The law and professional considerations of confidentiality.

In this month's Policy column, Iwan Dowie explores the laws of confidentiality, which forms part of the legal obligation of every community nurse.

Respecting patient autonomy: legal and professional considerations.

In this month's Policy column, Iwan Dowie explores patient autonomy - a concept largely embedded within the community nursing setting. Through legal cases, a history of laws relating to patient autonomy are presented and its implications for community nurses discussed.

Record keeping and the community nurse.

Iwan Dowie discusses the need for appropriate record keeping in community nursing. Through a series of legal examples, a case is made for good documentation, with suggestions that include factual, eligible and well-written records.

Understanding the legal considerations of consent in nursing practice.

Consent to treatment is a common, albeit complex, aspect of nursing practice. Over the past few years, laws have been strengthened to provide increased recognition of patient autonomy. This has meant that there is a greater onus placed on nurses to understand how consent is obtained from patients, the elements required to ensure any consent is valid, and how to proceed when it has been determined that a patient does not have the mental capacity to consent to treatment. This article explores some of the legal considerations that nurses should keep in mind when seeking consent from a patient.

How to verify the death of a patient.

When a patient dies, it is important that nurses understand their role in the verification of death. This article explains the steps required to verify the death of an adult patient. Verification of death is not a mechanistic task, but one that requires sensitivity and compassion. It is also crucial that nurses understand the legal implications of verifying a patient's death. With the development of the current coronavirus disease 2019 (COVID-19) pandemic, nurses must also understand any changes in their role when verifying the death of a patient. Verification or confirmation of death is the process of ascertaining whether a patient is deceased, based on a physical assessment. Nurses can only verify a death if the patient is expected to die and has a do not attempt cardiopulmonary resuscitation (DNACPR) order in place. A DNACPR order is essential because it allows the nurse to verify the death without being concerned with the need to resuscitate the patient. Nurses should ensure they act in accordance with local and national guidance regarding the verification of a patient's death. REFLECTIVE ACTIVITY: How to articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: How this article might inform your practice when verifying a patient's death. How you could use this information to educate your colleagues on the appropriate steps required when verifying a patient's death.

Understanding the standard of care required by nurses.

It is an established principle that nurses owe their patients a duty of care, which incorporates a legal, an ethical and a professional duty. However, they must also meet the standard of care deemed necessary to maintain safe and effective delivery of care to patients. Defining what is meant by the standard of care is complex, and meeting it can be challenging in an increasingly pressurised healthcare environment. This article describes the standard of care required using previous legal cases. It also explores some of the challenges involved in defining the standard of care in a rapidly changing healthcare environment.

Legal, ethical and professional aspects of duty of care for nurses.

Duty of care is a fundamental aspect of nursing, and many nurses consider this to be an important part of their professional duties as a nurse. However, the legal underpinnings of duty of care are often overlooked, and, as such, nurses may be unsure about when to act if they encounter emergency situations or serious incidents, especially when they are off duty. This article examines the legal, ethical and professional aspects of duty of care, what these mean for nurses in practice, and how duty of care is intrinsically linked with standards of care and negligence.

Cyanoacrylate microbial sealants for skin preparation prior to surgery.

BACKGROUND: Surgical site infections (i.e. incisions that become infected) are a continuing concern in health care. Microbial sealant is a liquid that can be applied to the skin immediately before surgery and is thought to help reduce the incidence of surgical site infections (SSIs) by sealing in the skin flora, thus preventing contamination and infection of the surgical site. OBJECTIVES: To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on rates of SSI in people undergoing clean surgery. SEARCH METHODS: For this first update we searched the following electronic databases in July 2013: the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE - In-Process & Other Non-Indexed Citations, Ovid EMBASE and EBSCO CINAHL. SELECTION CRITERIA: Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract or any part of the body with an existing infection) in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant. DATA COLLECTION AND ANALYSIS: All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trials. MAIN RESULTS: Three trials (524 participants undergoing clean surgery) met the inclusion criteria. The trials all compared cyanoacrylate microbial sealant with no sealant, and, when pooled, we found there were fewer SSIs with the use of microbial sealant (10/261 participants) than with the control comparison (29/274 participants). The difference between the two groups was statistically significant (risk ratio (RR) 0.36, 95% CI 0.18 to 0.72) but given the number of participants and quality of the studies, they should be treated with caution. There were some adverse events in one study, but these were not judged to be a result of the use of microbial sealant. AUTHORS' CONCLUSIONS: In this first update there is still insufficient evidence available to determine whether the use of microbial sealants reduces the risk of surgical site infection or not. Further rigorous, adequately-powered RCTs are required to investigate this properly.

Supporting the lecturer to deliver high-fidelity simulation.

In response to a shortage of clinical practice placements for pre-registration nurses and midwives, nursing faculties have been examining alternative ways to support students to develop their clinical skills, with simulation being one of the more popular methods. In a nursing context, simulation is often used to replicate a clinical setting, such as a hospital ward or the patient's home. Some universities have introduced clinical suites that enable replication of clinical environments and offer the use of human patient simulators to mimic patient-focused scenarios. This article describes a small informal review that aimed to identify how lecturers felt about simulation in one faculty using high-fidelity simulated scenarios to inform the development of a subsequent research study. The results indicate that although many staff use simulation and believe it is a beneficial approach to learning, many also lack confidence and do not feel sufficiently prepared in its use. Most participants felt that the development of a simulation module for lecturers would increase their confidence.

Cyanoacrylate as a microbial sealant: examining the evidence.

This article examines the evidence base for the use of microbial sealant as a skin preparation prior to surgery. Firstly, using the steps of evidence-based practice the use of cyanoacrylate as a microbial sealant was explored. Next the evidence regarding the use of cyanoacrylate based microbial sealant was sought and then critically appraised. Having found evidence to support its use to be lacking in rigour and quality, an argument is made for the omission of cyanoacrylate-based microbial sealants as part of current preoperative preparation.

Cyanoacrylate microbial sealants for skin preparation prior to surgery.

BACKGROUND: Surgical site infections are a continuing concern in health care. Microbial sealant is a liquid applied to the skin immediately before surgery. It is thought to contribute to reducing surgical site infections by sealing in the skin flora to prevent contamination and infection of the surgical site. OBJECTIVES: To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on the rates of surgical site infection in people undergoing clean surgery. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (searched 10 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), Ovid MEDLINE (1950 to April Week 3 2010), Ovid MEDLINE - In-Process & Other Non-Indexed Citations (searched 10 May 2010), Ovid EMBASE (1980 to 2010 Week 18) and EBSCO CINAHL (1982 to 10 May 2010). We searched bibliographies and contacted manufacturers of microbial sealants for unpublished studies. There were no restrictions based on language, date or publication status. SELECTION CRITERIA: Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant. DATA COLLECTION AND ANALYSIS: All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trial. MAIN RESULTS: One small trial (177 participants undergoing hernia repair) met the inclusion criteria. There was no statistically significant difference in the rates of surgical site infection (three patients in the control group developed a surgical site infection compared with none in the intervention group; risk ratio (RR) 0.17, 95% CI 0.01 to 3.19, P = 0.23). AUTHORS' CONCLUSIONS: There is currently insufficient evidence as to whether the use of microbial sealants reduces the risk of surgical site infection in people undergoing clean surgery and further rigorous RCTs are required.

Reflections on academic supervision.

Academic supervision is vital for students who are developing academic careers. New lecturers have little training to prepare them for the role of supervisor and may not feel adequately prepared to support the needs of students. This article discusses academic supervision from the viewpoint of a nurse lecturer, examines the nature of supervision and makes recommendations for practice.