The Mental Capacity Act 2005: considerations for nursing practice

Stevens, Emma

doi:10.7748/ns2013.09.28.2.35.e7909

Cited by 6 publications

(6 citation statements)

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“…However, all HCPs involved in providing treatments should be cognisant with assessment requirements, as DMC is time specific to each and every patient procedure. 27 Education and training may therefore be required to support all professional groups in undertaking DMC. 28…”

Section: Discussionmentioning

confidence: 99%

“…While legislation is often a safeguard for patients and staff in decision-making contexts, 27,32 HCPs are cautioned to be mindful that inconsistent compliance with legislative requirements could lead to the infringement of patient’s rights under common law and statute. 3 These issues are particularly important in the context of treatment refusal.…”

Section: Discussionmentioning

confidence: 99%

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Capacity and consent: Knowledge and practice of legal and healthcare standards

Lamont

Stewart²,

Chiarella

2017

Nurs Ethics

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The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why 'duty of care' is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Capacity and consent: Knowledge and practice of legal and healthcare standards

Lamont

Stewart²,

Chiarella

2017

Nurs Ethics

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“…Nurse-managed patient-focused assessment processes contain a number of complex elements. Central to the impact of clinical setting is that physical illness may have a significant impact upon the capacity status of patients (Burton et al, 2012;Fassassi, Bianchi, Stiefel, & Waeber, 2009;Owen, 2009;Raymont et al, 2004;Stevens, 2013). Participants in this study act on knowledge that patients may have a variety of healthcare needs of differing levels of acuity, complexity and severity, all of which may manifest in different ways.…”

Section: (F04)mentioning

confidence: 99%

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

Jones

Gill

Kenkre

2020

Journal of Clinical Nursing

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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.

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“…Nurses and other healthcare professionals, while striving for empowerment of people in their care, also have a responsibility to protect vulnerable adults from harm and abuse (Nursing and Midwifery Council (NMC), 2015), and at times, this may create a tension, because the self-determination of individuals who have been judged to have capacity may be harmful and at odds with what is perceived to be in their best interests (Stevens, 2013b). Capacity legislation aims to protect individual autonomy and avoid undue paternalism, partly through ensuring people are not deemed to lack capacity simply because they make an unwise decision (Banner, 2013).…”

Section: Mcamentioning

confidence: 99%

Fluctuating capacity and impulsiveness in acquired brain injury: the dilemma of “unwise” decisions under the Mental Capacity Act

Lennard¹

2016

The Journal of Adult Protection

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Purpose – The purpose of this paper is to examine the dilemma at the heart of nursing care – the striving for empowerment of people in nurses’ care with the responsibility to protect vulnerable adults from harm. In doing so, it argues that in difficult and borderline cases, capacity assessment is complex and ultimately based on a judgment involving interpretation, and welcomes the views of clinicians who have challenged the procedural test of capacity in the Mental Capacity Act (MCA). Design/methodology/approach – It presents an illustrative study of a person with acquired brain injury (ABI) resident in a nursing home, who had been assessed under the MCA and judged to have capacity regarding health and welfare decisions, who subsequently displayed a persistent and impulsive desire to leave the unit without thought of risk and vulnerability to herself, prompting safeguarding concerns, and a reassessment of her capacity. Findings – The paper asserts that supporting people with ABI during capacity assessments, as the MCA decrees, in a very structured way can create a false sense of “capacity”. It maintains that executive impairments in ABI, being difficult to assess in formal settings, are best undertaken over time, in real-life settings, with evidence from third parties. It welcomes the MCA’s desire to protect individual autonomy and avoid undue paternalism, through ensuring people are not deemed to lack capacity simply because they make an unwise decision. Originality/value – But it goes on to argue that in ABI it is often the fact of unwise decision making that is the prominent factor and main concern, particularly in regard to impulsive decision making. If nurses have to make a judgment as to how unwise decisions made with decision-making capacity are to be distinguished from unwise decisions made without it in people with ABI, then, the author concludes, a major area of difficulty for nurses is ascertaining when the presumption of capacity should be challenged, an area that an updated code of practice needs to clarify.

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The Mental Capacity Act 2005: considerations for nursing practice

Cited by 6 publications

References 0 publications

Capacity and consent: Knowledge and practice of legal and healthcare standards

Capacity and consent: Knowledge and practice of legal and healthcare standards

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

Fluctuating capacity and impulsiveness in acquired brain injury: the dilemma of “unwise” decisions under the Mental Capacity Act

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