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This introductory chapter gives an overview of the purpose and structure of the book. Nurses have a central role to play in helping patients to manage the demands of the procedures described in this manual. We also need to be mindful of the evidence upon which we are basing the care we deliver. We hope that through increasing the clarity with which the evidence for the procedures in this edition are presented you will be better able to underpin the care you deliver to your patients in your day‐to‐day practice.
The chapter also highlights how the risk management implications of the areas of practice are now integrated into each chapter. The chapter then goes on to explain how the structure of the book is organized into three broad sections that represent, as far as possible, the needs of a patient along their care pathway.
The first edition of The Royal Marsden Manual of Clinical Nursing Procedures was produced in the early 1980s as a core procedure manual for safe nursing practice within The Royal Marsden Hospital, the first cancer hospital in the world. Implicit behind that first edition was the drive to ensure that patients received the very best care – expertise in carrying out clinical procedures combined with an attitude of respect and compassion.
Thirty years later these attitudes are still fundamental. The Chief Nurse Jane Cummings has ‘committed to make sure all patients receive the very best care with compassion and clinical skill’ (DH [3]). The values and behaviours of this compassionate practice are: Care, Compassion, Competence, Communication, Courage and Commitment – the 6Cs (DH [3]). This manual of clinical procedures focuses on bringing together current evidence, acting as an essential resource for practice and providing the theory underpinning Competence, one of the 6Cs.
This ninth edition focuses for the first time on procedures that are applicable in all areas of acute inpatient hospital care. (Procedures specific to the care of the cancer patient can be found in the new companion volume The Royal Marsden Clinical Cancer Nursing Procedures.) The Manual is informed by the day‐to‐day practice in the hospital and conversely is the corporate policy and procedure document for the adult inpatient service of the organization. It therefore does not cover all aspects of acute nursing practice or those relating to children's or community nursing. However, it does contain the procedures and changes in practice that reflect modern acute nursing care.
Core to nursing, wherever it takes place, is the commitment to care for individuals and to keep them safe so that when and wherever the procedures are used, they are to be carried out within the framework of the Nursing and Midwifery Code (NMC [10]). In respect of clinical competency, the NMC Code states that you must:
  • have the knowledge and skills for safe and effective practice without direct supervision
  • keep your knowledge and skills up to date throughout your working life
  • recognize and work within the limits of your competence (NMC [10]).
The Manual has been structured to enable nurses to develop competency, recognizing that competence is not just about knowing how to do something but also about understanding the rationale for doing it and the impact it may have on the patient.
Some of the procedures in the Manual will be newer for nursing, carried out by nurses such as advanced nurse practitioners. Developing new roles and taking responsibility for new procedures have obvious risks attached and, although every individual nurse is accountable for their own actions, every healthcare organization has to take vicarious liability for the care, treatment and procedures that take place. An organization will have expectations of all its nurses in respect of keeping patients, themselves and the environment safe. There are obvious ethical and moral reasons for this: ‘Nurses have a moral obligation to protect those we serve and to provide the best care we have available’ (Wilson [19], p.118). Risk management has therefore become an integral part of day‐to‐day nursing work. For this reason, the risk management implications of the areas of practice have been integrated into each chapter.


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