The Mental Capacity Act 2005 was implemented on the 7th October 2007 and is a UK Parliamentary Act that enables health and social care professionals to provide care and treatment for patients who lack capacity and are unable to give consent to their treatment. (Code of Practice, 2007)
Capacity is defined as “sufficient understanding and memory to comprehend in a general way the situation in which one finds oneself and the nature, purpose, and consequence of any act or transaction into which one proposes to enter” (Merriam-Webster, 2018). In the healthcare industry, a person’s mental capacity is the foundation of effective communication. Capacity is influenced in any sort of impairment of the brain or mind, such as a learning disability, mental health condition, stroke, substance misuse or concussion (Mind, 2017)
The Mental Capacity Act introduced several new roles, bodies and powers, all of which support the Act’s provisions; Attorneys, a court of protection and court-appointed deputies, and independent mental capacity advocates (Code of Practice, 2007). The act will apply in conjunction with other legislation, affecting people who may lack capacity in relation to speci?c matters; meaning professionals working under the Act should also be aware of their obligations under other legislation. (CQC, 2017). The Mental Capacity Acts’ core principles are to assume that adults, over the age of 16, have mental capacity to make informed choices and decisions; the right to autonomy, unless confidently proven otherwise (NHS,2018). Everyone has the right to be supported to make their own decisions, regardless of whether it’s an unwise or eccentric decision. (ibid.) Individuals who lack capacity, have the right to a best interest decision made on their behalf, and it needs to be the least restrictive option (ibid).
The principle of best interests is fundamental to any decision made on behalf of a person who lacks capacity. However, in the case of Aintree University Hospitals NHS Foundation Trust v James (2013), it was only then, that there was clarity in what ‘best interests’ actually meant. Best interests is closely linked to empathy, being that the person making the decision should, as far as possible: “Put themselves in the place of the individual patient” (Aintree v James (2013). It was made clear that any best-interests decision must be subjective; considering an individual’s preferences on a decision-specific basis. Nurses and other decision-makers must make sure they establish patients’ views and attitudes by building a professional and trusting relationship with the patient (NMC, 2015).
Within the Mental Capacity Act, Deprivation of Liberty Safeguards, commonly known as DoLS, was implemented to protect people, who do not have the capacity to maintain their own safety. (Gov.uk, 2010) The Mental Capacity Act and Deprivation of Liberty Safeguards are closely intertwined. In July 2018, the Government published a Mental Capacity Amendment which will see DoLS replaced by the Liberty Protection Safeguards (LPS). (SCIE 2015). Wilson et all, (2010) states that training in the Mental Capacity Act has been shown to help strengthen practice in areas such as documentation and maintain the acts principles. However, Willner et all (2011) found that a small minority of staff had not undergone any Mental Capacity training, even though they had the same knowledge of those who had; which raised questions about the efficiency and effectiveness of the training.
The Care Act took affect on the 1st April and the main purpose of the act was to overhaul the existing 60-year-old legislation regarding social care in England. Gov. (2014) to make provision about safeguarding adults from abuse or neglect; to make provision about care standards; to establish and make provision about Health Education England; to establish and make provision about the Health Research Authority; to make provision about integrating care and support with health services; and for connected purposes. The Care Act is mainly about people who are 18 and over and need care and support.
More focus is now on prevention; reducing the likelihood of care needed in the future and maintaining people’s independence. In 2016, a £72,000 cap on costs was implemented (Caremark Limited, 2014).
The care acts ‘wellbeing’ principle is to ensure that Local Authorities uphold their duty in ensuring that peoples wellbeing is at the center of all it does. There is emphasis on outcomes and establishing people’s connections within communities. Councils are no longer able to contract social work functions; such as assessments; this ensures dependable environments during a person’s healthcare experience. Local services and councils are to co-produce; meaning people who use healthcare services and carers are treated as equal partners; included in all aspects of care and support. Professionals are to maintain individual’s safety and security, and to ensure that any actions taken to support a protect an individual; affect their rights and freedom as little as possible.
Wellbeing and prevention are closely linked; wellbeing defined as the mental, physical, emotional and psychological health of individuals. Prevention is that the action of stopping one thing happening or arising. Using the empowerment approach, healthcare professionals would help patients make informed decisions; and it has the potential to improve the health and wellbeing of communities. Local councils’ new duty to promote people’s wellbeing apply not just to users of services, but also to carers. Carers, who could be family members or friends, are given new financial entitlements under the act.
The Act establishes a national minimum threshold at which people will be eligible for
support. Assessments are based on whether an individual can meet certain outcomes rather than levels of need. There is a system by which people may appeal against council decisions on eligibility and funding for care and support. SCIE. (2016).
The act ensures local authorities are able to offer all individuals the access to correct information and financial advice, rather than it only being individuals who are entitled to funding or support from the council. Adult safeguarding is a key principle. Local authorities should build enquiries if they believe AN adult is, or is in danger of, being abused or neglected.
Local authorities, communities and healthcare professionals will co- produce; a collaborative approach to safeguarding will enable the individual to maintain their own safety, as well as receiving support and guidance to make an informed decision. (SCIE, 2015)
Care, compassion and respect have always been enshrined in the value statements of the health profession (NMC, 2009) Healthcare professionals should always maintain a professional and optimistic approach to their role. Individual attitudes will attribute to the overall effectiveness of the patient’s quality of care, health outcomes and their individual experience. Professionalism, however, can mean different things to different healthcare professionals (Morgan et al, 2014). Altruism is the ability to be selfless and is essential in unlocking a nurse’s compassion and empathy; therefore, creating a more positive environment for the patient. (All nurses INC, 2010). Freudenberger HJ, (1974) states that healthcare professionals must also maintain a level of calmness within themselves in order to fully support their patient; this is important to prevent burnout and stress which may hinder them carrying out their duty effectively. Compassion allows a patient to feel cared for, respected and trust that the healthcare professional has their best interest in mind Cornwell & Goodrich, (2009). When patients are relaxed, they often have a shorter length of stay in the hospital, decreased pain, decreased anxiety and an overall optimistic outlook on their recovery (AMN Healthcare, Inc, 2016). Additionally, the patient may be more willing to reach out to a nurse who has a positive approach to patient treatment. Fry, Veatch & Taylor (2010) argue that personal values, such as respect, responsibility, and obligation are dependent on the moral attitude of the professional. Professional behavior is behaving in a manner to achieve optimal outcomes in professional tasks and interactions.
According to Masters (2009), in order for health workers to provide quality care and meet patients changing health care needs, they must become lifelong learners dedicated to updating their professional knowledge; through continuous professional development. Reflective practice is a fundamental component of continuing professional development and is required by all regulatory bodies of healthcare professionals in order to revalidate registration; almost erasing complacency within healthcare (Atwal & Jones, 2009). The NMC code (2015) states that professionals must fulfil all registration requirements by keeping knowledge up to date and taking part in development activities that maintain and develop competence. Professional development is essential as healthcare professionals have direct patient contact during admission, diagnosis, treatment and outcome (Nursing Times, 2018).
Friedman, A., Davis, K., and Phillips, M. (2001). States that ‘differences in career stage, preferred learning style, individual ambition; affect the likelihood of taking part in CPD’; these barriers could ultimately impede on a professional’s competence. Age can play a major role in maintaining professional development, as the older the professional is, the more relaxed the individual may be in refreshing and developing knowledge; this could lead to position complacency; leading to job dissatisfaction, or unable to progress further within a setting.
Reflective learning is associated with “looking back” on experiences and understanding what actions could be taken in the future, perhaps changing the outcome (Schon, 1983). Reflection enables health professionals to share knowledge with others, to benefit practice and helps practitioners make sense of challenging and complicated situations (Chapman et al, 2008). This helps to optimize their work practice and improve interprofessional relationships. Strengths and weaknesses can also be identified from reflection, enabling an enhancement in the development of areas needed to be improved. The Gibbs’ reflective cycle (1988) encourages a clear description of the situation, analysis of feelings, evaluation of the experience and an analysis to make sense of the experience. This would be followed by conclusions where other options are considered and reflection upon experience to examine what one would do if the situation arose again. Hand, (1995) states that reflection enhances personal development by leading to self-awareness, which helps to expand and develop clinical knowledge and skills; which ultimately leads to empowerment.