Important legal principles of consent and mental capacity.

Consent is an essential part of healthcare practice, allowing patients to make autonomous decisions. However, this changes when a patient has mental incapacity or is unable to make decisions for themselves for a duration of time. This month's Policy column looks at some of the key principles of the Mental Capacity Act 2005, and how this can be applied in community nursing practice.

Why Should Nurses Care About the Supreme Court?

Many cases have direct and indirect bearing on health care policy and public health.

Positive obligations to protect against deprivation of liberty in the community.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the positive obligation to protect vulnerable people from unauthorised deprivations of liberty in various community settings.

Community and family nurse: Present keys, future challenges. / Enfermería Familiar y Comunitaria: claves de presente, retos de futuro.

It is the mission of the Community and Family Nurse through an integral and holistic approach to accompany people from cradle to death in developing their health potential, and promote different family, work and social environments to facilitate this development. Throughout history, various international, European and national organizations have regulated the figure of the Community and Family Nurse, and now their functions, powers and professional performance are fully regulated. The Community and Family Nurse can respond to the needs of a changing population and take on new responsibilities in management and research. Their extensive basic and advanced skills gathered under a rigorous training programme, benefit the health system, the nursing profession, citizenry and its communities. Many challenges remain for the Health Departments of each Autonomous Region to make it possible for this specialty to develop its full potential for improving care.

The implementation of the Mental Health Nursing Specialty in Andalusia. A community approach. / La implantación de la especialidad de Enfermería de Salud Mental en Andalucía desde un enfoque comunitario.

Health systems have a responsibility to respond to the new health needs of the population, which are characterized by factors such as aging, chronicity and/or dependency situations and which requires quality and specialized care adapted to different areas where care is provided, care offered by trained and increasingly qualified professionals to improve the health outcomes of the caregivers. In 2016, in Andalusia the regulatory framework by which is created the statutory professional category of nurse/specialists is published, including the specialty of Mental Health Nursing in the Andalusian Health Service. In the field of Mental Health, the development of this normative framework and the definition and occupation of positions, will allow the health system to combine the role of nurse specialist nurses with that of nurses who provide general care, registered nurses, in order to advance in the best response to the health needs of citizens in this area of care. The development of the specialty will be an added value both to improve the health outcomes of people with mental health problems, and to improve the quality of care, efficiency and sustainability of health systems.

Family and community nursing, chronology of a specialty. / Enfermería familiar y comunitaria, cronología de una especialidad.

More the 30 years have passed since the first Royal Decree that regulated nursing specialties was published in 1987. It is the Royal Decree published in 2005 that really allowed the training development of part of the specialties recognized in it (family and community nursing, paediatric nursing, geriatric nursing and occupational health nursing) since the obstetric-gynaecological specialist nurses (midwives) and mental health specialists had long since already started their training processes through the resident internal nurse model, today, training in the specialty of family and community nursing has been implemented in all the autonomous communities, but has not had the same development in terms of the incorporation of specialists in the health institutions of the respective health services of the autonomous communities This circumstance is generating a great lack of motivation among community nurses, both specialists and those who hope to obtain the qualification through a specialty exam. Many of the objectives achieved to date have been made possible thanks to the work of the scientific societies of community nursing (Association of Community Nursing [AEC] and Federation of Associations of Community Nursing and Primary Care [FAECAP]), which have allowed progress to be made and the process not to be halted, although there are still many achievements to be made on which the aforementioned scientific societies continue to work. In a society in which nursing care is increasingly necessary and demanded, it must have greater consideration and position in health policies, since it has demonstrated its effectiveness and can be the model that allows the health system to be sustainable. Therefore, nurses who specialize in family and community nursing must cease constituting an opportunity and become a reality.

La enfermera de pediatría de atención primaria, referente de salud para los pacientes y las familias en la edad infantojuvenil / Primary care nurse in pediatrics, a reference of health for patients and families in infants-youth age

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Neglect by carers.

There have been two widely reported criminal cases where informal carers, including family members, have been found guilty of the gross negligence manslaughter of the vulnerable person in their care. In this article, Richard Griffith considers the duty on informal carers when caring for a person and the duty on district nurses to protect vulnerable persons from harm.

District nurses now less likely to face prosecution for gross negligence manslaughter.

In this article the author discusses the Court of Appeal decision in R v Rose [2017] that redefines the threshold for prosecution for gross negligence manslaughter. The impact on district nurses will be that they are unlikely to face prosecution where a careless error contributed to a patient's death unless there was a serious and obvious risk of death at the time the error was made.

Obtaining a real consent.

Obtaining a real consent is fundamental to the propriety of treatment given by district nurses. Real consent respects patient autonomy and is underpinned by three key elements. In this article, on the principles of patient consent, Richard Griffith outlines the elements of a real consent and the importance of obtaining consent to district nurse practice.

Undertaking research on people who lack decision-making capacity.

The Declaration of Helsinki requires that health care research takes place with the informed consent of those who participate in the study. This approach upholds the autonomy of the participants, but restricts research to subjects who have decision-making capacity. The Mental Capacity Act 2005 introduced safeguards that enable researchers to investigate the care and treatment of people with incapacity, while protecting this vulnerable patient group. These safeguards allow people who lack decision-making capacity to benefit from research findings. In this article, Richard Griffith outlines the requirements that must be met when district nurses conduct research on subjects who lack decision-making capacity.

Especialidad de enfermería familiar y comunitaria. La historia interminable / No disponible

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Professionalism in practice: the Coroner's Court.

A coroner recently declared a district nursing service as unfit for purpose following the death of a patient and held the care given by district nurses was unprofessional and contributed to the patient's decline and death. In this article Richard Griffith considers the coroners concerns in relation to the professional standards imposed on district nurses.

Enfermería penitenciaria: marco legal y realidad asistencial / Prison nursing: legal framework and care reality

Introducción: La Enfermería Penitenciaria ha experimentado durante las últimas décadas una profunda trasformación, similar a la experimentada por el resto de la Enfermería, pero hay una distancia importante con la legislación que la ampara. Objetivo: explorar la realidad asistencial de la Enfermería Penitenciaria mediante la recopilación y análisis de los principales documentos legales que regulan la Sanidad Penitenciaria en los centros penitenciarios españoles. Metodología: Revisión bibliográfica en fuentes como Medline, Cuiden, Scielo, Dialnet, etc. Se emplearon las palabras clave: 'enfermería', 'cárcel', 'prisión', 'evolución', 'funciones enfermería prisiones', 'leyes enfermería prisiones' y 'sanidad penitenciaria'. Se revisan artículos entre 1834 y 2015. Además se utilizaron tres libros especializados sobre Sanidad Penitenciaria, se revisó Revista Española de Sanidad Penitenciaria y la página web del Ministerio del Interior de Instituciones Penitenciarias, así como varios documentos legales relacionados con el tema. Resultados: Se seleccionaron 43 documentos, debido a su pertinencia con el tema objeto de estudio. Se rechazaron 4 artículos por carecer de la misma. Se analizaron los documentos en cuanto a marco legal y funciones de enfermería en prisiones en sus diferentes apartados (asistencial, docente, investigador y de gestión). Conclusión: Las funciones que los enfermeros desempeñan actualmente en los CP son las marcadas por la legislación sanitaria extrapenitenciaria, además de las normas administrativas internas establecidas por la Institución Penitenciaria. Debería replantearse la necesaria integración de la Sanidad Penitenciaria en el Sistema Público de Salud de forma que garantice la igualdad de la asistencia sanitaria para las personas privadas de libertad y proporcione los mismos derechos y deberes a los profesionales sanitarios que la ejercen (AU)

Introduction: Prison nursing has undergone a major transformation in recent decades, similar to that experienced in other sectors of nursing. However, a considerable distance has to be covered before the provisions of protective legislation become a reality. Objective: To analyze the main legal documents which regulate the functions of Prison Nursing and to compare it with the reality of health care for nurses in Spanish prisons. Methodology: Narrative bibliographic review based on various sources such as Medline, Cuiden, Scielo, Dialnet, etc. Results: 43 documents were selected for their relevance to the subject matter of the study. 4 were rejected for not having any relevance. The documents were analysed for references to the legal framework and functions of nursing in prisons in different sections (health care, teaching, research and management). Conclusion: The functions currently carried out in prisons are the ones provided for by health care legislation outside the prison context, along with the internal administrative regulations established by prisons. The possibility should be reconsidered of integrating Prison Healthcare into the Public Healthcare System so as to guarantee equality of healthcare for persons deprived of liberty and to provide the same rights and obligations to health professionals working in this sector (AU)

Situación actual de la especialidad de Enfermería Familiar y Comunitaria en España / State speciality Family and Community Nursing in Spain

Objetivo: Conocer la realidad sobre la aplicación del programa formativo en cada una de las Unidades Multiprofesionales de Atención Familiar y Comunitaria, y también describir la situación actual y perspectivas laborales de los actuales especialistas de Enfermería Familiar y Comunitaria. Método: Estudio descriptivo de corte transversal realizado durante los meses de Septiembre y Octubre del 2014 a los profesionales residentes y especialistas de Enfermería Familiar y Comunitaria de toda España. Para obtener los datos se facilitó de forma online un cuestionario autoadministrado de carácter voluntario y anónimo, el cual fue elaborado por un grupo de expertos en la especialidad de Enfermería Familiar y Comunitaria pertenecientes a la Asociación Gallega de Enfermería Familiar y Comunitaria de Galicia (AGEFEC). Resultados: Se estudió una muestra de 342 profesionales. El 69% eran residentes y el 31% especialistas en Enfermería Familiar y Comunitaria. El 54% de los especialistas y el 56% de los residentes indican un déficit en la adquisición de competencias recogidas en el programa formativo de su especialidad. El 46% de los especialistas está trabajando actualmente en el ámbito de la Atención Primaria. Conclusiones: Resulta de vital importancia ofrecer una formación especializada en Enfermería Familiar y Comunitaria lo más homogenizada posible, sirviendo como un instrumento necesario para garantizar la calidad de la formación en todo el sistema sanitario (AU)

Objective: Knowing the reality on the implementation of the training program in each of the teaching units Multiprofessional Family Care and Community, and also to describe the current situation and perspectives of current labor specialists of Family and Community Nursing. Method: Descriptive cross-sectional study conducted during the months of September and October 2014 resident`s professionals and specialists of Family and Community Nursing throughout Spain. For data was provided so online a self-administered questionnaire voluntary and anonymous, which was developed by a group of experts in the specialty of Family and Community Nursing belonging to the Galician Association of Family and Community Nursing Galicia (AGEFEC). Results: A sample of 342 professionals was studied. 69% were residents and 31% specialists in Family and Community Nursing. 54% of specialists and 56% of residents indicate a deficit in the acquisition of skills included in the training program for their specialty. 46% of specialists are currently working in the field of primary care. Conclusions: It is important to provide a specialized training Family and Community Nursing homogenized as possible, serving as a necessary step to ensure the quality of training throughout the health system instrument (AU)

Meeting the special medicinal needs of patients.

The clinical needs of patients can often be met by prescribing and administering a licensed medicine. District nurses will have some cases where a medicine cannot be used because the patient is unable to take it in its licensed form. In such situations, district nurses may be able to arrange for the patient to be supplied with an unlicensed medicine specifically made to meet that patient's special need. This article discusses the options available to district nurses to lawfully supply patients who have a special medication need due to, for example, an allergy to a particular ingredient or an inability to swallow solid oral medicines, such as tablets or capsules.