Factors influencing nurses’ judgements about self‐neglect cases

Abstract

From the perspective of the practising nurse self-neglect may best be understood in terms of a set of complex and often poorly defined clinical problems in which two key clinical issues are "how do I judge whether this person has the capacity to make decisions about their lifestyle?" and "do we need to treat this person using mental health legislation?" These are taxing questions as judging if a patient has the capacity to make decisions about their lifestyle choices is difficult for even the most experienced clinicians. Such determinations require nurses to form a judgement as to mental capacity of the patient. We do not know what patient characteristics and in what combination nurses use these when making these judgements. This factorial survey aimed to identify which patient characteristics influenced Registered Nurses' judgements on decision-making capacity and decisions on the use of interventions which require statutory interventions in cases of self-neglect. Judgements on decision-making capacity were overwhelmingly predicted by information of the patients' mental health status. Nurses place patients in one of three broad categories of no mental illness, minor mental illness and severe mental illness. This categorization appears to operate as a fast and frugal heuristic indicating that nurses may use mental status as a cognitive screen to work from in judging self-neglect. Although there is a correlation between the severity of mental illness and the capacity for making decisions they are not the same. This study shows the continued work that needs done in educating nurses not only about self-neglect but also about the role a patient's mental status may have in assessment of problems.

Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey

“…2009), substance abuse (Wallander & Bloomqvist 2009), child abuse (O’Toole et al. 1997), self‐neglect (Lauder et al. 2006) and acute confusion (Ludwick 1999).…”

Home Care Nursesʼ Experiences With and Perceptions of Elder Self-Neglect

“…have been conducted with nurses (Adams & Johnson, 1998;Ernst & Smith, 2012;Lauder et al, 2006), and none of those nurses were identified as clinicians who made home visits. The current study is the first to represent home healthcare nurses' perceptions and interactions with elder self-neglect.…”

“…Lauder et al (2006) also found that nurses used individual's mental health status to determine that individual's capacity to make decisions. In addition to calling for more Nurses attributed self-neglecting behaviors to psychological reasons such as undiagnosed mental illness, depression, or dementia.…”

Capacity, consent, and mental health legislation: Time for a new standard?

“…The tendency of nurses to equate mental illness with lack of capacity was confi rmed in a survey conducted by Lauder, Ludwick, Zeller, and Winchell (2006) who found that information on mental health status predicted nurses' judgements on decision-making capacity. It is noteworthy that the New Zealand Mental Health (Compulsory Assessment and Treatment) Act requires the responsible clinician to seek consent, even where defi ned a priori.…”