The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [5]
The sources of evidence, along with examples, are identified as follows:
1 Clinical experience (E):
Encompasses expert practical know-how, gained through working with others and reflecting on best practice.
If there is no written evidence to support clinical experience as a justification for undertaking a procedure the text will be referenced as an E but will not be preceded by an author’s name.
Example: (Dougherty 2008: E). This is drawn from the following article that gives expert clinical opinion: Dougherty, L. (2008) Obtaining peripheral vascular access. In: Intravenous Therapy in Nursing Practice (eds L. Dougherty & J. Lamb), 2nd edn. Blackwell Publishing, Oxford.
2 Patient (P):
Gained through expert patient feedback and extensive experience of working with patients.
Example: (Diamond 1999: P). This has been gained from a personal account of care written by a patient, Diamond, J. (1999) C: Because Cowards Get Cancer Too. Vermillion, London.
3 Context (C):
May include Audit and Performance data, Social and Professional Networks, Local and National Policy, guidelines from Professional Bodies (e.g. Royal College of Nursing; RCN) and manufacturer’s recommendations.
Example: (DH 2001: C). This document gives guidelines for good practice: DH (2001) Reference Guide to Consent for Examination or Treatment. Department of Health, London.
4 Research (R):
Evidence gained through research.
Example: (Fellowes et al. 2004: R 1a). This has been drawn from the following evidence: Fellowes, D., Wilkinson, S. & Moore, P. (2004) Communication skills training for healthcare professionals working with cancer patients, their families and/or carers. Cochrane Database Syst Rev, 2, CD003751. DOI: 10.10002/14651858.CD003571.pub2.
The levels that have been chosen are adapted from Sackett, Strauss and Richardson (2000) as follows:
1 (a) Systematic reviews of randomized controlled trials (RCTs).
(b) Individual RCTs with narrow confidence limits.
2 (a) Systematic reviews of cohort studies.
(b) Individual cohort studies and low quality RCTs.
3 (a) Systematic reviews of case-controlled studies.
(b) Case-controlled studies.
4 Case series and poor quality cohort and case-controlled studies.
5 Expert opinion.
The rationale for the system and further explanation is discussed in more detail in Chapter 1.
The Manual is informed by the day-to-day practice in the Royal Marsden Hospital NHS Foundation Trust and conversely is the corporate policy and procedure document 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 practice.
Core to nursing, wherever it takes place, is the commitment to care for individuals and to keep them safe. Increasing use is being made of the internet to record and access information essential in maintaining this safe environment. This edition of The Royal Marsden Hospital Manual of Clinical Nursing Procedures has been significantly revised to reflect the move to utilize electronic records and web-based information in the process of providing patient care.
A more detailed uniform structure has been introduced for all chapters so that there is a balance to the information included. The number of chapters has been reduced, grouping together similar procedures related to an aspect of human functioning. This is to avoid the need to duplicate material and to make it easier for the reader to find.
The chapters have been organized into four broad sections that represent as far as possible the needs of a patient along their care pathway. The first section, Managing the patient journey, presents the generic information that the nurse needs for every patient who enters the acute care environment. The second section, Supporting the patient with human