Reflective accounts

Mental capacity law

A CPD article improved Rose Gallacher’s understanding of mental capacity law and making best-interests decisions.
Mental capacity law

A CPD article improved Rose Gallachers understanding of mental capacity law and making best-interests decisions

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The article provided information about mental capacity law. It outlined how capacity assessments are undertaken, and how best-interests decisions should be made for those who lack capacity.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

I learned that a two-stage capacity assessment should be undertaken to determine whether a person lacks capacity to make a decision. This involves establishing if the person has a temporary or permanent impairment or disturbance of the mind or brain, and determining if this means that they are unable to make a decision at the time it needs to be made.

Healthcare

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A CPD article improved Rose Gallacher’s understanding of mental capacity law and making best-interests decisions


Picture: Alamy

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The article provided information about mental capacity law. It outlined how capacity assessments are undertaken, and how best-interests decisions should be made for those who lack capacity.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

I learned that a two-stage capacity assessment should be undertaken to determine whether a person lacks capacity to make a decision. This involves establishing if the person has a temporary or permanent impairment or disturbance of the mind or brain, and determining if this means that they are unable to make a decision at the time it needs to be made.

Healthcare professionals should consider whether the person is able to understand, retain, weigh up and use the information relevant to the decision. The article emphasised that capacity assessments should not be based on assumptions about a person’s age, sex or diagnosis; for example, assuming they lack capacity if they have been diagnosed with dementia.

Several factors can influence the accuracy of a capacity assessment, such as language difficulties, and subsequently lay interpreters introducing bias. Another factor is the environment in which the assessment takes place; if there are too many people or unfamiliar healthcare professionals present, the person may feel uncomfortable or confused, which can affect their decision-making ability.

If an individual has been found to lack capacity, any decisions made about their treatment and care must be made in their best interests.

How did you change or improve your practice?

The article has improved my understanding of the legal issues related to capacity. Reflecting on the various areas that should be considered when assessing a person’s capacity has enabled me to understand how and why complex decisions are made.

In my practice, I will ensure that the person’s well-being is central to any best-interests decisions made. I am aware of the importance of best-interests meetings, which were recommended in the article to discuss the various care options available to a person, and to determine their associated risks and benefits. These meetings should involve health and social care professionals, family, friends, carers and any other individuals who may be aware of the person’s wishes.

The article also suggested developing an advance care plan to record a person’s future care preferences, in the event that they no longer have capacity. I will ensure that capacity assessments, advance care plans and the person’s wishes are clearly documented, to provide evidence of any decisions made and ensure legal protection from liability.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

The article is relevant to the theme of prioritising people, which states that nurses must act in the best interests of individuals at all times. The article outlined the principles that healthcare professionals should use to guide best-interests decisions, including encouraging the person’s participation, consulting those close to them, and considering the person’s views.

The Code also states that nurses must support and document a person’s right to accept or refuse care and treatment, and emphasises that they must act as an advocate for vulnerable people, which includes those who lack capacity.

Rose Gallacher is a staff nurse at Royal Alexandra Hospital, Paisley


This reflective account is based on NS872 Regan A, Sheehy C (2016) Understanding mental capacity law and making best-interests decisions. Nursing Standard. 31, 14, 54-62

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