This assignment, it will discuss what accountability is, why it is important within adult nursing, looking into capacity in an analytical aspect, whilst maintaining confidentiality within the assignment. Enabling the reader to get a better understanding of capacity whilst looking at it through legal, ethical, and professional accountability. Capacity is both decision and time specific. We cannot decide what is in a person’s best interests just because of their age, their looks, or how they behave. Capacity according to the NHS (2016) discusses “that capacity is the ability to use and understand information to make a decision, and communicate any decision made. A person lacks capacity if their mind is impaired or disturbed in some way and this means the person is unable to make a decision at that time”. If someone has to make a decision for a person because they cannot make it for themselves, they must decide what is in the best interests of that patient, get the patient’s family involved to understand the patient’s wishes and allow the patient to have some control in what they want and to listen to their needs. The NMC (2015) states “accountability is the principle that individuals and organizations are responsible for their actions and may be required to explain them to others.” The RCN (2016) mentions that accountability is also a part of the delegation. If you delegate a task out to a member of staff, both the registered member of staff and the member of staff being given the task must ensure that it is both appropriate and will not cause the patient any harm. Furthermore, the RCN (2016) states the importance of accountability within not just the adult field of nursing but all parts of nursing; is ensuring that we act within the best interests of our patients and about challenging our senior colleagues if they give us a task that we are not comfortable in performing confidently; ensuring that patient safety is our utmost fundament within our profession.
Confidentiality is an important aspect within health care. And throughout this assignment, it will keep anything that has happened within practice confidential. RCN (2016) states that confidentiality is what underpins the trust between patients and healthcare workers. Disclosing information about patients/clients to somebody who has no right to the material, is very serious which could lead to a breach of trust from the patient/client and is misconduct within the profession. A patient came in for orthopedic surgery, although they could give consent and were deemed to have the capacity to have their blood pressure taken with their permission. They had learning difficulties which meant as healthcare professionals we needed to do the two-stage test to ensure that they had the capacity to make the right decision to go ahead with the surgery. RCN (2016) describes stage one as looking at whether the patient has an impairment or whether their brain has an abnormal functioning; and stage two looks at whether the impairment of disturbance, disallows the patient to make a decision when they are needed to.
The mental capacity act came out in 2005 which was then implemented in 2007. Social care institute for excellence (2016) states that the mental capacity act 2005 is made up of five principles. These 5 principles enable healthcare professionals to make the wisest decision when it comes to supporting a patient’s decision-making. Principle one is to presume capacity unless proven otherwise, principle two is about allowing the individuals to be supported in making their own decision, principle three in allowing people to make unwise decisions, principle four is about the person’s best interests, and principle five is about going for a less restrictive option when it comes to a person’s care. The reason the mental capacity act 2005 was brought out was that it was found that people were consenting to procedures that they did not fully understand nor have the full capacity to make a decision. Brown. R, Barber. P and Martin.D (2015) states “in stark contrast with the mental health act 1983 the mental capacity act begins by establishing five key principles to be followed whenever working within the framework of the act.” Furthermore, Brown. R, Barber. P and Martin.D (2015) go into more detail about the five key principles as:
- “A person must be assumed to have capacity unless it is established that he or she lacks capacity
- A person is not to be treated as unable to make a decision unless all practicable steps to help him or her to do so have been taken without success
- A person is not to be treated as unable to make a decision merely because he or she makes an unwise decision
- An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his or her best interests
- Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.”
When a healthcare professional is determining a person’s capacity, they must ensure they receive enough information to make an informed decision, not overload the person with too much information that might make them confused, and the amount of information given needs to reflect to the decision being made.
However, Dimond (2016, pg.13) enables to look at mental capacity in more detail, because it mentions that just because a person lacks the mental capacity to make a particular decision it does not mean they suffer from a mental disorder.
If a patient lacks mental capacity, is under continuous supervision, and not free to leave, then deprivation of liberty should be put in place, to ensure that a patient is receiving treatment within their best interests of them. Dimond. B (2016, pg.253) mentions that the deprivation of liberty safeguards “was enacted as a result of the decision of the European Court of Human rights (ECHR) which held, in the Bournewood case, that the liberty of those lacking the requisite mental capacity who were admitted to hospital under the common law doctrine of necessity was not protected as required Article 5 of the European Convention on Human rights.” Furthermore Dimond. B (2016, pg.254) goes on to mention that “a person can only be deprived of the liberty by the MCA if:
· The deprivation is authorized by an order of the court of protection under section 16 (2)(a) of the MCA (and P is not ineligible because he comes under the MHA as set out in Schedule 1A to the MCA); or
· The deprivation is authorized in accordance with the deprivation of liberty procedures (DOLs) set out in Schedule A1 (and P is not ineligible because he comes under the MHA as set out in Schedule 1A to the MCA); or
· The deprivation is carried out because it is necessary in order to give life-sustaining treatment, or to carry out a vital act to prevent serious deterioration in the person’s condition, while a decision as respects any relevant issue is sought from the court.”
Social care institute for excellence (2016) speaks about principle five of the mental capacity act. When a person is making a decision on behalf of someone they need to take into consideration, whether we can choose to determine or proceed in a way that would restrict a person’s rights and freedoms of action, or whether it is needed to actually decide to proceed at all. In all cases when it comes to making a decision on behalf of someone, we should always weigh up whether what we are deciding is going to help the person in any way. Trying to go for the less restrictive option for them.
When a patient has not got any family or friends that can help make them an informed decision when it comes to their treatment. An IMAC which are independent mental capacity advocate may be considered if health care professionals needed to propose a medical intervention or change a person living arrangements. For example, if they were not safe on their own and may need to go into a care home. Brown. R, Barber. P and Martin.D (2015) mention that the IMAC were a late addition to the Mental Capacity act 2005. They were not brought into the act until 2007. They have been available since April 2007 in England. Only people who have been trained to provide ‘best interests’ advocacy, should only be appointed to cases where an IMAC is required. Their role is to support and represent the person concerned, establish a person’s wishes and feelings, and to ensure that the Act’s principles and best interests’ checklists are followed.
Merriam-Webster (2019) describes ethics “as a plural in form but singular or plural in construction: the discipline dealing with that is good and bad and with moral duty and obligation.” Going on to state that both morals and ethics have some distinction in how they are used. Morals is one’s individual’s values in which they consider what is right or wrong in their eyes. Whereas ethics introduces more of moral principles.
Edward.S (2009) mentions that as a nurse we can face many more ethical problems than other members of society have to face. Whilst we are nurses, we come into contact with many different people with ethical beliefs and moral education. This means that sometimes we may need to change different ways of responding to moral problems, which could differ to our own ethical beliefs. Our nursing acts need to be direct to moral ends. Allowing to bring our states which not only do our patients value them but are of importance to them. Examples of these states are feeling well, being free from pain, feeling calm, and feeling that one has a good quality of life or quality that has improved and not deteriorated. Principles of health care ethics is narrowed down into four principles. These principles are respect for autonomy, the principle of nonmaleficence, the principle of beneficence, and the principle of justice. The principles of ethics when it approaches to healthcare is about looking at a person’s view, looking at a different view, and giving our own opinion based on what we think. Furthermore, Edward.S (2009, pg. 57) mentions “to say that a person has autonomy, or equivalently, is autonomous, is to say that they have the capacity for self-government. In other words, they are capable of making their own decisions about matters which concern their own life.” They then go onto say that sometimes as healthcare professionals we can overwhelm the patient’s with too much information, even if the information is relevant, is not respecting a patient’s autonomy. The importance of autonomy is attached to the law. Meaning if patients want to reject even life-saving treatment then they should be able to freely make that decision.
Tringle. J and Cribb. A (2014, pg.23) states “that ‘habitual ethics’ the ethical judgments that individuals make as a matter of course; the values that are built into ways of working. Any shift in the philosophy or culture of nursing which entails that normal practice and expectations are changed has an enormous impact. Practice can be enhanced (or made worse) for literally thousands of people. Generally speaking, much less rest upon prolonged agonizing about particular cases, however difficult they are.”
Ethical issues that can cause setbacks to patients when it comes to capacity is that they may not have the knowledge or the understanding to consent when it comes to procedures. Tingle. J and Cribb. A (2014) state that patients are unable to consent to something fully if they are in incomprehension of the knowledge provided to them, misleading in what they are told, or simple cannot grasp the information being mentioned to them. Sometimes as healthcare professionals we speak in medical terms that many people who do not understand medicine will acknowledge what their health professional has told them. Sometimes patients do not always ask what terms can mean and ask for them to reiterate. However, sometimes it can be harder for healthcare professionals to explain a complicated matter in terms that are both perfectly clear to the layperson and, at the same time, both accurate and complete.
Chitty. K and Black. B (2011) states that for many years a lot of people are looking into whether nursing is a profession. Some people believe that nursing is an emerging profession, whereas many others see nursing as a fully-fledged profession. The code by the NMC (2015) states “nurses, midwives, and nursing associates must act in line with the Code, whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing and midwifery practice in other roles, such as leadership, education, or research. The values and principles set out in the code can be applied in a range of different practice settings, but they are not negotiable or discretionary.” The code admits that the standards they have produced within the code are not just the standards they have produced, but what they have been told by members of the public, of what they expect from healthcare professionals when they are being taken care of within a health setting. Further stating that health professionals if they want to be within the profession must be committed to the professional standards, as it is of great importance and the foundation of the practice. The NMC (2015) goes onto say “they can work in diverse contexts and have different levels of autonomy and responsibility. However, all of the professions we regulate exercise professional judgment and are accountable for their work.”
Although accountability is important and as professionals, we must be responsible for any actions we implement, we must abide by the law at the same time. Cornock.M (2014) states one must be able to answer any of the judgments they make, according to the code of conduct. They are accountable to anything they do as a professional at all times, whether it is on or off duty. Liability for one’s actions is different to being accountable as what evidence they provide will be judged and, if deemed to be liable could ensure a penalty being given to the healthcare professional. As healthcare professionals, we have a degree of autonomy in the way we undertake our practice. Allowing professionals to make our own clinical decisions and commitment. He looks into whom, as healthcare professionals are, we accountable to. Saying that we have many people we are accountable to, our patients, our employers, the NMC, and society.
Chitty. K and Black. B (2011) discusses that due to nursing being so dynamic, many of the changes in nursing see many of the legal aspects in nursing care evolving to help protect not only the patients but the healthcare professionals.
Within this assignment, I have learned about what an independent mental capacity advocate is, and what their role is within the mental capacity act 2005. What the five principles are of the mental capacity act 2005, and how they can be applied within a practice? I understand more about the importance of accountability, what the law states, and what the NMC state. Learned more about what ethics are and how sometimes it can be challenging within the profession as sometimes people can have completely different beliefs and morals to you. That we need to not enforce our own beliefs and ethics but to help our patients to make wise decisions based on the information we give them and allow them to maintain their best interests. I understand now what liability is and what it could mean within my future career. At the moment I am a student nurse, and whilst in practice, I will discuss, understand and analytically go through anything I do whilst under the supervision of my mentor. Reflect and see if we were to go back and redo our actions, whether what we do we would it make a difference to the patient’s experience and the care they receive. As student nurses we have a great opportunity to look into different areas of practice, it can help us to understand that whilst on one ward something may work, other times it may not work on a different ward. Occasionally we have to ask other healthcare professionals whether what we think is correct, would they do the same as us? Sometimes we have to change how we act with different patients as some patients may need a little bit more help and understanding than others. As a student nurse, I am able to step back and see what fellow nurses and mentors might do in a situation and ask questions. Now that I have a theatrical background into the subject of capacity I can now try and apply this to my practice. With capacity, I now understand that just because someone lacks capacity does not mean they have mental health problems. That when we are trying to make decisions for someone with a lack of capacity, we still want to involve both the person and their family/carers to get the best interests for them. That we can use a two-stage test that will help us to make an informed decision about whether a person has the capacity or not. I would say at the start of this assignment I would have been bondy level one as my knowledge in this area was nowhere near as good as my knowledge is now. I believe that once I put this knowledge and understanding within practice my bondy level will go up to a bondy level 2. Many of the sources within this assignment was credible sources, as the NMC and RCN are very well known and respected when it comes to nursing practice. The books I used were also credible because they would not have been able to be published if they were not reliable sources. However, sometimes with books, they can be outdated.
- Chitty, K. and Black, B. (2011). Professional nursing. Maryland Heights, Mo.: Saunders/Elsevier.
- Cornock.M (2014) Legal principles of responsibility and accountability in professional healthcare [online] Available at: https://oro.open.ac.uk/49089/3/Legal%20principles%20of%20responsibility%20and%20accountability%20in%20healthcare.pdf [accessed on the 24th of March 2019]
- Dimond, B. (2016). Legal Aspects of Mental Capacity: A Practical Guide for Health and Social C. 2nd ed. John Wiley & Sons.
- Edwards, S. (2009). Nursing ethics. New York: Macmillan.
- Martin, D. (n.d.). Mental capacity act 2005 - a guide for practice. 3rd ed.
- Merriam-Webster (2019) Ethics vs Morals: Is there a difference? [online] Available at: https://www.merriam-webster.com/dictionary/ethic [accessed on the 24th of March 2019]
- NHS (2016) Assessing Capacity [online] Available at: https://www.nhs.uk/conditions/consent-to-treatment/capacity/ [accessed on the 18th of March 2019]
- NMC (2015 updated 2018) Delegation and accountability [online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/delegation-and-accountability-supplementary-information-to-the-nmc-code.pdf [accessed on the 26th of February 2019]
- NMC (2015) updated 2018) The Code [online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [accessed on the 24th of March 2019]
- RCN (2016) accountability and delegation [online] Available at: https://rcni.com/hosted-content/rcn/first-steps/accountability-and-delegation [accessed on the 26th of February 2019]
- RCN (2016) Capacity [online] Available at: https://rcni.com/hosted-content/rcn/first-steps/capacity [accessed on the 18th of March 2019]
- RCN (2016) Confidentiality, Consent and Capacity [online] Available at: https://rcni.com/hosted-content/rcn/first-steps/confidentiality-consent-and-capacity [accessed on the 18th of March 2019]
- Social care institute for excellence (2016) Mental Capacity Act (MCA) [online] Available at: https://www.scie.org.uk/mca/introduction/mental-capacity-act-2005-at-a-glance [accessed on the 24th of March 2019]
- Tingle, J. and Cribb, A. (2013). Nursing Law and Ethics, 4th Edition. John Wiley & Sons.