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.

Legal duty of care and the community nurse.

In this month's Policy column, the author explores the concepts of duty of care, forseeability and proximity, and how the community nurse can be better prepared when caring for the patient.

Legal aspects of dying and the community nurse.

In this month's Policy column, Iwan Dowie explores the legality behind caring for those approaching end of life.

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.

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.

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.

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.

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.

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.

The changing nature of the district nurse patient relationship.

In this article Richard Griffith considers three recent developments in policy and law that have changed the nature of the relationship between district nurses and their patients. The traditional, often paternalistic, professional knows best approach must now give way to a patient focused partnership.

The Mental Capacity Act: a review of the current literature.

The Mental Capacity Act (MCA) is a piece of statutory legislation which is designed to empower and protect those who are assessed as being unable to make decisions for themselves. At the time of implementation, the legislation was described as visionary and it had the potential to change the lives of many. However, a post-legislative scrutiny report published in 2014 concluded that there is a lack of knowledge among professionals of the MCA, and so it is not embedded into daily clinical practice. This review of literature has identified four key themes: assessment, training, knowledge and empowerment. These appear to concur with the findings of the House of Lords report. The successful integration of the MCA into professionals' everyday practice is high on the political agenda, thus reinforcing the message that following the guidance set out in the MCA legislation is mandatory and not a choice. A shift in culture and improvement in knowledge and understanding of the MCA is required in order for it to be used in the correct manner for which it was designed.

Covert administration of medicines: a contentious issue.

In its State of Care (2015) report the Care Quality Commission once again highlight unsafe management of medicines as a key concern in those care providers that require improvement. Underpinning the poor management of medicines is the unsafe and routine use of covert administration. In this article Richard Griffith looks at the legal and professional obligations for district nurses when they consider advising the use of covert medicines.

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.

Can covert administration of medicines be in a patient's best interests?

In this article Richard Griffith considers whether it is ever in a patient's best interests to be given medicine by covert means, such as disguising it in food.

Understanding the Code: use of medicines.

The revised Code of the Nursing and Midwifery Council (NMC), the statutory professional regulator for district nurses, makes clear that while district nurses can interpret the values and principles for medication use in community settings, the standards are not negotiable or discretionary. They must be applied or the district nurse's fitness to practice will be called into question. In the final article in the series analysing the legal implications of the NMC Code on district nurse practice, Richard Griffith considers standard 18 on medicines.

Understanding the Code: keeping accurate records.

In his continuing series looking at the legal and professional implications of the Nursing and Midwifery Council's revised Code of Conduct, Richard Griffith discusses the elements of accurate record keeping under Standard 10 of the Code. This article considers the importance of accurate record keeping for the safety of patients and protection of district nurses. The legal implications of records are explained along with how district nurses should write records to ensure these legal requirements are met.

Understanding the Code: working in partnership.

In his continuing series looking at the law underpinning the standards set out in the revised Code ( NMC, 2015 ), Richard Griffith considers standard 2, which requires district nurses to work in partnership with the people in their care. Although the right to self-determination and the requirement for consent has been a legal principle in health care for over 100 years, its emphasis has been on providing a defence for health professionals rather than promoting partnership in the district nurse-patient relationship. Recent developments in policy and law have begun to herald a change in emphasis from 'health professional knows best' to a more patient-focused approach to decisions about care and treatment.

Health visitors' accounts of the impacts of 'Hall 4' on their practice and profession: a qualitative study.

The publication of the fourth edition of Health for all children (Hall 4) in 2003 marked a shift in health visiting towards a more targeted service. This paper aims to explore, through the accounts of health visitors, the impacts of this changed policy context for health visiting practice and for the health visiting profession. The study, upon which this paper is based, was a qualitative exploration carried out in one NHS locality with broad socioeconomic diversity. Semi-structured interviews were undertaken with 16 health visitors. The data was analysed using thematic and narrative techniques. In the study health visitors expressed concerns about the impacts of Hall 4 on health visiting practice, particularly in relation to health visiting expertise and the increase focus on child protection work shaping health visiting practice. In conjunction, health visitors'accounts suggest low morale as a profession.The paper concludes that the impacts of future policy change on health visiting practice must be fully considered; and, measures taken to prepare and support health visitors through periods of policy change.

Interpreting guidance on prosecution for assisted dying for district nurses.

Following a ruling by the House of Lords in 2009, the Director of Public Prosecutions issued guidance setting out the circumstances that would be likely to lead to the prosecution of a person for encouraging or assisting suicide under the Suicide Act 1961, section 2. In that guidance, a district nurse assisting a person to commit suicide would be one of the circumstances that would lead to prosecution. The Director of Public Prosecutions recently unexpectedly amended her guidance in relation to health professionals. This article discusses the implications of the amendment and argues that it will cause confusion among district nurses and give rise to an unrealistic expectation about the role a district nurse can lawfully take in assisting a person to die.