Sara Lister, Head of Pastoral Care and Psychological Support, The Royal Marsden NHS Foundation Trust.

Justine Hofland, Formerly Divisional Clinical Nurse Director Cancer Services, The Royal Marsden NHS Foundation Trust.

Hayley Grafton, Chief Nursing Information Officer, The Royal Marsden NHS Foundation Trust.

Catherine Wilson, Formerly Head of School, The Royal Marsden School, The Royal Marsden NHS Foundation Trust.

Foreword xvii

Acknowledgements xviii

List of contributors xix

Quick reference to the procedure guidelines xxiii

How to use your manual xxv

About the companion website xxviii

1 The context of nursing 1

Overview 2

Background 2

Context of nursing 2

Evidence-based practice 7

Structure of the manual 9

Structure of the chapters 9

Finally 9

References 10

Part One Managing the patient journey 13

2 Admissions and assessment 15

Overview 16

Inpatient assessment and the process of care 16

Observation 24

Physical assessment 25

References 44

3 Discharge care and planning 47

Overview 48

Discharge care and planning 48

Discharging patients from hospital: internal procedures 49

Interface between primary and secondary care: external processes 56

Informal carers 62

The role of voluntary services 65

References 66

4 Infection prevention and control 69

Overview 70

Infection prevention and control 70

Hand hygiene 80

Personal protective equipment (PPE) 92

Specific patient-related procedures 107

Isolation procedures 111

Environmental hygiene and the management of waste in the healthcare environment 118

Prevention and management of inoculation injury 125

References 126

Part Two Supporting patients with human functioning 131

5 Communication, psychological wellbeing and safeguarding 133

Overview 134

Communication 134

Providing information and making shared decisions 147

Communicating with specific populations 151

Psychological wellbeing 157

Safeguarding, mental capacity and the Mental Health Act 180

References 199

6 Elimination 205

Overview 206

Normal elimination 206

Altered urinary elimination 212

Altered faecal elimination 243

Stoma care 264

References 277

7 Moving and positioning 283

Overview 284

Moving and positioning: general principles 284

Moving and positioning an unconscious patient 297

Moving and positioning a patient with an artificial airway 299

Moving and positioning a patient with respiratory compromise 303

Moving and positioning a patient with neurological impairment 307

Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury 320

Moving and positioning a patient with raised intracranial pressure 330

Moving and positioning a patient with an amputation 331

References 336

8 Nutrition and fluid balance 339

Overview 340

Fluid balance 340

Nutritional status 357

Provision of nutritional support: Oral 365

Nutritional management of patients with dysphagia 371

Enteral tube feeding 372

Parenteral nutrition 395

References 398

9 Patient comfort and supporting personal hygiene 403

Overview 404

Personal hygiene 404

Sleep promotion in a hospitalized patient 416

Patient environment 418

Eye care 423

Ear care 433

Mouth care 437

References 450

10 Pain assessment and management 457

Overview 458

Pain 458

Pain management 467

Regional analgesia: local anaesthetic nerve blocks and infusions 473

Epidural analgesia 475

Entonox administration 485

Non-pharmacological methods of managing pain 489

References 492

11 Symptom control and care towards the end of life 497

Overview 498

End-of-life care 498

Symptom control 516

Terminal sedation 527

Care after death (last offices) 528

References 535

12 Respiratory care, CPR and blood transfusion 539

Overview 540

Respiratory therapy 540

Oxygen therapy 543

High-flow oxygen via a nasal cannula 552

Humidification 555

Non-invasive ventilation 556

Chest drain management 564

Tracheostomy and laryngectomy care 581

Basic life support 612

Transfusion of blood and blood components 626

References 650

Part Three Supporting patients through the diagnostic process 657

13 Diagnostic tests 659

Overview 660

Diagnostic tests 660

Blood sampling 664

Venepuncture: obtaining blood samples from a peripheral vein 667

Blood cultures 677

Cerebrospinal fluid obtained by lumbar puncture 679

Specimen collection: swab sampling 683

Specimen collection: urine sampling 692

Specimen collection: faecal sampling 698

Specimen collection: respiratory tract secretion sampling 700

Specimen collection: pleural fluid 702

Endoscopic investigations 702

Liver biopsy 708

Radiological investigations: X-ray 710

Magnetic resonance imaging (MRI) 710

Computed tomography (CT) 712

References 714

14 Observations 719

Overview 720

Observations 720

Pulse (heart rate) 723

Electrocardiogram (ECG) 730

Blood pressure 738

Respiration and pulse oximetry 745

Peak flow 757

Temperature 762

Urinalysis 768

Blood glucose 773

Neurological observations 781

References 796

Part Four Supporting patients through treatment 801

15 Medicines optimization: ensuring quality and safety 803

Overview 804

Medicines management 804

Self-administration of medicines 817

Controlled drugs 817

Routes of administration 827

Parenteral administration (injections and infusions) 854

Peripheral cannulas 898

Infiltration and extravasation 915

References 927

16 Perioperative care 937

Overview 938

Pre-operative care 938

Intraoperative care 973

Post-operative care 999

References 1022

17 Wound management 1029

Overview 1030

Wounds 1030

Pressure ulcers 1043

Surgical wounds 1053

Negative pressure wound therapy 1055

References 1058

Part Five Looking after ourselves so we can support patients 1061

18 Self-care and wellbeing 1063

Overview 1064

Self-care and wellbeing 1064

Mindfulness 1072

Eating and drinking 1073

Physical wellbeing and musculoskeletal health 1077

References 1081

Appendix: Standards of Proficiency for Registered Nurses 1085

List of abbreviations 1089

Index 1093