Nurse managed patient focused assessment and care: A grounded theory of qualified nurses in acute and critical care settings assessing the mental capacity of adult patients

Abstract

Aims To explore processes used by qualified nurses in assessing mental capacity of acutely and critically ill hospitalised adult patients. Background Mental capacity is the ability to understand, reason and make decisions. Acute and critical illness may impact upon the decision‐making abilities of hospitalised adult patients but little is known about how qualified nurses across a range of acute settings assess the capacity of such patients in their care. Design A qualitative grounded theory approach informed by the Corbin and Strauss (Basics of Qualitative Research (Third Edition). London, UK: Sage, 2008) methodological pathway. Methods Data were collected through digitally recorded, semi‐structured interviews to explore assessment of capacity processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales, UK. Data were analysed using iterative constant comparative processes leading to a core category and grounded theory. The study is presented in accordance with the COREQ checklist. Results Informal, intuitive, holistic nurse‐led processes were used to assess the mental capacity of patients which combined processes for the assessment of their physiological and mental capacity status, recognising the need to support their rights, dignity and autonomy. The assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi‐professional assessment was necessary and ongoing, and in which qualified nurses had a co‐ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care. Conclusion This theory provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness. Relevance to clinical practice This framework may inform related clinical practice and can serve as a basis of an assessment tool in what has been identified as a fundamental role of the qualified nurse.

Guidance to inform research recruitment processes for studies involving critically ill patients

“…Such activity is governed by legislation including the Human Rights Act (1998) and the Mental Capacity Act (2005). 4,5 While resources on legal frameworks are available to ICU research teams, accessing and implementing these can be challenging in the reality of clinical practice. Moreover, ensuring that research recruitment processes are ethical, as well as patient and family centred, is beyond the scope of legal frameworks.…”

Intervenções de enfermagem que capacitam a Pessoa em Situação Crítica: Revisão integrativa da literatura

“…Segundo Funnell (2016), os objetivos dos cuidados com foco na capacitação e educação da PSC são: aumentar a autonomia, permitir a tomada de decisão informada, possibilitar a resolução de problemas e alcançar objetivos comportamentais auto-determinados. Para Jones et al (2020), a capacidade é relacionada com a aptidão de uma pessoa para tomar decisões num determinado momento, ainda que com perda temporária de capacidade ou capacidade flutuante em outros momentos. Assim, a avaliação da capacidade mental é um aspeto fundamental e deve ser conduzida como parte de uma avaliação holística da condição e das necessidades das pessoas em ambientes de cuidados críticos, pela equipa multidisciplinar.…”

“…No que concerne ao envolvimento da família, Jones et al (2020) referem que esta desempenha um papel permanente nos processos de transição, fornecendo informações valiosas sobre definições do que constituía a capacidade "normal" para a pessoa doente. Importa, ainda, compreender o impacto que a situação critica de um familiar tem para a família.…”