The Royal Marsden Manual of Clinical Nursing Procedures, Student Edition

Book Preface

It is my great pleasure as the Acting Chief Nurse of The Royal Marsden NHS Foundation Trust to introduce the tenth Student Edition of The Royal Marsden Manual of Clinical Nursing Procedures. As a Royal Marsden cancer trained nurse, a contribu-tor and a clinical user of the manual for many years, I am hon-oured to have been asked to introduce this edition. The manual is internationally renowned and used by nurses across the world to ensure their practice is evidence based and effective.

It is essential that we are able to critically analyse our judge-ments in the light of current knowledge. For all of us working with patients and their families or significant others, there is an imper-ative to question and renew our practice using the many sources of knowledge available to us. In the busy world of clinical practice in a ward or unit, or in the community, it can be challenging to find time to search for the evidence and this is where the Student Edition of The Royal Marsden Manual of Clinical Nursing Procedures is a real practical help.

As in the ninth edition, reviewing the evidence or sources of knowledge has been made explicit, with each level of evidence graded. This grading provides the reader with an understanding of whether the reference comes from a randomized controlled trial, national or international guidance, or expert opinion. Nursing care in any setting is a combination of sensitive thera-peutic relationships coupled with effective clinical care based on the best evidence that exists. Some areas of practice have attracted international research, such as cardiopulmonary resuscitation and infection prevention and control; other areas of practice have not attracted such robust research and therefore it is more of a challenge to ensure evidence-based care. Each time a new edition of the manual is prepared, we reflect on the gaps in research and knowledge; this provides the impetus to develop new concept analyses and further research studies. As student nurses, you will continue to build upon your skills and knowledge and become contributors to new evidence-based care and practice.
This new Student Edition incorporates a breadth of tools to support your learning, including objectives at the beginning of each chapter and a variety of learning activities that will either test your knowledge or prompt you to consider how you may apply what you are learning in practice. In addition, the proce-dures were tried out by the student nurses at King’s College London while on placement at the hospital to ensure they worked in practice.

As you look at the list of contributors to the manual, you will see that this edition has continued to be written by nurses who are experts and active in clinical practice. This has the double advantage of ensuring that this manual reflects the reality of prac-tice and ensuring that nurses at The Royal Marsden NHS Foundation Trust are frequently reviewing the evidence and reflecting upon the care they provide.

A textbook devoted to improving and enhancing clinical prac-tice needs to be alive to the clinical practitioner. You will see that this edition has continued the improvements made to the format in recent editions, including many more figures and photographs to make the manual more effective in clinical care.

As I commend this tenth Student Edition of The Royal Marsden Manual of Clinical Nursing Procedures to you, I am aware that it will be used in many different countries and settings. Having had the privilege of visiting and meeting nurses across the world, I know that there are more commonalities than differ-ences between us. The common theme is, of course, the need to ensure that we as nurses provide personalized care that is sensi-tively planned and that it is based on the best available evidence. The Student Edition of The Royal Marsden Manual of Clinical Nursing Procedures is a wonderful resource for such evidence and I hope it will be widely used in all clinical settings across the world.

Finally, I would like to congratulate the editors, Sara Lister, Justine Hofland, Hayley Grafton and particularly Catherine Wilson, for their excellent work preparing this edition. I would also like to thank all the nurses and allied health professionals at The Royal Marsden Hospital who have worked so hard on this tenth edition.

Mr Andrew Dimech
Acting Chief Nurse
The Royal Marsden NHS Foundation Trust

Brief table of contents
Foreword xvii
Acknowledgements xviii
List of contributors xix
Quick reference to the procedure guidelines xxiii
How to use your manual xxv
About the companion website xxviii
1 The context of nursing 1
Part One Managing the patient journey 13
2 Admissions and assessment 15
3 Discharge care and planning 47
4 Infection prevention and control 69
Part Two Supporting patients with human functioning 131
5 Communication, psychological wellbeing and safeguarding 133
6 Elimination 205
7 Moving and positioning 283
8 Nutrition and fluid balance 339
9 Patient comfort and supporting personal hygiene 403
10 Pain assessment and management 457
11 Symptom control and care towards the end of life 497
12 Respiratory care, CPR and blood transfusion 539
Part Three Supporting patients through the diagnostic process 657
13 Diagnostic tests 659
14 Observations 719
Part Four Supporting patients through treatment 801
15 Medicines optimization: ensuring quality and safety 803
16 Perioperative care 937
17 Wound management 1029
vi Brief table of contents
Part Five Looking after ourselves so we can support patients 1061
18 Self-care and wellbeing 1063
Appendix: Standards of Proficiency for Registered Nurses 1085
List of abbreviations 1089
Index