretraining era, developed midwifery practices or hired
nology both within and outside hospitals. Since the late themselves out as “monthly” nurses to care for women in
nineteenth century, public health nurses have provided their homes for a month after childbirth (Young, 2004).
essential health and medical care to isolated populations First Nations women provided much-needed help to new,
in both rural and urban centres, a legacy taken up by white settler societies as they spread across the frontier—
street nurses caring for people on new frontiers. a history too long ignored because the skilled medical
As these situations suggest, nursing takes place within care provided by these women, particularly in midwifery
broad cultural, sociopolitical, and economic contexts and childhood diseases, was critical to the very survival
that also influence both its practitioners and its prac- of these new communities. Women who were members
tice. Nursing evolved similarly in most Western nations, of religious groups were also early skilled caregivers, dat-
partially shaped by societal events and such changes as ing back to the first group of European nuns who arrived
industrialization, urbanization, wars, cycles of economic in 1639 in what is now Quebec, with a mission to provide
depression and expansion, and the women’s movement. care for the bodies and souls of both settlers and native
Developments in scientific and technological knowledge inhabitants. These women cared for the sick and desti-
and the consolidation of Western medicine have changed tute where they landed (see figure 1.1) but many soon
conceptualizations of health and illness, as well as the followed the new immigrants west and founded hospitals,
meanings associated with them. Historical research con- some of which have survived into the present.
tributes to nursing knowledge in two main ways: (a) It
develops in-depth analyses of these complex relation-
ships, and (b) it creates enhanced understandings of the
past that inform both present and future situations.
Early historians of nursing focused primarily on
Hôtel Dieu, Quebec. From Gibbon, J., Mathewson, M. (1947). Three Centuries of Canadian
questions about professionalization, education, and lead-
ership, tending to see their history as a steady march of
progress through time. Although indebted to these writ-
ers who have preserved vast amounts of source material,
historians since the 1980s have examined the profes-
sion more critically—paying closer attention to issues
that complicate and add greater complexity to their
analyses. It is important, for example, to understand
who was considered a “nurse” and what nursing work
encompassed in a particular historical period. Answers
Nursing. Toronto: Macmillan Co. of Canada
to these questions are contingent on who was available

to work as a nurse, what status or value society attributed
to nurses’ (and women’s) work, and how nurses were
compensated for that work within a specific timeframe.
Inclusion of gender, race, ethnicity, and class in histori-
cal analyses raises important questions about the social
arrangements and relationships of power that shaped
who was included or excluded as a nurse. Although, for
the most part, nurses have worked as subordinates within
health care systems, they often held positions of privi- FIGURE 1.1 Arrival of the first three Augustinian sisters in
lege, increased social status, and respect in comparison Quebec, 1639.
M01_KOZI2703_04_SE_C01.indd 2 27/02/17 10:37 AM

Chapter 1 Historical and Contemporary Nursing Practice 3
Library and Archives Canada

FIGURE 1.2 Nuns at prayer, along with their patients, at an early Hotel Dieu hospital.
By the late nineteenth century, immigration, grow- Revolution in Quebec during the 1960s, in reaction
ing urbanization, and changing concepts around the to the hegemony of the church over French-Canadian
transmission and treatment of diseases contributed to society, brought in a period of rapid secularization with
the push for formally trained nurses. Early Canadian closer government control over institutions, eroding the
towns and cities were plagued by inadequate sanitation nuns’ authority within their institutions and shifting
and sewage systems. Waves of infectious diseases, such nursing education into the public sphere (Charles, 2003;
as typhus, influenza, and smallpox, regularly devastated Paul, 2005; Violette, 2005) (Figure 1.2). Both systems
both immigrant and native populations (Cassel, 1994). built on religious and cultural ideals of respectable femi-
Wealthy patrons initially established hospitals during the ninity that integrated contemporary ideas about scien-
late nineteenth century as philanthropic institutions that tific thinking with womanly, selfless devotion to duty and
served the increasingly visible “sick poor.” Measures to service.
improve and protect the delivery of food and water sup- The first official training school was established
plies, a gradual acceptance of germ theory in disease in St. Catharines, Ontario, in 1874 by Dr. Theophilus
transmission, and the availability of anesthesia all helped Mack. Over the next decades, the number of nurses
to increase confidence in the idea of scientific medi- rose dramatically from only 300 at the turn of the
cine. Although cures for many illnesses often lagged far twentieth century to 20 000 by the end of World War I
behind identification of causes, perceptions of increased (McPherson, 1996). Student nurses formed the major
therapeutic efficacy predisposed the better-off classes portion of the hospital workforce until the 1940s, with
to choose care in medical institutions over treatments the expectation that they would become self-employed
(including surgeries) in their homes. Hospital adminis- as private duty nurses outside the hospital on graduation.
trators increasingly relied on these paying patients to The apprenticeship training system was the predominant
offset the costs of caring for the poor (Gagan & Gagan, model of nursing education in both large and small
2002). Significantly, the advent of trained nurses lent hospitals across the country until the 1970s. Several
both efficiency and respectability to this shift toward universities did offer combined programs whereby it was
hospital care. possible to earn a degree in nursing, such as the first
Two main influences have shaped formally pre- degree program established at the University of British
pared nursing in Canada. The British system, associ- Columbia in 1919.The focus of these programs was
ated primarily with Florence Nightingale during the often on preparing nurses to be supervisors, educators,
mid-nineteenth century, has attracted the most historical and public health nurses.
attention, even if her vision for an independent nurs- Nursing became one of the few respectable opportuni-
ing force complementary to, and not dependent on, ties for paid work available to women in the first half of the
hospital administration was never fully realized. French- twentieth century. The vast majority of student placements
Canadian religious communities, which also contrib- in nursing schools were reserved for young, white women
uted significantly to the development of trained nurses, whose families could afford to do without their financial
blended religious and work life to own and manage hos- contribution, at least for the duration of their training.
pitals and training schools across the country. The Quiet Two men appear in the 1899 graduating class of Victoria
M01_KOZI2703_04_SE_C01.indd 3 27/02/17 10:37 AM

Library and Archives Canada/Canadian Nurses Association fonds
©Library and Archives Canada. Reproduced with the permission of Library and Archives Canada.
FIGURE 1.3 Ottawa General Hospital graduation 1912.
General Hospital in Halifax (Nursing Education in Nova

Scotia, n.d.), but men, in general, have remained vastly
underrepresented in the ranks of an occupation strongly
tied to the concept, promoted sometimes by nurses them-
selves, that nursing is women’s work (McPherson, 1996).
Despite the Canadian Nurses Association’s official policy
of nondiscrimination, in place since the 1940s, few black FIGURE 1.4 Aboriginal nurse with a patient at Blood Hospital,
nurses gained entrance to training programs until the Cardston, Alberta.
1970s (McPherson, 1996). In British Columbia, a few
nursing students of Asian background were admitted dur-
ing the late 1930s for the explicit purpose of nursing Poor health status (and subsequent rejection) of wartime
among their own ethnic communities. And in 1954, Jean recruits because of preventable and treatable illnesses
Cuthand Goodwill became the first Aboriginal woman in contracted in childhood, the devastating impact of the
Saskatchewan to graduate from nursing school, but again, influenza epidemic (1917–1918), and a high rate of tuber-
not until the 1970s was a concerted effort made to recruit culosis and venereal diseases among returning World War I
First Nations and Inuit students into nursing (McBain, soldiers in 1918 fuelled demands for increased government
2005) (see Figures 1.3 and 1.4). responsibility in matters of health. Specially trained nurses
Various professionalization movements throughout were dispersed into schools and homes across Canada,
the twentieth century also intensified debates over who in both urban and rural districts. Nurses, as women, met
was, or could become, a nurse. In the early decades, nurs- gendered expectations that they were the ideal people to
ing leaders attempted to distance skilled nursing work from bring the new “gospel of good health” to mothers and
domestic caregiving and midwifery. Following a success- their families. By helping to spread new scientific theories
ful campaign by physicians to gain control over medical of health, including those on social and mental hygiene,
practice, nurses sought to establish control over nursing nurses were responsible for Canadianizing new immigrants
through the standardization of educational curricula and through the promotion of white, middle-class, urban-based
the legal authority to credential graduates of recognized ideals of health, which they found that their clients some-
hospital-based training programs. Most provinces brought times could not, or would not, meet.
in nurse registration between 1910 and 1922, thus sepa- The Victorian Order of Nurses was founded in
rating trained nurses from others who used the title nurse 1897, but other organizations, such as the Margaret Scott
(Mansell, 2003). Newfoundland and Labrador nurses Nursing Mission in Winnipeg, the Alberta District Nursing
obtained registration in 1954, Northwest Territories nurses Service, the Newfoundland Outport Nursing and Industrial
in 1975, and Yukon nurses in 1992. Association (NONIA), and the Medical Service to Settlers
During the first half of the twentieth century, most in Quebec, emerged to meet these public health needs.
nurses worked in private duty after graduation, but chang- Several provincial divisions of the Canadian Red Cross
ing concepts in public health provided other opportunities. Society began outpost programs in isolated parts of their
Women’s groups were instrumental in pushing for reform, territories (Elliott, 2004; McKay, 2007; Penney, 1996;
particularly in maternal and child health, and initiated many Richardson, 1998; Rousseau & Daigle, 2000). The federal
services that provincial health authorities later took over. health department did not regularly supply nursing stations
M01_KOZI2703_04_SE_C01.indd 4 27/02/17 10:37 AM

Victorian Order of Nurses Canada

FIGURE 1.5 Three patients of Victorian Order of Nurses
(VON) cared for in their own homes. The VON still provides
community and home care services across Canada.
and nurses to First Nations and Inuit populations in the War (1899–1902), but they were not officially part of
sub-Arctic and Arctic regions of the country until after the Canadian military. With the formation of the first
World War II (McPherson, 2003; Meijer-Drees & McBain, permanent nursing service as part of the Canadian
2001). Together, these nurses brought much-needed health Army Medical Corps (CAMC) in 1904, civilian nurses
care to areas underserved by physicians, and they often became fully integrated into the Canadian armed forces
found they needed to undertake such tasks as midwifery, as soldiers, enlisting as lieutenants with the specially
stitching of wounds, or teeth pulling, for which they had created officer’s rank and title of nursing sister, serving
received little training (see Figures 1.5, 1.6, 1.7, and 1.8). under the supervision of higher-ranked matrons. During
Several small groups of civilian nurses volun- 1944, Matron-in-Chief Elizabeth Smellie became the
teered with the Canadian militia during the Northwest first woman in the world to rise to the rank of a full
Rebellion (1885), with the Northwest Mounted Police
during the Klondike Gold Rush (1898), and with the
British Expeditionary Force during the South African Gibson, J., Mathewson, M. (1947). Three Centuries of Canadian Nursing.
Gibson, J., Mathewson, M. (1947). Three Centuries
of Canadian Nursing. Toronto: MacMillan
Toronto: MacMillan
FIGURE 1.6 Well-baby clinic in Manitoba. FIGURE 1.7 District nurse at Old Pendryl Cottage, Alberta.
M01_KOZI2703_04_SE_C01.indd 5 27/02/17 10:37 AM

Wilberforce Red Cross Outpost & Historic House
University of Ottawa
FIGURE 1.9 Canadian civilian nurses with the British
Expeditionary Force in South Africa (1899–1902).
FIGURE 1.8 Red Cross Nurse Gertrude Leroy Miller discharg-

ing a patient from the nursing outpost at Wilberforce, Ontario,
in the 1930s.
colonel. Initially, nursing sisters were the only women to

serve in the military, and they readily filled every avail-
able position in the Canadian armed forces throughout
both World Wars—even creating long waiting lists to get
into the military. Canadian military nurses served with
the North Atlantic Treaty Organization (NATO) forces
in Europe during the 1950s and with the Allied Forces
during the Korean War (1950–1953), as well as with
peacekeeping forces during the 1990s and beyond.
At least 3141 nursing sisters served during World
War I and 4079 during World War II. They called them-
selves soldiers and understood their work as winning the
FIGURE 1.10 World War I Nursing Sister Mabel Lucas
war through the salvage of damaged men. They actively Rutherford (left) and three colleagues in their dress uniforms.
sought opportunities to move closer to the front lines,
readily accepting increased risk and danger as part of
the job. In both wars, some died as a result of enemy
action and military-related illnesses and accidents; two
were prisoners of war under the Japanese army in Hong
Kong for almost 2 years during World War II; others
were torpedoed, bombed, or strafed—and survived to
talk about the experiences. Some of them left personal
accounts of these experiences; some questioned the
contradictory values of caring and saving lives while
working in organizations designed for the destruction
of lives. The armed forces placed high value on the
knowledge and skills of nurses, reluctantly moving them
forward as they demonstrated better outcomes for the
soldiers under their care than less-trained personnel

could achieve. The military was adamant, however, that
nurses were temporary—only for the duration of the
war, regardless of what nurses preferred with regard to
their military careers (Toman, 2007) (see Figures 1.9, FIGURE 1.11 World War II Nursing Sister Dorothy Macham
1.10, and 1.11). attending to a wounded soldier.
M01_KOZI2703_04_SE_C01.indd 6 27/02/17 10:37 AM

During the 1930s, the private duty market for nurses

shrank because of both an oversupply of graduate nurses Contemporary Nursing
and the widespread economic depression that left at least
30% of the Canadian population unemployed. A boom
Practice
in hospital construction and the growing use of medical
An in-depth study of contemporary nursing practice
technologies, among other factors, increased the need for
includes a look at selected definitions of nursing, a frame-
nurses again, precipitating a nursing shortage that contin-
work for the Canadian health system, the goals of the
ued into the 1970s. The nursing leadership campaigned
nurse within this system, the acts that legislate health
to move nurses’ training into educational institutions and
care and nursing practice, and the scope and standards
gradually weaned hospital administrators from depending
of practice. This chapter will concentrate on definitions
on student labour, opening up further employment oppor-
and the goals and roles of nursing. Currently, four legis-
tunities for graduate nurses within hospitals. Although
lated categories of nursing exist in Canada: (a) Licensed
hospitals soon became the preferred employer for nurses,
(Registered) Practical Nurses, (b) Registered Nurses, (c)
the shortage was so great that hospitals had to make sub-
Registered Psychiatric Nurses, and (d) Nurse Practitioners
stantial changes in the workplace to attract new students
(Extended Class). Each has a scope of practice legislated
for training and married nurses back into the workforce.
within a province or territory. For the Canadian health
Due to nursing shortages, Nursing Assistants (CNAs) were
care system, see Chapter 9, and for legal issues, see
created to assist RNs in hospitals.
Chapter 6.
Changes in medical and surgical therapeutics were
central forces in defining the nature and scope of nursing
practices. By accepting delegated medical tasks, nurses
have been instrumental in facilitating the spread and Definitions of Nursing
acceptance of many technologies that range from ther- To understand what nursing is, we must first define the
mometers in the early twentieth century, through routine word. Many definitions exist, some of which misrepresent
blood tests in the 1940s and 1950s, to the complex sys- the complex knowledge and skill of professional nursing.
tems of medical monitoring in place today (Sandelowski, Common dictionary definitions, for example, still refer to
2000; Toman, 2001). An increasingly specialized nursing the nurse as “a person, usually a woman, trained to care
workforce has resulted in a hierarchical relationship for the sick” (Cayne, 1988). Today, however, many men
among nurses and between nurses and lesser-skilled aux- are choosing to become nurses, and nurses also provide
iliary workers, whose positions emerged initially to help preventive and health-promoting care to well clients.
address the shortage of trained nurses. This section provides several definitions of nursing, and
Each of these issues lies within a body of histori- Chapter 4 provides other definitions created by nursing
cal research that offers alternative perspectives through theorists.
which we can question who and what is determining In 1860, Florence Nightingale described nursing as
today’s nursing practice. On the one hand, the wider the “use of fresh air, light, warmth, cleanliness, quiet
socioeconomic and political milieu has shaped nurses and the proper selection and administration of diet”
and their work; on the other hand, nurses have partici- (Nightingale, 1938, p. 8). She considered a clean, well-
pated in shaping the health care system and the role of ventilated, and quiet environment essential for recovery
nursing within it. Curiosity about the roots of the nursing from illnesses. Often considered the first nurse theorist,
profession has merit in itself, but many would argue that Nightingale raised the status of nursing through educa-
the value of nursing history lies in its relevance to cur- tion. Nurses were no longer untrained housekeepers but
rent issues in professional practice. Much more research persons educated in the care of the sick.
is needed, for example, on the history of registered Virginia Henderson was one of the first modern
psychiatric nursing programs and how the baccalaureate nurses to define nursing. In 1960, she wrote: “The unique
degree as entry to practice has affected perceptions of function of the nurse is to assist the individual, sick or
nursing work among nurses themselves and the wider well, in the performance of those activities contributing
society. Hospital-based training and work environments to health or its recovery (or to peaceful death) that he
tried to standardize nurses, nurses’ knowledge, and nurs- would perform unaided if he had the necessary strength,
ing care, creating the illusion of a homogeneous nurs- will, or knowledge, and to do this in such a way as to
ing workforce while devaluing the vast diversity among help him gain independence as rapidly as possible”
people performing nursing work. A more critical analysis (Henderson, 1966, p. 3). Like Nightingale, Henderson
of the roles of gender, class, race, and ethnicity, and the described nursing in relation to the client and the client’s
way these factors have worked to include or exclude environment. Unlike Nightingale, Henderson saw the
those wanting to enter the profession, is necessary to nurse as concerned with both well and ill individuals,
understand who became nurses in Canada and how acknowledged that nurses interact with clients even when
these influences still shape who become nurses in today’s recovery may not be feasible, and mentioned the teach-
multicultural health care context. ing and advocacy roles of the nurse.
M01_KOZI2703_04_SE_C01.indd 7 27/02/17 10:37 AM

Professional nursing associations have also examined Recipients of Nursing

nursing and developed their definitions of it. In 1987,
the Canadian Nurses Association (CNA) described nurs- Nurses work with many and varied recipients of care.
ing practice as a dynamic, caring, helping relationship in The recipients can be individuals, families, groups, com-
which the nurse helps the client to achieve and maintain munities, and populations. Even when planning and
optimal health (CNA, 1987). Many countries have cho- implementing care to various recipients, it is important
sen to use the International Council of Nurses (2015) for the nurse to recognize that these recipients live within
definition: a larger society—for instance, individuals are connected
to families, groups live in the community, and multiple
Nursing encompasses autonomous and collab- communities exist within a given population. Groups are
orative care of individuals of all ages, families, collections of individuals with a shared goal or purpose,
groups and communities, sick or well and in and communities may be defined by geography, culture,
all settings. Nursing includes the promotion of or other characteristics.
health, prevention of illness, and the care of ill, In this book, we have generally identified the recipi-
disabled, and dying people. Advocacy, promotion ent of care as the individual (see Chapter 12). We have,
of a safe environment, research, participation in however, also provided some beginning information on
shaping health policy and in patient and health families and working with families in providing nursing
systems management, and education are also key care (see Chapter 13). When referring to individuals who
nursing roles (ICN, 2015b). are receiving nursing care, the literature refers to them
as consumers, patients, residents, or clients and by other
In the latter half of the twentieth century, a number terms. A consumer is an individual, a group of people,
of nurse theorists developed their own theoretical defini- or a community that uses a service or commodity. People
tions of nursing. Theoretical definitions are important who use health care products or services are consumers
because they go beyond simplistic common definitions. of health care.
They describe what nursing is and the interrelationship A patient is a person who is waiting for or undergo-
among nurses, nursing, the environment, the client, and ing medical treatment and care. The word patient comes
the intended client outcome—health. See Chapters 4 from a Latin word meaning “to suffer” or “to bear.”
and 23. Several themes are common to all the various Traditionally, the person receiving health care has been
definitions of nursing (see Box 1.1). called a patient. Usually, people become patients when
Caring is described as the “essence of nursing” they seek assistance because of illness or for surgery.
(Leininger, 1984). It is a complex concept that has mul- Some nurses believe that the word patient implies pas-
tiple aspects: affective, cognitive, and ethical. Research sive acceptance of the decisions and care of health care
to explore the meaning of caring in nursing has been professionals. Additionally, with the emphasis on health
increasing because nursing, more than any other profes- promotion and prevention of illness, many recipients of
sion, has “the distinction of being responsible for the nursing care are not ill persons. Moreover, in addition
caring that clients receive in the health care system” to caring for patients, nurses interact with family mem-
(Miller, 1995, p. 29). Details about caring are discussed in bers and significant others to provide support, informa-
Chapter 22. See also Watson’s assumptions of caring in tion, and comfort. See Evidence-Informed Practice for a
Box 4.2 in Chapter 4 (see page 59). recent study with patients in a hospital setting.
For the reasons mentioned above, nurses also refer
to recipients of health care as clients. A client is a person
who engages the advice or services of another who is
BOX 1.1 THEMES COMMON TO DEFINITIONS qualified to provide this service. The term client presents
Although several different definitions of nursing have the receivers of health care as collaborators in the care,
been made over the years, they do share some that is, as people who are also responsible for their own
common themes: health. Thus, the health status of a client is the respon-
• Nursing is caring. sibility of the individual that is met in collaboration with
• Nursing is an art. health care professionals. In this book, we have generally
used the term patient to describe the individual admitted
• Nursing is a science.
to an acute care facility or otherwise seeking care, the
• Nursing is client centred.
term resident for an individual cared for in a long-term
• Nursing is holistic. care facility, and the term client to describe recipients of
• Nursing is adaptive. nursing care in other settings. The topics discussed in
• Nursing is concerned with health promotion, health this book are often equally applicable to clients, patients,
maintenance, and health restoration. and residents. When this is the case, readers may see ref-
• Nursing is a helping profession. erences to more than one recipient of care in the same
paragraph.
M01_KOZI2703_04_SE_C01.indd 8 02/03/17 1:01 PM

include immunizations, prenatal and infant care, and pre-

EVIDENCE-INFORMED vention of sexually transmitted infections.
PRACTICE RESTORING HEALTH Restoring health focuses on the
Pain experienced by patients has long been studied, but ill client, and it extends from early detection of disease
no clear consensus has been reached on the results of the through helping the client during the recovery period.
studies or the proposed strategies. In this study, all eligible Examples of nursing activities focused on restoring health
patients in the clinical areas of cardiology, medicine, and include the following:
surgery in 12 hospital units were visited within a 4-hour
period to assess their pain experience. Of the 65% who • Providing direct care to the ill person, such as adminis-
responded, 70.4% indicated they had pain at that time. tering medications, baths, and specific procedures and
Although the duration, anatomic location, and severity of treatments
pain varied across the patients, almost all (92%) indicated
that hospital staff had assessed their pain within the previ- • Performing diagnostic and assessment procedures, such
ous 8 hours. Gender and age differences were noted in the as measuring blood pressure and examining feces for
responses. The study patients also indicated that their pain occult blood
interfered with their activities, to varying degrees. Although • Consulting and working collaboratively with other
this study did not consider the problem of memory in that
health care professionals about client problems
it only asked for the pain experience “right now,” it is clear
that pain remains a multifactorial experience that is difficult • Teaching clients about recovery activities, such as exer-
to describe and treat. cises that will accelerate recovery after a cerebrovascular
CLINICAL IMPLICATIONS: Health care organizations accident (stroke)
that desire to create a culture where pain assessment • Rehabilitating clients to their optimal functional level
and treatment are expected and valued will need to following physical or mental illness, injury, or chemical
first acknowledge that pain is a real issue for many addiction
patients.
CARING FOR THE DYING This area of nursing practice
Source: Jabusch, K. M., Lewthwaite, B. J., Mandzuk, L. L., Schnell-Hoehn, K. N.,
& Wheeler, B. J. (2015). The pain experience of inpatients in a teaching hospital: involves comforting and caring for people of all ages who
Revisiting a strategic priority. Pain Management Nursing, 16(1), 69–76. are dying. It includes helping clients be as comfortable as
possible until death and helping the support people cope
with death. Nurses carrying out these activities work in
homes, hospitals, and extended care facilities. Some agen-
cies, called hospices, are specifically designed for this purpose.
Scope of Nursing See Chapter 48 for further discussion.
Nursing practice involves four areas: (a) promoting health
and wellness, (b) preventing illness, (c) restoring health, and
(d) caring for the dying. Within each of these areas, nurses
Nursing Numbers and Settings
seek to articulate and follow best practices in terms of the Canada has four categories of regulated nurses: (a) reg-
care they provide. Various chapters of this book relate to istered nurses (RNs), (b) licensed (registered) practi-
each of the areas of nursing practice. The Registered Nurses’ cal nurses (LPNs/RPNs), (c) Nurse Practitioners (NPs),
Association of Ontario has led the way in developing a (d) registered psychiatric nurses (RPNs) (see Box 1.2 for
series of best practices documents (see the Weblinks section definitions of each category of regulated nurses). The
in this chapter). Reference to appropriate best practices docu- Canadian Institute for Health Information reported that
ments can be found in the chapters throughout the book. Canada had a supply of 415 864 regulated nurses in
2015. Of these, RNs numbered 296 731 practical nurses
PROMOTING HEALTH AND WELLNESS “Wellness is a
113 367 and psychiatric nurses 5766. The RN num-
process that engages people in activities and behaviors that
bers include 4353 nurse practitioners (NPs) (Canadian
enhance quality of life and maximize personal potential”
Institute for Health Information [CIHI], 2016). The
(Anspaugh, Hamrick, & Rosata, 2003, p. 490). Nurses pro-
acute care hospital remains the primary practice set-
mote wellness in clients who are healthy as well as those
ting. In 2014, approximately 63.3% of RNs, 47.2% of
who are ill. This promotion may involve individual and
LPNs/RPNs, and 38.8% of NPs worked in hospitals.
community activities to enhance healthy lifestyles, such as
The remainder worked in clients’ homes; community
improving nutrition and physical fitness, preventing prob-
agencies, including long-term care facilities; ambulatory
lematic drug and alcohol use, smoking cessation, and pre-
clinics; and nursing practice centres (CIHI, 2016). The
venting accidents and injury in the home and workplace.
CIHI also noted that the supply of RNs declined by 1%
See Chapters 8 and 14 for further discussion.
in 2014 but increased by 1.2% in 2015; the numbers of
PREVENTING ILLNESS The goal of illness-prevention LPNs and RPNs had slower growth. In addition, per-
programs is to maintain optimal health by preventing haps as a function of the aging of the “baby boomer”
disease. Examples of nursing activities that prevent illness generation, fewer (30 897) new nurses registered for the
M01_KOZI2703_04_SE_C01.indd 9 02/03/17 9:35 AM

BOX 1.2 DEFINITIONS AND ROLES first time, compared with those who allowed their reg-
istration to lapse (22 534). This pattern may has strong
OF CATEGORIES OF NURSES
significance for future health care delivery in Canada.
Registered nurses (RNs, including NPs) work both autono- Figure 1.12 shows nurses in a variety of settings.
mously and in collaboration with other health care providers Nurses have different degrees of nursing autonomy
to coordinate health care, deliver direct services, and sup- and nursing responsibility in the various settings. They
port clients in their self-care decisions and actions in health,
may provide direct care, engage in health teaching for
illness, injury, and disability in all stages of life. RNs are cur-
diverse individuals and groups, serve as nursing advo-
rently regulated in all 10 provinces and three territories.
Nurse practitioners (NPs) are RNs with additional edu- cates and agents of change, and help determine health
cational preparation and experience. NPs may order and policies affecting consumers in the community and in
interpret diagnostic tests; prescribe pharmaceuticals, medi- hospitals.
cal devices, and other therapies; and perform procedures. The CNA maintains that an individual’s health
NPs are currently regulated in all 10 provinces and three affects the quality of that person’s life. Health is influ-
territories. enced not only by the health care system but also by
Registered psychiatric nurses (RPNs) work both autono- human biology, lifestyle choices, and the environment.
mously and in collaboration with clients and other health With this in mind, the CNA advocates a framework to
care team members to coordinate health care and provide provide direction for the Canadian health care system
client-centred services to individuals, families, groups,
that includes (a) the conditions of the Canada Health Act
and communities. RPNs focus on mental and develop-
and (b) the principles of primary health care.
mental health, mental illness, and addictions while inte-
grating physical health into their care. RPNs are currently The Canada Health Act (1984) lists the conditions
and recognized in the four western provinces (Manitoba, or national standards that provincial and territorial
Saskatchewan, Alberta, and British Columbia) and the terri- health insurance plans must respect to be able to receive
tory of Yukon. federal cash contributions: public administration, acces-
Licensed practical nurses (LPNs) work independently sibility, comprehensiveness, universality, and portability.
or in collaboration with other members of a health care The CNA believes that these conditions are essential to
team. LPNs assess clients and work in health promotion Canada’s health care system.
and illness prevention. They assess, plan, implement, and
evaluate care for clients. LPNs are currently regulated in all 1. Public administration means that federal, provincial, and
10 provinces and three territories. territorial health insurance programs should be non-
profit programs operated by public authorities who are
Source: Excerpt from Regulated Nurses: 2014. Copyright © by Canadian Institute for
Health Information. Used by permission of Canadian Institute for Health Information. appointed by government.
© Elena Dorfman/Addison Wesley/Pearson Education, Inc.
FIGURE 1.12 Nurses practise in a

variety of settings. Clockwise from
left: Pediatric nursing, operating
room nursing, geriatric nursing, home
nursing, and community nursing.
M01_KOZI2703_04_SE_C01.indd 10 27/02/17 4:38 PM

Another random document with
no related content on Scribd:
do not want to be rude and I certainly shall be if she involves me in these
feminist arguments.”
“I don’t believe Margaret would argue with you, Gage.” She said it
lightly, her insinuation that he was beyond the pale of argument flicking
him with a little sting.
“Possibly not. However, I should not care to waste her time. And as I
said to you to-night I don’t like her effect on you.”
“I am not particularly under her influence, Gage. I have my own ideas.
What you probably mean is that you object to my doing the things which
are interesting women all over the world.”
“When have I ever objected to anything you’ve done?”
“I’ve done nothing, have I? Been secretary to a few small town clubs.
Kept house. Tended my babies. That’s all I’ve done except play the piano.”
“Did that dissatisfy you as much as your tone implies?”
“It’s not enough to satisfy women now.”
He shrugged.
“Well—do anything you please, my dear. I certainly won’t stop you if
you run for office.”
She was very cold.
“You’re sneering at me, Gage.”
He tossed away his cigarette and came up to her where she stood, still
muffled in the cloak she had worn. She was fast in his embrace and it gave
her the moment of relief she had sought. She closed her eyes and lay
relaxed against his shoulder. And then came the creeping little fear. He had
managed her like that. He couldn’t respect her.
“Darling Helen—”
Her thought spoke.
“Margaret would never have let herself go off the point like this—”
“Oh, damn Margaret!” said Gage, letting her go, angrily.
Helen looked at him in disgust and went upstairs.
It wasn’t, thought Gage, pacing up and down the living room, as if he

were a reactionary. Helen knew that. He had no objection to women doing
anything. He’d said so. He’d shown it. He’d put women on his local
Republican committee. And sized them up pretty well too, he told himself.
They worked well enough on certain things. Some of them had good minds.
But the issue with him and Helen had nothing to do with granting women a
concession here and there. That was all right. The trouble was with this
woman, these women who made Helen so restless, so unsettled for no
particular reason, with no particular object. He hated, as he had said, the
self-consciousness of it all. He hated this self-conscious talk, this delving
into emotions, this analysis of psychical states and actions, this setting of
sex against sex. It ate into emotions. It had made women like that Margaret.
He measured his dislike of her, bitterly. Even on their wedding trip she had
interfered. He remembered the first flagging in Helen’s abandonment to her
love for him. That letter from Margaret, outwardly kind, he felt, outwardly
all right, but suggesting things had brought it about. Helen had shown it to
him.
“She’s afraid we’ll become commonplace married people,” she said,
“but we won’t, will we?”
There, at the start, it had begun. Discussion when there should have been
no discussion—feelings pried into. How he hated college women. It should
be prohibited somehow—these girls getting together and talking about
things. Forming these alliances. All along the line, for six years, and this
was the first time he’d even met her, this Margaret had been held up to him.
Margaret’s letters had come and with each of them would sweep over Helen
that fear that she was becoming dull—sliding backward—those little
reactions against him—those pull-backs. At the time Bennett was born the
same thing had happened. First the natural beauty, then that fear of being
swept under by “domesticity.” The way they used the word as if it were a
shame, a disgrace. He felt he had never told Helen the half he felt about
these things. And now that rotten oath had put him in the wrong. He’d have
to apologize. He’d have to begin with an apology and there he would be put
in the entire wrong again. It wasn’t as if women didn’t have to be handled
like children anyhow. They did. What could you do with them when they
got into moods except coax them out of it? There was Helen upstairs now,
probably hating him—wishing she were free—envying that spinster friend
of hers.
His thoughts took a sudden turn. She couldn’t quite wish that. Surely she
didn’t want not to be married to him. She’d never said anything like that.
He didn’t really think she had ever for a minute wished it. She was crazy
about Bennett and Peggy. She loved him too.
On that thought he went upstairs, his apology on his lips, his mind
tangled, but his need of peace with Helen very great.
CHAPTER II
FREDA
F REDA met her father on the street three blocks from home. She saw him
coming, laden as usual with books, a package of papers from the
psychology class to correct—and the meat. The collar of his ulster was
turned up around his ears but Freda knew him even in the gathering
twilight, a block away. There was a dependency about Eric Thorstad’s
figure—about the meat—that was part of her life.
“Liver or veal?” she asked gayly, taking the fat package from under his
arm.
“It’s a secret.”
“Sausage,” she said, “I can tell by the feel and the smell.”
“Aren’t you late, Freda?”
“I went to the movies.”
“Again? I wish you wouldn’t go so often. What do you get out of them?”
“Thrills, father dear.”
“All unreal.”
She skipped into a stride that matched his.
“A thrill is a shiver of romance,” she declared, “it’s never unreal.”
“And what gives the shiver? The white sheet?”
“I’m open minded. Could be a well tailored garden, Nazimova’s gown, a
murder on a mountain.”
He laughed and they went along briskly until they came to the third in a
row of small yellow frame houses, and turned in at the scrap of cement
walk which led up to the porch.
In the kitchen Mrs. Thorstad turned from the stove to kiss them both.
“How was your meeting?” asked her husband.
A kind of glow came over Adeline Thorstad’s face.
“It was a lovely meeting. I am sure that it is significant that so many
women, even women like old Mrs. Reece will come to hear a talk on their
civic responsibilities. You should have managed to come, Freda.”
Freda put an arm about her mother’s shoulders.
“I couldn’t,” she said. “I’d have spoiled the circle of thought. I don’t care
whether women vote or not.”
She was six inches taller than her mother’s neat prettiness and at first
glance not nearly so attractive. Her rather coarse hair was too thick and
pulled back into a loose low knot and her features were heavier than those
of her mother’s, her skin less delicate. The neat pyramid of her mother’s
blond hair, her smooth, fair skin were almost as they had been fifteen years
before. But Freda showed more promise for fifteen years hence. Her hair
shaded from yellow to orange red, her eyes were deep blue and her loose-
hung, badly managed figure showed a broad gracefulness that her mother’s
lacked.
She had somehow taken the little qualities of her mother’s prettiness and
made them grander, so that she seemed to have been modeled from an
imperfect idea rather than a standard type. In her father was the largeness of
build which might have accounted for her, though not too obviously for Mr.
Thorstad stooped a little and days in the classroom had drained his face of
much natural color. Still he had carried over from some ancestor a
suggestion of power which he and his daughter shared.
“Don’t talk like that, Freda. It’s so reactionary. Women nowadays—”
“I know. But I don’t especially approve of women nowadays,” teased
Freda. “I think that maybe we were a lot more interesting or delightful or
romantic as we were when we didn’t pretend to have brains.”
But her mother ignored her.
“Don’t talk nonsense,” she said. “Set the table and then I must tell you
my news.”
They were used to news from Mrs. Thorstad. She was full of the
indomitable energy that created little events and situations and exulted in
them. Victories in the intrigues of the district federated clubs, small
entanglements, intricate machinations were commonplaces to her husband
and daughter since Mrs. Thorstad had become district vice-president.
So now when the sausage, flanked by its mound of mashed potatoes,
came sizzling to the table and Freda had satisfied her soul by putting three
sprays of red marsh-berries in a dull green bowl in the middle, they looked
forward to dinner with more anticipation than to Mrs. Thorstad’s surprise.
But she began impressively, and without delay.
“I think that this entrance of women into politics may alter the whole
course of our lives.”
Freda and her father exchanged a whimsical friendly glance in which no
disrespect blended.
“No doubt,” said Mr. Thorstad.
“If I were called to public office, think what a difference it would
make!”
“What difference?” asked Freda.
“Why—there’d be more money, more chances to better ourselves.”
Her husband seemed to shrink at the cheaply aspiring phrase, then
looked at her with something like the patience of one who refuses to be
hurt.
“So now you want to be the breadwinner too, my dear?”
Perhaps she took that for jocosity. She did not answer directly.
“I met Mrs. Brownley—the Mrs. Brownley—at a meeting not long ago.
She said she thought there would be a future for me.”
“No doubt,” said her husband, again.
He gazed into the sausage platter reflectively.
Twenty years ago, he might have remembered, Adeline Miller had
thought there was a future for him. She had intended to better herself
through him. She was teaching then in a little town and he was county
superintendent. They had met and been attracted and after a little she had
condoned the fact of his Swedish name and of the two parents who spoke
no English. She had exchanged the name of Miller for Thorstad, soberly,
definitely determined to better herself and profit by the change.
Then there came Freda. Freda, who had stimulated them both as healthy
promising babies are likely to stimulate their parents. Thorstad had become
a High School instructor, then had left that position after eight years to
come as assistant to the professor of psychology in the Mohawk State
Normal School, at a slightly lower salary, but “bettering himself.” Ten years
ago, that was. He was head of his department now—at three thousand a
year. It was his natural height and he had attained it—not a prospector in his
work, but a good instructor always. It had taken much labor to have come
so far, nights of study, summers spent in boarding houses near the
University that he might get his degrees. And Adeline had gone along her
own path. During all these years in Mohawk she had been busy too. First
with little literary clubs, later with civic councils, state federations, all the
intricate machinery of woman’s clubdom.
She had her rewards. Federation meetings in the cities, little speeches
which she made with increasing skill. She had been “speaking” for a long
time now. During the war she fortified her position with volunteer speaking
for Liberty Loans, War Saving Stamps. All this in the name of “bettering
others.” All this with that guiding impulse to “better herself.”
Her husband made no demands on her time which interfered with any
public work. If it was necessary he could cook his own meals, make his
own bed, even do his own washing, and there had been times when he had
done all this for himself and Freda. Not that Mrs. Thorstad ever neglected
her family. The Family, like Democracy and the Cradle, were three strong
talking points always. She was a fair cook and a good housekeeper, a little
mechanical in her routine but always adequate. And when she was away she
always left a batch of bread and doughnuts and cookies. It was never hard
on Eric and he, unlike some men, was handy around the house. He was
handy with Freda too from the time he dressed her as a baby until now.
Now he was handy with her moods, with her incomprehensible
unwillingness to better herself by sharing in her mother’s plans.
Leaning a little toward her mother now, Freda brought the conversation
off generalities.
“But the news? We are all agog.”
“The news is that we are to have distinguished guests on Thursday. Mrs.
Brownley, Mrs. Gage Flandon, and Miss Margaret Duffield of New York
are making a tour of the country and they are to stop here for a day. I am to
arrange everything for them. There is no telling to what it may lead.”
“They’re coming here?” Freda’s tone was disgusted. “A lot of women
spellbinders. Oh, Lord, save us. I’m going camping.”
“It is a great privilege,” said her mother, with a tight little motion of her
lips. “I shall need you, Freda.”
CHAPTER III
ON THE STUMP
S T. PIERRE was the big city of the state. Around it a host of little towns,
farming, manufacturing, farther away even mining, made it their center
and paid it tribute by mail-order and otherwise. It was one of the Middle
West cities at which every big theatrical star, every big musical “attraction,”
every well booked lecturer spent at least one night. It boasted branch
establishments of exclusive New York and Chicago shops. It had its
paragraph in the marriage, birth and death section in Vogue. Altogether it
was not at all to be ignored.
Harriet Thompson had known what she was doing when she sent
Margaret Duffield West to organize the women of the St. Pierre section in
groups which could be manipulated for the Republican party.
Margaret stayed with Mrs. Brownley for a few days and then spent a
week with Helen, during which time she found a pleasant room and bath
which she leased by the month, and to which she insisted on going.
Helen’s remonstrances had no effect.
“You’re foolish to think of such a thing as my camping on you. Why I
may be here for several months. No, I couldn’t. Besides we’ll have a really
better time if we don’t have to be guesting each other. And I get a
reasonable amount for expenses which really needn’t be added on to your
grocery bill. Gage has party expense enough.”
Gage was very cordial, particularly as he saw that her visit was not to be
indefinite. It hurried him perhaps into greater gallantry than he might have
otherwise shown. He did everything to be the obliging host and to his
surprise enjoyed himself immensely. Margaret was more than a good talker.
She gave him inside talk on some things that had happened in Washington.
She could discuss politicians with him. No one spoke of the deteriorating
influences of marriage and the home on women. Margaret was delightful
with the children. She did not hint at a desire to see him psychoanalyzed.
He found himself rather more coöperative than antagonistic and on the day
of Margaret’s definite removal to her new room he was even sorry.
Helen found the new room most attractive. It was a one-room and bath
apartment, so-called, furnished rather badly but with a great deal of air and
light.
“It feels like college,” she said, sinking down on a cretonne covered
couch bed. “Atrocious furniture but so delightfully independent. What fun it
must be to feel so solidly on your own, Margaret.”
“Not always fun, but satisfying,” said Margaret, making a few passes at
straightening furniture.
Helen sighed faintly and then lost the sigh in a little laugh.
“I’m actually afraid to ask you some things,” she admitted, “I’m afraid
of what you’ll say. Would you really sooner not be married?”
“I think so. Emotional moments of course. On the whole I think I’d
rather not be.”
“But you didn’t always feel that way.”
“No—not six years ago.”
“Then was there a man you wanted?”
“There were several men. But I didn’t want them hard enough or they
didn’t want me simultaneously.”
“Where are they now?”
“God knows—quarreling with their wives, perhaps.”
“And you don’t care?”
“Truly—not a bit.” Margaret’s eyes were level and quite frank. “It’s all
dreadful nonsense, this magazine story stuff about the spinsters with their
secret yearnings covered up all the time. I’m going to do something to prick
that bubble before I die. Of course the conceit of married people is endless
but at least spinsters have a right to as much dignity as bachelors.”
“All right,” said Helen, “I’ll respect you. I know I’m going home and
that you aren’t following me with wistful eyes wishing you could caress my
babies. Is that it? You comb your hair without a qualm and go down to
dinner.”
“Exactly. Only before you go I want you to promise to go with us on this
trip to the country towns. We’ll be gone three days only. Gage can spare
you.”
“I don’t quite see what use I’d be.”
“I do. I want you to talk to them and charm them. I can organize. Mrs.
Brownley can give them Republican gospel. What I want you to do is to
give them a little of the charm of being a Republican. Borrow some of
Gage’s arguments and use your own manner in giving them and the result
will be what I want.”
“Don’t I seem rather superfluous?”
“We couldn’t do it without you. Mrs. Brownley for name—you for
charm—and I’ll do the rest of the work.”
Helen looked at her watch.
“Gage will beat me,” she declared, “I’m late for dinner again.”
II
The train bumped along for several hours. Mrs. Brownley read, her book
adjusted at a proper distance from her leveled eye-glasses. Helen and
Margaret fell into one of those interminable conversations on what was
worth while a woman’s doing. They were unexcited, but at Mohawk, Mrs.
Thorstad arrived thirty minutes early at the railroad station, with Mrs.
Watson’s car, which she had commandeered. Mrs. Watson had also offered
lunch but at the last minute her Hilda had become sick and thrown her into
such confusion that Mrs. Thorstad, brightly rising to the occasion, had taken
lunch upon herself and even now Freda was putting a pan of scalloped
potatoes into the oven and anxiously testing the baking ham.
It had fallen naturally to Mrs. Thorstad to arrange the meeting in
Mohawk, Mrs. Brownley writing her that she need not consider it a partisan
meeting, that its object was merely educative, to explain to the women what
the Republican party meant. And Mrs. Thorstad had few scruples about
using her influence to get as large a group together for the meeting as she
could. To have these three celebrities for a whole day had been a matter of
absorbing thought to her. They were to have a luncheon at her home, then to
have an afternoon meeting at the Library and a further meeting in the
evening. Mrs. Thorstad knew she could get a crowd out. She always could.
Freda had not minded getting lunch. She didn’t mind cooking, especially
when they could lay themselves out in expense as was considered proper to-
day. But she hated meeting these strange, serious-minded women. She had
looked in the glass at herself and decided several times that she was
altogether out of place. She had tried to bribe her mother into pretending
she was a servant. But that was in vain. So Freda had put on the black
taffeta dress which she had made from a Vogue pattern and was hoping they
had missed their train.
Coming to the kitchen door her mother called her and she went in
reluctantly. Then she saw Helen and her face lit up with interest. Her
mother had said Mrs. Flandon was nice looking but she had pictured some
earnest looking youngish woman. This—this picture of soft gray fur and
dull gold hair! She was like a magazine cover. She was what Freda had
thought existed but what she couldn’t prove. And it was proven.
Speeding on the heels of her delight came shyness. She shook hands
awkwardly, trying to back out immediately. But Helen did not let her go at
once.
“We are a lot of trouble, I’m afraid, Miss Thorstad.”
“Oh, no you’re not. It’s not a bit of trouble. I’ll have lunch ready soon,
but it will be very simple,” said Freda.
Her voice, thought Freda, is like her clothes. It’s luxurious.
The lunch was ready soon and to the visitors it was very pleasant as they
went into the little dining-room. It was so small that the chairs on one side
had to be careful not to back up against the sideboard. The rug was worn to
thinness but the straight curtains at the windows, which did not shut out the
sun, were daffodil yellow and on the table the little pottery bowl with three
blossoming daffodils picked out the same note of defiant sunlight again.
Helen looked around her appreciatively.
Freda served them quietly, slipping into her own chair, nearest the door
to the kitchen, only after the dishes were all in place and every one eating.
She took her own plate from her mother absently. The others were talking.
She listened to them, the throaty, assured voice of Mrs. Brownley, Miss
Duffield’s clear, definite tones and the voice of Mrs. Flandon, with a note of
laughter in it always, as if she mocked at the things she said. Yet always
with light laughter.
“Are you interested in all this political business?” asked Mrs. Flandon of
her, suddenly.
“No,” said Freda, “Not especially. But mother is, so I hear a great deal of
it.”
Her mother laughed a little reprovingly.
“Freda has been too busy to give these things time and thought.”
“How are you busy? At home?”
She let her mother answer that.
“Freda graduated from the Normal last year. We hoped there would be a
teaching opening here for her but as there wasn’t, we persuaded her to stay
home with us and take a little special work at the Normal.”
Helen kept her eyes on the girl’s face. Keenly sensitive to beauty as she
was, she had felt that it was the girl rather than the mother who created the
atmosphere of this house with which she felt in sympathy. She wanted to
talk to her. As the meal progressed she kept her talking, drew her out little
by little, and confidence began to come back to Freda’s face and frankness
to her tongue.
“She’s beautiful,” thought Helen, “such a stunning creature.”
But it was later that she got the key to Freda.
They were in the living room and she picked up some of the books on
the table. They interested her. It was a kind of reading which showed some
taste and contemporary interest. There was the last thin little gray-brown
“Poetry,” there was “The Tree of Heaven,” “Miss Lulu Bett,” Louis
Untermeyer’s poems. Those must be Freda’s. There was also what you
might expect of Mrs. Thorstad. Side by side lay the “Education of Henry
Adams” and “The Economic Consequences of the Peace.”
“Of course the mother reads those,” thought Helen, “after she’s sure
they’re so much discussed that they’re not dangerous any longer. But the
mother never reads ‘Poetry.’ ”
“Your daughter likes poetry?” she asked Mrs. Thorstad.
“She reads a great deal of it. I wish I could make her like more solid
things. But of course she’s young.”
Mrs. Flandon went out to the kitchen where Freda was vigorously
clearing up.
“You’re doing all the work,” she protested.
“Very sketchily,” confessed Freda, “I can cook better than I clear up,
mother tells me.”
“That may be a virtue,” said Helen. She stood leaning against the door,
watching Freda.
“Who reads poetry with you?”
“Father—sometimes. Oh, you mustn’t think because you see some
things I’m reading that I’m that sort. I’m not at all. I’m really not clever
especially. I just like things. All kinds of things.”
“But what kinds?”
“Just so they are alive, that’s all I care. So I scatter—awfully. I can’t get
very much worked up about women in politics. It seems to me as if women
were wasting a lot of time sometimes.”
“You are like me—a natural born dilettante.”
“Are you that?” asked Freda. Her shyness had gone. Here was some one
to whom she could talk.
“I’m afraid I am. I like things just as you do—if they’re alive. It’s a bad
way to be. It’s hard to concentrate because some new beautiful thing or
emotion keeps dragging you off and destroys your continuity. And in this
world of earnest women—”
“You criticize yourself. You feel that you don’t measure up to the women
who do things. I know. But don’t you think, Mrs. Flandon, that something’s
being lost somewhere? Aren’t women losing—oh, the quality that made
poets write such things about them—I don’t know, it’s partly physical—
they aren’t relaxed—”
She stood, pouring her words out in unfinished phrases as if trying
desperately to make a confession or ask her questions before anything
interrupted, her face lit up with eagerness, its fine, unfinished beauty
diffused with half-felt desires. As she stopped, Helen let her stop, only
nodding.
“I know what you mean. You’re right. It’s all mixed up. It’s what is
puzzling the men too. We must talk, my dear.”
Helen was quite honest about that. She meant to talk with Freda. But
there was no time that afternoon. In the Library club-room, crowded with
women who had come at Mrs. Thorstad’s bidding for a “fresh inspiration,”
Helen found her hands full. She gave her talk, toning it up a bit because she
saw that Freda was expecting things of her and so wandering off the point a
little. But the charm that Margaret wanted was in action and Margaret,
quickly sensing the possibilities of Mrs. Thorstad’s town, settled down to
some thorough organization work.
It was after the meeting that night that Helen saw Freda again. And then
not in the hall. She had noticed the girl slip out after her own talk, as Mrs.
Brownley rose to “address” the meeting, and wondered where she was
going. To her discomfiture she had found that she was billeted on Mrs.
Watson for the night as befitted their respective social dignities, and that
Margaret was to spend the night at the Thorstad house.
But it was from Mrs. Watson’s spare room window that she saw Freda.
The skating rink, a square of land, flooded with water and frozen, lay
below. As she went to pull down the shade in her bed-room window—she
had escaped from Mrs. Watson as promptly as possible—Helen’s eyes fell
on the skaters, skimming swiftly about under arc lights which, flickering
bright and then dim, made the scene beautiful. And then she saw Freda. She
was wearing the red tam-o’-shanter which Mrs. Flandon had already seen
and a short red mackinaw and as she flashed past under the light, it was
unmistakably she—not alone. There was a young man with her.
Helen watched her come and go, hands crossed with her partner,
watched the swing of her graceful body as it swayed so easily towards the
man’s and was in perfect tune with it.
“That’s one way you get the alive and beautiful, is it?” thought Helen.
Then, after a little, by some signal, the rink was declared closed. The
skaters, at the sides of the rink, sat on little benches and took off their
skates. The young man knelt beside Freda and loosened the straps, a pretty
bit of gallantry in the moonlight.
He had her arm. They were going home, walking a little more close to
each other than was necessary, looking up, bending down. Helen could
almost feel what they were feeling, excitement, vigor, intimacy. A little
shiver went over her as she pulled down the shade at last and looked around
at the walls with their brown scrolls and mottoed injunction to
“Sleep sweetly in this quiet room,

Oh, thou, whoe’er thou art.”
CHAPTER IV
CITY MICE
T HE dismay of the young Brownleys was as great as that of Freda. But

their indomitable mothers won.
“But, mother,” cried Allison Brownley, “you don’t mean you’d ask
that—that little Swede girl here to the house? For a month? Why, I should
think you’d see how impossible that is. We can’t treat her as a servant, can
we?”
“No,” said Mrs. Brownley, “you can’t—not at all. She’s a very clever
girl—Normal School graduate.”
Allison sank on a divan, her short skirts shorter than ever in her
abandonment, her face a picture of horrified dismay.
“Normal School—you know what they are! Pimples and plaid skirts two
inches from the ground,—China silk white waists. Oh, mother dear, it’s
very sweet of you to think of her, but it couldn’t be done. What would we
do with her? Why, the days are just full! All kinds of things planned now
that Easter’s over. We couldn’t take her about, and we couldn’t leave her at
home. The Brownley girls and their little Swede friend! Mother, I do think
you ought to keep politics out of the home.”
Barbara joined in now. That was always her policy. To let Allie state the
case and get excited over it and then to go after her mother reasonably if her
mother didn’t give in. She was a more languorous type than Allie. “Bed-
room eyes” one of the boys had said, at the height of his puppy wit.
“If you had to ask them, mother, Lent would have been the time. It just
can’t be managed now. As a matter of fact I’ve practically asked Delia
Underwood to spend three weeks here.” That was a lie and she knew her
mother would know it, but it gave her mother a graceful way out of the
difficulty.
But unfortunately Mrs. Brownley did not seem to be looking for loop-
holes. She sat serenely at her desk, her eye-glasses poised upon the bills she
was auditing.
“I think you will like Miss Thorstad,” she answered, ignoring all the
protests. “You see it’s really quite important for me to have her here. The
mother is a very clever little woman and with a possible political future.
Miss Duffield thinks very highly of her. While we are doing this active
campaign work she will be invaluable here in the city. She’s a good
organizer—and she’s a plain woman. She can handle plain women, Miss
Duffield insists, better than we can. I wish you girls would understand that
there is a great deal involved in this campaign. If we stand well out here it
will be important for the district—in Washington.”
“Yes, mother—but why the daughter?”
“For the simple reason that Mrs. Thorstad said she didn’t like to leave
her at home alone. It put me in the position of having to ask her. She is, as I
remember, a pretty well-appearing girl. Mrs. Flandon, whom you admire so
much, Allie, was immensely taken with her. At any rate, they have been
asked, they will accept and they arrive next week.”
Allie looked dark.
“Well, mother,” she said, with a fair imitation of her mother’s tone, “if
you expect me to give up everything for the sake of this little Swede, you’re
mistaken. The men will just howl when they see her.”
“Cheer up, Allie,” said Barbara, “they may fall in love with her.
Brunhilde, you know—and all of that. I think it’s a shame, mother.”
The girls looked at each other. They weren’t ordinarily allies, but this
mess was one they both would have to worry over. Their mother rose.
“Of course, girls,” she said, “it is an inconvenience. But it’s a good thing
to do. It means more than you may guess. Be nice to Miss Thorstad and
you’ll not be sorry. It might mean that platinum bracelet for you, Barbara,
and for Allie—”
“Mother,” exclaimed Allie, “if I’m an angel to your little Swede would
you let me have a new runabout—a Pierce, painted any color I like?”
Her mother merely smiled at her but Allie knew her claim was good. She
turned to her sister as her mother left the room.
“She’s going to do it, Bobbie, and we might just as well get something
out of it. I’ll tell the girls I’m getting my new car that way and they’ll all
help. We’ll give little Miss Olson the time of her life.”
“You get more out of it than I do, I notice.” Barbara was inspecting
herself in the mirror of her vanity case from which she allowed nothing
except sleep to separate her.
“That’s all right, Bob. I’ll do most of the heavy work, I’ll bet.”
“I shan’t be able to do much, I’ll tell you that. Miss Burns wants me for
fittings every day next week and I’ve a lot of dates, for evenings.”
“Ted’s giving you quite a rush, isn’t he darling? Do you think he’s
landed this time or is it just that it’s your turn?”
Barbara did not blush. She looked straight at her sister, her slim face
disgusted.
“Pretty raw, aren’t you? As a matter of fact I think he could be landed if
I had the slightest desire to do it. I’m not at all sure that I want him.”
Allie grinned.
“That’s all right. That’s what they all say, all the ones he gives a rush and
leaves lamenting. I am sort of surprised that you’d fall for him so hard.
Even if he is the ideal lover, every one who isn’t cross-eyed knows how he
does it. I’d like a little more originality, myself.”
“I tell you this, Allie. That man has been misunderstood. Because he’s so
rich and good looking every one’s chased after him and then when he was
decently civil they’ve taken advantage of him by spreading stories about his
flirtations. He’s told me some things about girls—”
“Dirty cad,” said Allie, cheerfully.
“All right, if you want to be insulting, I won’t talk to you.”
“Well, tell me what he said. I won’t think about his being a dirty cad
until afterwards.”
What humor there was was lost on Barbara.
“I don’t care to talk any more about him.”
Barbara looked at her watch to conclude matters.
“And by the way, Allie, mother said I could use the limousine. I’ve got a
lot of things to do and I’ll need Chester all afternoon. Mrs. Watts is taking
mother to the Morley reception and I’m calling for her. She said you could
have the electric.”
“My God!” said Allie. “Why doesn’t she offer me a hearse? Thanks, I’d
sooner take old 1898 out again. And think about that Pierce I’m going to
earn.”
She was out of the room in a minute, flying up the stairs, some grotesque
words to a dance tune floating behind her. The Packard runabout, “old
1898,” was humming down the garage drive half an hour later. Stopping at
two houses impressive as her own, she regaled the girls who were her
friends with accounts of the “Swedish invasion.” It was a good story,
especially with the promise of the reward tacked on the end.
II
But it was three days before Freda had capitulated. Her first reaction had
been an angry shame at her mother’s inclusion of her in her own invitation.
She had simply flatly refused to go. A little later it was possible to regard
the business with some humor, and the shame had lost its sting. She had
never known those people anyhow—never would know them—it didn’t
matter what they thought. When she saw that the matter was not ended and
sensed the depth of determination in her mother’s mind that her daughter
should go with her to the Brownley’s she tried to be more definite even than
before in her refusal. Her mother did not seem to hear her. She insisted on
keeping the subject open, never admitting for a minute that it was or could
be closed. She dwelt endlessly on the advantages of the visit—on the fact
that the chance for Freda had come at last.
“Chance!” stormed Freda, “why it isn’t a chance to do anything except
sponge on a few rich people whom I’ve never seen before in my life. You
don’t really suppose, mother, that I’d go down there and let those Brownley
girls make my life miserable. You don’t seem to realize, mother, that those
two Brownleys are a very gay lot. They must be about my age—the older
one anyway. Why, I wouldn’t think of it. What on earth would I do? What
on earth would I wear? What would I say? What on earth would I be there
anyhow? I’m no politician. I’m not helping Mrs. Brownley strengthen her
fences or anything. If you ask me, mother, I wouldn’t think of going if I
were you. Don’t you know she’s just making a play to the gallery by having
you? Probably bragging about her great sense of democracy! Why,
mother!”
“You don’t seem to realize,”—Mrs. Thorstad always began that way by
assuming that you had missed her point, a point which was and always
would be in accord with Right Living and Democracy and the Family and
the Home, “that these social distinctions are of no value in my estimation.
In this great country—”
Freda led her mother away from the brink of oratory.
“Look here,” she said, “if they aren’t a lot more important than we are—
if you don’t think they are—what is this wonderful chance you are talking
about?”
Just at what point Freda gave in, just at what point she felt that the
possibilities of her trip outweighed its impossibilities she did not know. It
was certain that the young Brownleys gave way to no noisier public
mockery of the proposed visit than did Freda. She was even a little shrill.
She told everybody how she “hated it,” how she was going along to the
homes of the idle rich to chaperon her mother, that she was “breaking into
high society,” that she was gathering material for a book on “how the other
half lives,” that she would probably be mistaken for a housemaid and asked
to dust the bed-rooms, that mother was trying to “marry her off,” that she
“didn’t have an idea what to wear.” She talked to almost every one she met,
somewhat unnecessarily, somewhat defiantly, as if determined to let any
one know about her reasons for going, as if defending herself against any
accusations concerning her motive in making such a visit, perhaps making
sure that no later discomfiture on her own part could be made more severe
by any suspicion of pleasurable anticipation.
She planned her clothes for St. Pierre with mocking but intense
deliberation. A dark blue tricotine dress—she bought that at the ladies’
specialty shop and taking it home ripped off all the trimming substituting
the flattest and darkest of braid. That was safe, she knew. She might not be
startling but she would be inoffensive, she told her mother. There was a
dress made by Miss Peterson, who sewed by the day, from a remnant of
bronze georgette, and half shamefacedly Freda came home one night with a
piece of flame colored satin and made it herself into a gown which hung
from the shoulders very straightly and was caught at the waist with silver
cord (from the drapery department). And there was an evening dress at
which Freda scoffed but she and Miss Peterson spent some fascinated hours
over it, making pale green taffetas and tulle fit her lovely shoulders.
“Though what I’m getting these clothes for is a mystery to me,”
grumbled Freda. “They probably won’t even ask me to go out. Probably
suggest that I eat with the servants.”
Yet she tried on the evening dress in the privacy of her room parading
before her bureau mirror, which could not be induced to show both halves
of her at once. And as she looked in the glass there came back the reflection
of a girl a little flushed, excited, eager, as if in spite of all her mockery there
was a dream that she would conquer unknown people and things—a hope
that wonders were about to happen.
Never was there a trace of that before her mother. Having agreed to go,
Freda was, on the whole, complaisant, but on principle unenthusiastic.
Her father gave her two hundred dollars the night before she went away.
Mrs. Thorstad was at a neighbor’s house and the gift was made in her
absence without comment on that fact. Freda, whose idea of a sizable check
for her spending money was five dollars and of an exceptionally large one,
ten, gasped.
“But what do I need this for?”
“You’ll find ways, my dear. It’s—for some of the little things which
these other young ladies may have and you may lack. To put you at ease.”
“Yes, but it’s too much, father dear. For three or four weeks. You can’t
possibly afford it.”
“Oh, yes, my dear. Only try to be happy, won’t you? Remember that it’s
always worth while to learn and that there are very few people in the world
who aren’t friendly by nature.”
That thought carried Freda through the next twenty-four hours,
beginning with worry when she got on the train as to whether they were
expecting her after all, through a flurry of excitement at the sense of “city”
in St. Pierre, the luxury of the limousine which had been sent to meet them,
through the embarrassment of hearing her mother begin to orate in a mild
fashion on the beauty of Mrs. Brownley’s home and the “real home spirit”
which she felt in it. Freda felt sure that such conversation was not only out
of place but bad taste anyway. She was divided between a desire to carry
the visit off properly, showing the Brownleys that she was not gauche and
stupid, and an impulse to stalk through the days coldly, showing her disdain
for mere material things and the impossibility of impressing her. Yet the
deep softness of the hall rugs, the broad noiseless stair carpets, the glimpses
through doorways into long quiet rooms seemingly full of softly
upholstered furniture, lamps with wonderfully colored shades, pictures

Textbook Fundamentals of Canadian Nursing Concepts Process and Practice Fourth Canadian Edition Barbara J Kozier Ebook All Chapter PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Textbook Fundamentals of Canadian Nursing Concepts Process and Practice Fourth Canadian Edition Barbara J Kozier Ebook All Chapter PDF

Uploaded by

Copyright:

Available Formats

Fundamentals of Canadian Nursing:

Concepts, Process, and Practice,

Biota Grow 2C gather 2C cook Loucas

Psychiatric Mental Health Nursing for Canadian Practice

Fundamentals of Social Research Fourth Canadian Edition

Engineering Economic Analysis Fourth Canadian Edition

Business Communication: Process & Product: Brief Sixth

Financial management theory and practice Third Canadian

Interplay The Process of Interpersonal Communication

Concepts and Cases in Nursing Ethics - Fourth Edition

A01_KOZI2703_04_SE_FM.indd 1 03/03/17 3:30 PM

Glenora Erb, BScN, RN

Audrey Berman, PhD, RN

Shirlee J. Snyder, EdD, RN

Geralyn Frandsen, EdD, RN

Madeleine Buck, RN, BScN, MSc(A)

Linda Ferguson, RN, BSN, MN, PhD

Lucia Yiu, RN, BSc, BA, MScN

Lynnette Leeseberg Stamler, PhD, RN, FAAN

A01_KOZI2703_04_SE_FM.indd 3 03/03/17 3:30 PM

Originally published under title: Fundamentals of nursing, the

RT41.K69 2017 610.73 C2016-904384-3

A01_KOZI2703_04_SE_FM.indd 4 16/06/17 9:32 AM

Canadian Reviewers xviii

Chapter 1 Chapter 4 Chapter 6

Chapter 7 Chapter 8 The Nurse’s Role in Health

A01_KOZI2703_04_SE_FM.indd 5 17/03/17 10:31 AM

Chapter 17 Preschoolers (4 to 5 Years) 318 Moral Development 355

A01_KOZI2703_04_SE_FM.indd 6 17/03/17 10:32 AM

UNIT 4 INTEGRAL ASPECTS OF NURSING 364

Chapter 21 Chapter 23 Computer Technology and Informatics

Chapter 28 Male Genitals and Inguinal Area 621 Implementing 689

A01_KOZI2703_04_SE_FM.indd 7 17/03/17 10:36 AM

Chapter 32 Chapter 34 Chapter 35

Chapter 37 Chapter 39 Vegetarian Diets 1143

A01_KOZI2703_04_SE_FM.indd 8 17/03/17 10:35 AM

Physiology of the Respiratory

Chapter 45 Spiritual, Religious, and Faith Coping 1443

A01_KOZI2703_04_SE_FM.indd 9 17/03/17 10:34 AM

A01_KOZI2703_04_SE_FM.indd 11 03/03/17 3:30 PM

Lynnette Leeseberg Stamler

A01_KOZI2703_04_SE_FM.indd 12 03/03/17 3:30 PM

Linda Ferguson dedicates this edition to those nurses in professional practice

Lynnette Leeseberg Stamler dedicates this edition to the many

A01_KOZI2703_04_SE_FM.indd 13 03/03/17 3:30 PM

A01_KOZI2703_04_SE_FM.indd 14 03/03/17 3:30 PM

A01_KOZI2703_04_SE_FM.indd 15 03/03/17 3:30 PM

Resources and Supplements

Online Resources Learning Catalytics

MyNursingLab Learning Catalytics is a “bring your own device” assessment

A01_KOZI2703_04_SE_FM.indd 16 03/03/17 3:30 PM

A01_KOZI2703_04_SE_FM.indd 17 03/03/17 3:30 PM

A01_KOZI2703_04_SE_FM.indd 18 03/03/17 3:30 PM

Chapter The Foundation of

M01_KOZI2703_04_SE_C01.indd 1 17/03/17 10:37 AM

to these questions are contingent on who was available

M01_KOZI2703_04_SE_C01.indd 2 27/02/17 10:37 AM

Library and Archives Canada

M01_KOZI2703_04_SE_C01.indd 3 27/02/17 10:37 AM

General Hospital in Halifax (Nursing Education in Nova

M01_KOZI2703_04_SE_C01.indd 4 27/02/17 10:37 AM

Victorian Order of Nurses Canada

M01_KOZI2703_04_SE_C01.indd 5 27/02/17 10:37 AM