Chapter 1: The context of nursing
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Structure of the chapters
The structure of the chapters is consistent throughout the manual. The core of each chapter is the procedures or guidelines. The other sections provide supporting information so that the procedure can be carried out with understanding of the clinical, technical, physiological, psychological and professional knowledge and evidence from which it has been developed. In each chapter there are the following elements:
- Overview: as the chapters are large and have considerable content, each one begins with an overview to guide the reader, informing them of the scope and the constituent sections of the chapter.
- Definition: each section begins with a definition of the terms and an explanation of the aspects of care, with any technical or difficult concepts explained.
- Anatomy and physiology: if it is necessary to understand the anatomy or physiology of a part of the body to perform a procedure, then the chapter or section includes a discussion of the related anatomy and physiology. If appropriate, this is illustrated with diagrams so the context of the procedure can be fully understood by the reader (e.g. electrical functioning of the heart to explain how electrocardiography works).
- Related theory: if it is necessary to understand theoretical principles in order to understand a procedure, then these are included (e.g. theory of communication).
- Evidence‐based approaches: these sections provide background information and present the research and expert opinion in the relevant area. If appropriate, the indications and contraindications are included, as are any principles of care.
- Clinical governance: these sections outline any professional guidance, law or other national policy that may be relevant to the procedures. If relevant, this also includes any professional competences or qualifications required in order to perform the procedures. Any risk management considerations are also included in these sections, including principles of harm‐free care.
- Pre‐procedural considerations: when carrying out any procedure, there are certain actions that may need to be completed, or equipment prepared, or medication given, before the procedure begins. These are made explicit under this heading.
- Procedure: each chapter includes the current procedures that are used in the acute hospital setting. They have been drawn from the daily nursing practice at The Royal Marsden NHS Foundation Trust. Only procedures about which the authors have knowledge and expertise are included. Each procedure gives detailed, step‐by‐step actions, supported by rationales. Where available, the known evidence underpinning these rationales is indicated.
- Problem solving and resolution: if relevant, each procedure is followed by a table of potential problems that may be encountered while carrying out the procedure as well as suggestions as to the cause, prevention and any action that may help to resolve the problem.
- Post‐procedural considerations: care for the patient does not end with the procedure. This section details any documentation the nurse may need to complete, education and information that needs to be given to the patient, and ongoing observations or referrals to other members of the multiprofessional team that may be required.
- Complications: any ongoing problems or potential complications associated with the procedure are discussed in a final section. Evidence‐based suggestions for resolution are also included.
- Illustrations: colour illustrations have been used to demonstrate the steps of some procedures. These will enable the nurse to see in greater detail, for example, the correct position of the hands or the angle of a needle.
- Websites and references: many of the chapters have a list of related websites that can be consulted for further information. All of the chapters end with a reference list. Only texts from the past 10 years have been included, unless they are seminal texts.
