The Royal Marsden Manual of Clinical Nursing Procedures Student Edition (Royal Marsden Manual Series)

The student edition of The Royal Marsden Manual of Clinical Nursing Procedures has been the definitive, market-leading textbook of clinical nursing skills for fifteen years. This internationally best-selling title sets the gold standard for nursing care, providing the procedures, rationale, and guidance required by pre-registration students to deliver clinically effective, patient-focused care with expertise and confidence. With over two-hundred detailed procedures which reflect the skills required to meet The Standards of Proficiency for Registered Nurses (NMC 2019), this comprehensive manual presents the evidence and underlying theory alongside full-colour illustrations and a range of learning activities designed to support student nurses in clinical practice. Loved and trusted by millions, The Royal Marsden Manual of Clinical Nursing Procedures, Student Edition continues to be a truly indispensable textbook for students, and includes coverage of patient assessment and discharge planning, communication, infection prevention and control, perioperative care, wound management, nutrition, diagnostic testing, medicines management, and much more. Learning features in this revised tenth edition include: Learning outcomes – summarise the focus of the information in each chapter Learning in practice – asks you to consider issues within your practice environment Case studies – provide learning around a particular patient scenario Clinical applications – ask you to consider how you would apply your knowledge to a clinical situation Stretch activities – challenge you with more nuanced, advanced issues to reflect upon Many of the features in the book are relevant to trainee nursing associates, especially when used in conjunction with supervision from academic and clinical teachers. A companion website to this title is available at www.royalmarsdenmanual.com/student10e Cover Title Page Copyright Page Brief table of contents Detailed table of contents Foreword Acknowledgements List of contributors Quick reference to the procedure guidelines How to use your manual About the companion website Chapter 1 The context of nursing Overview Background Context of nursing Political context Unwarranted variation NHS Long Term Plan Professional context Patient safety and quality of care New roles Evidence-based practice What is evidence-based practice? Evidence-based practice and The Royal Marsden Manual of Clinical Nursing Procedures Structure of the manual Structure of the chapters Finally References Part One Managing the patient journey Chapter 2 Admissions and assessment Overview Inpatient assessment and the process of care Definition Related theory Evidence-based approaches Post-procedural considerations Observation Definition Physical assessment Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Respiratory examination Anatomy Physiology Related theory Evidence-based approaches Cardiovascular examination Anatomy and physiology Related theory Evidence-based approaches Abdominal examination Anatomy and physiology Related theory Evidence-based approaches Post-procedural considerations References Chapter 3 Discharge care and planning Overview Discharge care and planning Definition Related theory Clinical governance Discharging patients from hospital: internal procedures Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Interface between primary and secondary care: external processes Related theory Evidence-based approaches Complications Complex discharges Definition Related theory Evidence-based approaches Discharge to a nursing home Related theory Complications Discharge planning at the end of life Evidence-based approaches Pre-procedural considerations Informal carers Definition Related theory Evidence-based approaches The role of voluntary services Related theory References Chapter 4 Infection prevention and control Overview Infection prevention and control Definitions Anatomy and physiology Related theory Evidence-based approaches Clinical governance Hand hygiene Definition Related theory Evidence-based approaches Pre-procedural considerations Hand washing Evidence-based approaches Use of alcohol-based handrub Evidence-based approaches Surgical hand antisepsis Evidence-based approaches Personal protective equipment (PPE) Definition Related theory Donning theatre attire Evidence-based approaches Specific patient-related procedures Standard precautions Related theory Aseptic technique Definition Related theory Pre-procedural considerations Nursing care of patients with suspected or known infection: managing safe care Related theory Evidence-based approaches Isolation procedures Definition Source isolation Definition Related theory Evidence-based approaches Post-procedural considerations Protective isolation Definition Related theory Evidence-based approaches Post-procedural considerations Environmental hygiene and the management of waste in the healthcare environment Definition Related theory Waste disposal Related theory Clinical governance Management of soiled linen in the healthcare environment Related theory Prevention and management of inoculation injury Related theory Complications References Part Two Supporting patients with human functioning Chapter 5 Communication, psychological wellbeing and safeguarding Overview Communication Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Principles of communication Providing information and making shared decisions Definition Related theory Evidence-based approaches Pre-procedural considerations Principles of providing information to a patient Communicating with specific populations Communicating with people with acquired communication disorders Definitions Related theory Evidence-based approaches Pre-procedural considerations Principles of communicating with people with aphasia Principles of communicating with people with impaired speech (dysarthria) Principles of communicating with people with impaired voice (dysphonia) Principles of communicating with people who are blind or partially sighted Principles of communicating with people who are deaf or hard of hearing Communicating with people who are worried or distressed Related theory Evidence-based approaches Pre-procedural considerations Psychological wellbeing Definition Related theory Adjustment Definition Related theory Denial and collusion Definitions Related theory Evidence-based approaches Complications Anxiety and panic Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Depression Definition Related theory Evidence-based approaches Pre-procedural considerations Anger, aggression and violence Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Delirium Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Dementia Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Referring on to psychological support services Evidence-based approaches Safeguarding, mental capacity and the Mental Health Act Safeguarding Definition Related theory Evidence-based approaches Clinical governance Principles of safeguarding Mental Capacity Act (2005) Definition Related theory Clinical governance Pre-procedural considerations Principles of mental capacity assessment Post-procedural considerations Deprivation of Liberty Safeguards (2009) Definition Related theory Clinical governance Pre-procedural considerations Principles relating to deprivation of liberty Post-procedural considerations Mental Health Act (2007) Related theory Evidence-based approaches Pre-procedural considerations Principles of using the Mental Health Act Post-procedural considerations Interface between the Mental Health Act (2007) and the Mental Capacity Act (2005) Related theory References Chapter 6 Elimination Overview Normal elimination Urinary elimination Definition Anatomy and physiology Faecal elimination Definition Anatomy and physiology Assisting patients with elimination Evidence-based approaches Clinical governance Pre-procedural considerations Altered urinary elimination Urinary incontinence Related theory Penile sheaths Evidence-based approaches Pre-procedural considerations Urinary catheterization Evidence-based approaches Clinical governance Pre-procedural considerations Suprapubic catheterization Evidence-based approaches Related theory Post-procedural considerations Intermittent catheterization Evidence-based approaches Related theory Pre-procedural considerations Catheter-associated complications Bladder irrigation Definition Evidence-based approaches Pre-procedural considerations Post-procedural considerations Nephrostomy tubes and ureteric stents Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations and complications Surgical urinary diversions Definition Evidence-based approaches Altered faecal elimination Diarrhoea Definition Related theory Pre-procedural considerations Faecal incontinence Definition Related theory Constipation Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Insertion of a nasogastric drainage tube Evidence-based approaches Clinical governance Pre-procedural considerations Enema administration Definition Evidence-based approaches Clinical governance Pre-procedural considerations Suppositories Definition Related theory Evidence-based approaches Pre-procedural considerations Digital rectal examination Definition Evidence-based approaches Clinical governance Pre-procedural considerations Digital removal of faeces Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Stoma care Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Pre-procedural assessment and care Post-procedural considerations Complications References Chapter 7 Moving and positioning Overview Moving and positioning: general principles Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Prevention of falls Definition Related theory Evidence-based approaches Risk factors Positioning a patient: in bed Evidence-based approaches Positioning a patient: sitting up in bed Evidence-based approaches Positioning a patient: side-lying Evidence-based approaches Moving a patient from sitting to standing Evidence-based approaches Positioning a patient: in a chair or wheelchair Evidence-based approaches Walking Definition Related theory Evidence-based approaches Moving and positioning an unconscious patient Definition Anatomy and physiology Evidence-based approaches Moving and positioning a patient with an artificial airway Definition Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Moving and positioning a patient with respiratory compromise Definition Anatomy and physiology Evidence-based approaches Positioning a patient to maximize ventilation/perfusion matching Anatomy and physiology Evidence-based approaches Positioning a patient to minimize the work of breathing Anatomy and physiology Evidence-based approaches Pre-procedural considerations Positioning a patient to maximize the drainage of secretions Anatomy and physiology Pre-procedural considerations Moving and positioning a patient with neurological impairment Definition Anatomy and physiology Related theory Evidence-based approaches Positioning a neurological patient with tonal problems in bed Pre-procedural considerations Positioning a neurological patient with tonal problems in a chair Pre-procedural considerations Post-procedural considerations Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Moving and positioning a patient with raised intracranial pressure Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Moving and positioning a patient with an amputation Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications References Chapter 8 Nutrition and fluid balance Overview Fluid balance Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Nutritional status Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Provision of nutritional support: Oral Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Nutritional management of patients with dysphagia Definition Evidence-based approaches Enteral tube feeding Definition Related theory Evidence-based approaches Pre-procedural considerations Nasogastric tube insertion Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Enteral tube removal Pre-procedural considerations Post-procedural considerations Enteral tube care Evidence-based approaches Percutaneous endoscopically placed gastrostomy (PEG) placement and care Pre-procedural considerations Post-procedural considerations Complications Silicone gastrostomy stoma plugs Definition Administration of enteral tube feed Pre-procedural considerations Post-procedural considerations Complications Enteral feeding tubes: administration of medication Evidence-based approaches Post-procedural considerations Parenteral nutrition Definition Related theory Evidence-based approaches Post-procedural considerations Complications References Chapter 9 Patient comfort and supporting personal hygiene Overview Personal hygiene Definition Anatomy and physiology Evidence-based approaches Pre-procedural considerations Sleep promotion in a hospitalized patient Definition Anatomy and physiology Related theory Evidence-based practice Patient environment Related theory Pre-procedural considerations Eye care Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Ear care Definition Anatomy and physiology Related theory Evidence-based approaches Mouth care Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations References Chapter 10 Pain assessment and management Overview Pain Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Pain management Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Regional analgesia: local anaesthetic nerve blocks and infusions Definition Anatomy, physiology and related theory Evidence-based approaches Clinical governance Epidural analgesia Definition Anatomy and physiology Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Removal of an epidural catheter Post-procedural considerations Entonox administration Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Complications Non-pharmacological methods of managing pain Psychological interventions Physical interventions References Chapter 11 Symptom control and care towards the end of life Overview End-of-life care Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Symptom control Dyspnoea (shortness of breath) Definition Evidence-based approaches Pre-procedural considerations Nausea and vomiting Definition Anatomy and physiology Related theory Evidence-based approaches Insertion of a nasogastric drainage tube Ascites Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Terminal sedation Definition Evidence-based approaches Pre-procedural considerations Care after death (last offices) Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations References Chapter 12 Respiratory care, CPR and blood transfusion Overview Respiratory therapy Definition Anatomy and physiology Evidence-based approaches Oxygen therapy Definition Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications High-flow oxygen via a nasal cannula Definition Evidence-based approaches Humidification Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Non-invasive ventilation Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Chest drain management Definition Anatomy and physiology Related theory Chest drain: insertion Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Chest drain: suction Evidence-based approaches Chest drain: changing the bottle Evidence-based approaches Post-procedural considerations Complications Chest drain removal Evidence-based approaches Tracheostomy and laryngectomy care Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Tracheostomy: dressing and tube tape or tie change Evidence-based approaches Tracheostomy: suctioning Evidence-based approaches Clinical governance Pre-procedural considerations Complications Tracheostomy: changing an inner cannula Evidence-based approaches Complications Tracheostomy: changing a tube Evidence-based approaches Pre-procedural considerations Complications Tracheostomy: applying a speaking valve Evidence-based approaches Pre-procedural considerations Complications Tracheostomy: decannulation Evidence-based approaches Pre-procedural considerations Complications Tracheostomy: emergency care and recannulation Evidence-based approaches Pre-procedural considerations Laryngectomy Related theory Laryngectomy: humidification Evidence-based approaches Laryngectomy: communication Evidence-based approaches Laryngectomy: care and emergency management Evidence-based approaches Basic life support Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Defibrillation Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Transfusion of blood and blood components Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications: general Complications: pulmonary Complications: minor transfusion reactions Complications: major transfusion reactions Complications: delayed transfusion reactions References Part Three Supporting patients through the diagnostic process Chapter 13 Diagnostic tests Overview Diagnostic tests Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Blood sampling Definition Evidence-based approaches Pre-procedural considerations Venepuncture: obtaining blood samples from a peripheral vein Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Blood cultures Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Cerebrospinal fluid obtained by lumbar puncture Definition Anatomy and physiology Related theory Evidence-based approaches Post-procedural considerations Complications Specimen collection: swab sampling Definition Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Specimen collection: urine sampling Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Specimen collection: faecal sampling Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Specimen collection: respiratory tract secretion sampling Definition Related theory Evidence-based approaches Clinical governance Post-procedural considerations Specimen collection: pleural fluid Definition Anatomy and physiology Related theory Evidence-based approaches Endoscopic investigations Definition Gastroscopy Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Colonoscopy Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Cystoscopy Definition Anatomy and physiology Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Liver biopsy Definition Anatomy and physiology Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Radiological investigations: X-ray Definition Evidence-based approaches Clinical governance Pre-procedural considerations Magnetic resonance imaging (MRI) Definition Evidence-based approaches Pre-procedural considerations Procedure Post-procedural considerations Computed tomography (CT) Definition Evidence-based approaches Pre-procedural considerations Procedure Post-procedural considerations References Chapter 14 Observations Overview Observations Definition Evidence-based approaches Clinical governance Pre-procedural considerations Pulse (heart rate) Definition Anatomy and physiology Evidence-based approaches Pre-procedural considerations Post-procedural considerations Electrocardiogram (ECG) Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Blood pressure Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Respiration and pulse oximetry Definitions Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Peak flow Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Temperature Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Urinalysis Definition Anatomy and physiology Evidence-based approaches Pre-procedural considerations Post-procedural considerations Blood glucose Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Neurological observations Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations References Part Four Supporting patients through treatment Chapter 15 Medicines optimization: ensuring quality and safety Overview Medicines management Definitions Legislation relating to medicines Supply of medicines Key principles for administration of medicines Medication errors: definition and causes Clinical governance Self-administration of medicines Definition Related theory Controlled drugs Definition Clinical governance Post-procedural considerations Routes of administration Enteral (oral) administration Definition Related theory Evidence-based approaches Pre-procedural considerations Topical administration Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Transdermal (percutaneous) administration Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Rectal administration Definition Related theory Evidence-based approaches Vaginal administration Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Pulmonary administration Definition Related theory Pre-procedural considerations Post-procedural considerations Complications Ophthalmic administration Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Nasal administration Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Otic administration Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Parenteral administration (injections and infusions) Definitions Anatomy and physiology Evidence-based approaches Pre-procedural considerations Pre-procedural considerations Intra-arterial injections and infusions Definition Intra-articular injections and infusions Definition Intrathecal administration of medication Definition Intradermal injection Definition Evidence-based approaches Pre-procedural considerations Subcutaneous injection Definition Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Subcutaneous infusion Definition Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Intramuscular injections Definition Evidence-based approaches Pre-procedural considerations Intravenous injections and infusions Definition Anatomy and physiology Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Peripheral cannulas Definition Anatomy and physiology Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications Infiltration and extravasation Definitions Related theory Evidence-based approaches Clinical governance Pre-procedural considerations Post-procedural considerations Complications References Chapter 16 Perioperative care Overview Pre-operative care Definition Related theory Evidence-based approaches Clinical governance Patient information and education Related theory Evidence-based approaches Consent Definition Evidence-based approaches Clinical governance Physical pre-operative preparation Definition Related theory Mechanical and pharmacological thromboembolism prophylaxis Definition Related theory Pre-operative fasting Definition Related theory Skin preparation Definition Related theory Marking skin for surgery Definition Related theory Pre-operative pregnancy testing Related theory Clinical governance Prevention of toxic shock syndrome from tampon use Definition Related theory Latex sensitivity and allergy Related theory Clinical governance Pre-operative theatre checklist Related theory Intraoperative care Definition Anaesthesia Definition Evidence-based approaches Clinical governance Pre-procedural considerations Airway management Definition Related theory Theatre Related theory Laparoscopic surgery Definition Related theory Pre-procedural considerations Complications Robotic surgery Related theory Clinical governance Endoscopy Definition Related theory Positioning the patient on the table Evidence-based approaches Infection prevention Evidence-based approaches Clinical governance Pre-procedural considerations Post-anaesthetic care unit (PACU) Definition Evidence-based approaches Pre-procedural considerations Post-procedural considerations Complications Post-operative care Definition Evidence-based approaches Post-operative observations Evidence-based approaches Clinical governance Haemodynamic instability Related theory Evidence-based approaches Ineffective breathing pattern Related theory Evidence-based approaches Fluid balance Definition Evidence-based approaches Surgical drains Definition Related theory Evidence-based approaches Surgical wounds Definition Related theory Complications Urinary output and catheters Related theory Evidence-based approaches Bowel function Related theory Evidence-based approaches Nutrition Related theory Evidence-based approaches Post-operative pain Evidence-based approaches Immobility Related theory Ongoing care on discharge Related theory References Chapter 17 Wound management Overview Wounds Definition Anatomy and physiology Related theory Evidence-based approaches Pre-procedural considerations Post-procedural considerations Pressure ulcers Definition Anatomy and physiology Evidence-based approaches Surgical wounds Definition Evidence-based approaches Removal of sutures or clips Evidence-based approaches Pre-procedural considerations Post-procedural considerations Negative pressure wound therapy Definition Evidence-based approaches Pre-procedural considerations Post-procedural considerations References Part Five Looking after ourselves so we can support patients Chapter 18 Self-care and wellbeing Overview Self-care and wellbeing Definitions Related theory Evidence-based approaches Mindfulness Definition Related theory Evidence-based approaches Pre-procedural considerations Problem solving Eating and drinking Related theory Evidence-based approaches Physical wellbeing and musculoskeletal health Related theory Evidence-based approaches Post-procedural considerations References Appendix: Standards of Proficiency for Registered Nurses List of abbreviations Index EULA The student edition of __The Royal Marsden Manual of Clinical Nursing Procedures__ has been the definitive, market-leading textbook of clinical nursing skills for fifteen years. This internationally best-selling title sets the gold standard for nursing care, providing the procedures, rationale, and guidance required by pre-registration students to deliver clinically effective, patient-focused care with expertise and confidence. With over two-hundred detailed procedures which reflect the skills required to meet __The Standards of Proficiency for Registered Nurses__ (NMC 2019), this comprehensive manual presents the evidence and underlying theory alongside full-colour illustrations and a range of learning activities designed to support student nurses in clinical practice. Loved and trusted by millions, __The Royal Marsden Manual of Clinical Nursing Procedures, Student Edition__ continues to be a truly indispensable textbook for students, and includes coverage of patient assessment and discharge planning, communication, infection prevention and control, perioperative care, wound management, nutrition, diagnostic testing, medicines management, and much more. Learning features in this revised tenth edition include: * Learning outcomes – summarise the focus of the information in each chapter * Learning in practice – asks you to consider issues within your practice environment * Case studies – provide learning around a particular patient scenario * Clinical applications – ask you to consider how you would apply your knowledge to a clinical situation * Stretch activities – challenge you with more nuanced, advanced issues to reflect upon A companion website to this title is available at **www.royalmarsdenmanual.com/student10e** "It is a privilege to write the preface for this tenth celebratory edition of The Royal Marsden Manual of Clinical Nursing Procedures. It is over 30 years since the first edition of the manual was published. The first edition was initially written for the nursing staff of the hospital with the aim of creating a reference that drew together information from diverse sources. The introduction to that first edition stated that intentionally it was 'very different from others [textbooks] that you may have used, because it gives the why as well as the how for each policy and procedure' (Royal Marsden Hospital 1984). In the foreword, the Chief Nursing Officer, Robert Tiffany, anticipated that 'the work would soon become an essential resource for individuals and organizations alike'. He wasn't wrong - in 2019 it was the best-selling nursing textbook in the UK. Over the thirty years that the manual has been in use, there have been many expert nurses (and more recently their professional colleagues from other professions) who have given their time to write so that knowledge could be made available to improve care of patients. Over the past 20 years, Dr Lisa Dougherty was 'the manual', and upon her retirement she leaves a legacy with a national and international reputation. With such a reputation to maintain, the work of updating and revising the manual is not one to be taken lightly. With each new edition come requests for more content and additional procedures alongside - paradoxically - requests to make it a slimmer, easier-to-handle textbook"-- Provided by publisher