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Evidence‐based practice and The Royal Marsden Manual of Clinical Nursing Procedures

The evidence that informs clinical nursing procedures is integral to The Royal Marsden Manual of Clinical Nursing Procedures. It is critically discussed in the sections within each chapter on ‘related theory’ and ‘evidence‐based approaches’. In these sections, the source of evidence (reflecting the sources described by Rycroft‐Malone et al. [37]) is indicated in the rationale that supports the steps in procedures. In previous editions, the level on the research hierarchy was also included, in an attempt to represent the robustness of the evidence. In this edition, that nomenclature has been dropped for two reasons: because the hierarchy does not include qualitative studies, some of which are significant in informing nursing practice, and because the hierarchy does not recognize the quality of a study, just the methodological approach.
The following key is used to indicate the sources of evidence:
  • Clinical experience (E)
    • Encompasses expert practical know‐how, gained through working with others and reflecting on best practice.
    • Example: (Dougherty [8], E). This is drawn from the following article that gives an expert clinical opinion: Dougherty, L. ([8]) Obtaining peripheral vascular access. In: Dougherty, L. & Lamb, J. (eds) Intravenous Therapy in Nursing Practice, 2nd edn. Oxford: Blackwell.
  • Patient (P)
    • Gained through expert patient feedback and extensive experience of working with patients.
    • Example: (Diamond [6], P). This was gained from a personal account of care written by a patient: Diamond, J. ([6]) C: Because Cowards Get Cancer Too. London: Vermilion.
  • Context (C)
    • Can include audit and performance data, social and professional networks, local and national policy, guidelines from professional bodies (e.g. the RCN) and manufacturers’ recommendations.
    • Example: (NMC [23], C). This reference is: NMC ([27]) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: Nursing and Midwifery Council.
  • Research (R)
    • Evidence gained through research.
    • Example: (Stevenson et al. [42], R). Stevenson, J.C., Emerson, L. & Millings, A. ([42]) The relationship between adult attachment orientation and mindfulness: A systematic review and meta‐analysis. Mindfulness, 8, 1438–1455.
In the text, the source will be represented as shown in Box 1.8. If there is no written evidence to support clinical experience or there are no guidelines to justify undertaking a procedure, the text will be referenced as an ‘E’ but will not be preceded by an author's name. Through this process, it is hoped that the reader will be aware of the source of the evidence upon which the care of patients is based and continue to critically evaluate their practice, engaging in research and audit where there are gaps or where best practice is not confirmed.
Box 1.8
Examples of sources
  • Clinical experience and guidelines (Dougherty [8], E)
  • Patient (Diamond [6], P)
  • Context (NMC [27], C)
  • Research (Stevenson et al. [42], R)
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