The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [16]
Table 1.2 Procedures that could be carried out by a healthcare assistant after relevant training and competency assessment supervised by a Registered Nurse (this is not an exhaustive list)
Procedure Chapter
Penile sheath application 6
Urinary catheter bag: emptying 6
Stoma care 6
Fluid input: measurement 8
Measuring the weight and height of the patient 8
Blood components: collection and delivery to the clinical area 8
Mouthcare 9
Venepuncture 11
Swab sampling: ear, eye, nose, penile, rectal, throat 11
Urine sampling: midstream specimen of urine – male/female 11
Faecal sampling 11
Pulse measurement 12
Electrocardiogram 12
Blood pressure measurement (manual) 12
Respiratory assessment and pulse oximetry 12
Peak flow reading using a manual peak flow meter 12
Temperature measurement 12
Urinalysis – reagent strip procedure 12
Blood glucose monitoring 12
Antiembolic stockings: assessment, fitting and wearing 14
Vigilance
Aiken et al. 2002 further emphasized the essential role of the Registered Nurse, describing them as ‘the surveillance system’. It is not just the actions of taking the vital signs, dressing the wound or starting the intravenous drip, it is also ‘the watchfulness’ that is always part of the nurse’s thinking process while activities such as these are completed (Meyer and Lavin 2005). This has been described as vigilance. Vigilance is the search for signals (Lancaster 1998), which are events that the individual determines to be indicators of something significant. Vigilance is not seen; it is only an action that occurs as the result of watching out for and responding to the signals that will suggest to others that vigilance has been happening. Meyer and Lavin 2005 propose that vigilance has five components (Box 1.4).
Box 1.4 Five components of vigilance and how this manual can help the nurse to develop them
Attaching meaning to what is: this is described as the ability to differentiate ‘adverse signals’ indicating danger from the ordinary ‘noise’ – the normal signs and symptoms. Developing theoretical and professional knowledge is an important part of learning to identify these signals. The reference material in the introductory chapters is essential to developing an understanding of the underlying physiological function or psychological response of the individual so the nurse understands what is normal.
Anticipating what might be: observe, as the normal procedures and responses are described so the abnormal becomes more apparent.
Calculating risks: understanding that there is an inherent risk in every situation. Problem-solving sections help to increase risk awareness and knowledge of the implications of untoward situations associated with procedures.
Readiness to act: developed from a knowledge base, this allows the nurse to know what might be required in a situation and to make sure interventions can be carried out quickly when necessary. The manual has been written by experts who are sharing years of experience of carrying out the procedures. Therefore they know what equipment is needed, have knowledge of the potential problems that might occur and, over time, they have built up solutions to address them.
Monitoring the results of interventions: experts writing chapters have made explicit the source of the rationale for steps in the intervention process, that is, professional knowledge.
Benefit of registered nurses delivering care
If qualified nurses deliver care there is also an increased opportunity for patients to benefit from therapeutic nursing. Evidence demonstrates that this does contribute positively to the patient’s experience of care (Spilsbury and Meyer 2001). As well as this often hidden aspect of nursing being essential to organizations, it is also essential for patients