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 ). 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. Core principles guide the decisions that are made about what to include in each new edition:
- The emphasis has always been on the procedures of nursing; the manual is not about the nursing care of an individual with a specific condition.
- The aim is for the manual to be used in practice, so the core of each chapter is the procedures. However, it is not just about how to do a procedure but also about understanding the reasons why.
- The aim is for the manual to be the ‘go‐to’ reference for clinical areas by drawing together information in one place.
- The rationales underpinning the procedures are drawn from a breadth of sources. As would be expected, these include research findings, national and professional guidelines, and policy, but in addition practice‐based evidence is essential. This means that only procedures that are part of nursing care at the Royal Marsden are included to ensure that expertise from practice informs each chapter.
As the first edition of the manual was published in 1984, I was beginning my nursing training at a neighbouring hospital. The focus of nursing, where I trained, was the patient, but alongside that was an increasing awareness that some of the procedures that we carried out were driven by tradition and ritual. There was an appetite for professional research‐based practice. The Royal Marsden Manual at that time was fulfilling an emerging need.
Over the following years, evidence‐based practice came into use more frequently and the scope of practice of nurses broadened, and so too did the structure and content of the manual. In the seventh edition (2008), a system was introduced that made explicit the type of evidence underpinning the steps in a procedure.
The ability to think critically and provide evidence‐based care is at the heart of the role of the nurse in the 21st century:
Registered nurses play a vital role in providing, leading and coordinating care that is compassionate, evidence‐based, and person‐centred. … The confidence and ability to think critically, apply knowledge and skills, and provide expert, evidence‐based, direct nursing care therefore lies at the centre of all registered nursing practice.(NMC )
In the eighth edition, a new structure was introduced that included more of the background information that might be necessary to fully understand the steps in a procedure, such as anatomy and physiology, explanation of equipment choices, and relevant professional and legislative guidance. Along with this came the first online version, which was available to organizations.
This tenth edition reflects the work that is beginning on preparing nurses for the future, linking content (as appropriate) to Future Nurse: Standards of Proficiency for Registered Nurses (NMC ). It also includes expanded content on mental capacity and safeguarding. The ‘Legal and professional issues’ section has been replaced with ‘Clinical governance’. A new chapter on self‐care and wellbeing has also been included, reflecting the expectation that nurses ‘must be emotionally intelligent and resilient individuals, who are able to manage their own personal health and wellbeing, and know when and how to access support’ (NMC ).
I am proud to write the preface to the tenth edition of The Royal Marsden Manual of Clinical Nursing Procedures; I am proud that this resource has been invaluable to nurses in the UK and abroad in a variety of clinical settings, as Robert Tiffany hoped it would be; I am proud that nursing has not just talked about ritualized practice but has taken steps to become evidence based, with a critical approach to patient care; I am proud that nurses have read and used the manual, and most importantly have given feedback when what they read wasn't clear or wasn't right. The foreword to the second edition ends by stating that the text wasn't a ‘final document’! As the tenth edition goes to print, I would echo that sentiment: the manual is always a work in progress – and even more so with the online edition. Work begins on the next edition as soon as this one goes to print, so please keep telling us what we need to do differently. This is your manual.
Joint editor of the sixth, seventh, eighth, ninth and tenth editions