Introduction

Since its launch in 1948 the National Health Service has been an organisation that has continuously evolved and grown. It has developed in response to political, economic and social factors and in addition the added pressures of medical advancement. The changes can be seen in every element of the services provided, from increasing evidence-based practice through to a transparent and open delivery of care. At this time more than ever healthcare professionals will be working to deliver health care within this dynamic environment, and thereby carry a responsibility to protect the public and to provide health care that is both current and up-to-date.

Even though the provision of health care has changed and expanded over the past fifty years, the core principle of free access to health care remains solid. It is clear within this ever-developing service that major areas that need to respond to changes are the professional roles. Arguably no single profession has changed and expanded so considerably as the role of the Nurse.

This can be seen in a role as commonplace as the Nurse Practitioner: once considered unique and specialist, it is slowly becoming a feature of, and established within, sexual health clinics throughout the UK. Many services now depend on the nurse to deliver specialist care in an autonomous and professional manner. Increasing demands on services fuelled by a continuing rise in STIs drive the demand for care and in turn for more creative ways of practice.

As a response to the rise in sexually transmitted infections the government in the UK has explored and considered the Sexual Health of the nation and as a result formulated new policy and guidelines that will further shape nursing practice.The sexual health strategy (DH 2001a) and more recently the 'choosing health' document, published in November 2004 (DH 2004a) place sexual health as a core element in the health of our society. Amongst their aims is 48-hour access to a sexual heath clinic (DH 2004a), a target that in some parts of the country cannot be met with the present availability of services. Additionally there is also the roll out of the National Chlamydia Screening Programming (DH 2004b), designed to capture the young people who are

Advanced Clinical Skills for GU Nurses. Edited by Matthew Grundy-Bowers and Jonathan Davies © 2007 John Wiley & Sons Ltd statistically the most at risk of contracting this commonly silent infection (Health Protection Agency 2005). More recently community pharmacies are being encouraged to become involved and test young people (DH 2005).

It is becoming clear, then, that sexual health nursing delivered within the framework of the NHS is part of the changing and dynamic system that affects other forms of health care. The increasing pool of sexually transmitted infections drives demands for services that are presently under review and being updated. It is with this in mind that nursing will continue to meet the challenge. At the forefront of new roles and working practices the nursing profession must continue with a responsive and professional approach to sexual health. It is important therefore to look at the new roles and consider the professional and legal responsibilities that encapsulate them. The eagerness and enthusiasm that is demonstrated by the nursing profession must continue to move forwards, and in harmony with this the profession must consider its position legally and professionally and continue to protect the public and enhance the reputation and role of the specialist sexual health nurse within today's NHS.

It is important to recognise the wide range of legal and professional issues that influence nursing practice. For the purpose of this chapter the focus will be on the common issues that affect sexual health nursing practice. These legal and professional issues are both vast and varied. The chapter aims to address the most relevant and challenging issues that sexual health nurses encounter in their daily practice.

• Confidentiality

• Consent to treatment

• Treatment of young people

It is important to acknowledge that the scope of the chapter does not allow for a full and varied explanation of all the legal and professional issues faced in sexual health, and also that the law and its application can evolve and change each time a new legal challenge is raised. It is therefore essential to consider this chapter in terms of an exploration of the legal issues faced in practice and not as a guide on the basis of which concrete decisions regarding practice are made. The chapter should be used to generate thoughts and discussion in consideration of practice.

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