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Legal Issues regarding Mary’s care and residence

Did she lack capacity?  From the information provided I can only assume she had capacity, as it was not stated otherwise.  (Mental Capacity Act, 2005)  None the less she had stated that she wanted to remain in her own home.

From the information provided Mary’s preferences were not discussed and the decision was made by a multi-disciplinary team and Mary’s family.  There was no mention of Mary being able to give her opinion or even that an advocate was available to speak on her behalf.  (NHS, 2015)

Why was Mary not included in this discussion, given this was in fact about Mary’s life and where she would be residing and her recovery?  From the information provided, it does not seem as though Mary was given any consideration or view as to how she wants her needs dealt with and where she would be happy to have her re-ablement needs met.

Could Mary of returned home and had care provided from the community by way of a care package, “meals on wheels”, adaptations such as grab rails around the home and her bed etc moved to the lower floors of her property?

Perhaps having physiotherapy as and when needed regarding her hip?  She could have had the family support and also friends such as neighbours nearby rather than having to settle into a residential facility and losing contact with all that she knows.

Sources used (sorry I have not had time to reference these fully)

http://www.legislation.gov.uk/ukpga/1998/42/contents

http://www.legislation.gov.uk/ukpga/2005/9/contents

http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/advocacy-services.aspx

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Mary has the capacity to make the decision of where she would like to stay, so it may seem that it is unethical/unfair for professionals and her family to make a decision about her life on her behalf that goes against her wishes. However, it would be wrong to let Mary stay at home so that she is happy, while putting her personal safety at risk. It would not be practical to let Mary stay at home if she cannot take care of her self, especially as she doesn't have relatives that live close by to help her. Discharging Mary to a nursing home will ensure that she gets the care that she cannot provide for her self within her own home. Mary should be included in choosing which nursing home she would prefer to be discharged to. It is important for nurses and professional teams to keep their patients, like Mary, involved in their own care, and empower them to make their own decisions where possible.

Konishi (2009) debates that conscious adult patients should themselves decide. With regard to nursing profession, nurses should provide the patients with information, explain suggested interventions, and let them free to either accept or reject oncoming procedures so that they and their families can make a decision about their condition.

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Mary'sThe NMC code (2010) states that health care professionals should "the fundamentals of care should be delivered effectively". If it has been agreed that Mary should be discharged into a nursing home, perhaps that is because this is where it'll be best for those fundamentals to be delivered well and effectively. In addition to this,if she lives in a care home, the health care professionals can "assess signs of worsening physical and mental health", to ensure that her injury or memory doesn't get worse, and if it does there are people are around to assist. Although the NMC code (2010) also states that "no assumptions" should be made about a persons care and that health care professionals should "ensure patients are included in making decisions about their care", it also states that when this is not possible health care professionals should act in the "persons best interest" yet always keeping in mind people have the "right to accept or refuse care". I think this is relevant here, as although Mary has not any say in her care as she would prefer to be treated at home, from a health care professionals point of view it's in Mary's best interest to be discharged into a care home due to her failing memory and injuries making it hard to do simple tasks. To ensure Mary is looked after well and also has a full understanding what is going on, the NMC code (2010) also states that people "should always be kept informed" about their care and treatment, as well as ensuring that health care professionals "identify priorities, manage time, staff and resources". I believe that this could help Mary as as she did nor agree to this type of treatment, she should be fully informed on what is going to happen to her. As well as this, staff could prioritise Mary by ensuring she always has someone to talk to during her time in the care home to prevent her becoming lonely, especially as her granddaughter can only visit her once a week.

Reference
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

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Health care ethics-
What we mean by ethics will also be examined not least because underlying all health-care actions and decisions, however ‘big’ or ‘small’ is a set of value choices that must be made by patients and their agents. (Veatch, 1997)

Ethics are difficult to define as many people have different ethics and believes, therefore, we rely on our moral judgement. This is society norms for what is seen as right and wrong.

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Nursing ethical values and definitions: A literature review -Nursing ethical values and definitions: A
literature review - M Shahriari (2013) 

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Nursing ethical values and definitions: A literature review -Nursing ethical values and definitions: A
literature review - M Shahriari (2013) 

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This article explores ethics and values within nursing

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Abstract

Background:

Ethical values offer a framework for behavior assessment, and nursing values influence nurses' goals, strategies, and actions. A literature review was adopted in order to determine and define ethical values for nurses.

Materials and Methods:

This literature review was conducted based on the Centre for Reviews and Dissemination guidelines. The key words used to search relevant sources were nursing, ethics, ethical values, and nursing values. The search of articles in English was carried out in Medline, CINAHL, PubMed, Scopus, Ovid, and Proquest databases. The search of articles in Persian was conducted in databases of Magiran, SID, and Irandoc publications. After assessing and analyzing the obtained data, 17 articles which had a distinct definition of ethical values were chosen and subjected to a thorough study.

Results:

The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

Conclusions:

This study showed that common ethical values are generally shared within the global community. However, in several areas, influences of social, cultural, and economical status and religious beliefs on values result in a different definition of these values. This study revealed that based on humanistic nature of nursing, common values in nursing protect human dignity and respect to the patients. Recognizing and definition of ethical values can help to improve nursing practice and develop codes of ethics.

Keywords: Ethics, literature review, nursing, professional values, values

INTRODUCTION

Nurses as one of the health service providers and members in health system who are responsible for giving care to the clients and patients based on ethical issues.[ 1] They need ethical knowledge to conduct their appropriate function to manage situations and to give safe and proper legal and ethical care in today's changing world.[ 2] With regard to practical care, they always try to answer the question of "What can I do?," whereas they should try to answer what is essential to be done for the patients in the context of ethical principles.[ 3] Ethics seek the best way of taking care of the patients as well as the best nursing function.[ 4]

Nurses are responsible for their clinical function, and their main responsibility is to take care of the clients and patients who deserve appropriate and safe care.[ 5] They act based on the values they have selected. These values form a framework to evaluate their activities influencing their goals, strategies, and function.[ 6] These values can also be counted as a resource for nurses' conduct toward clinical ethical competency and their confrontation with contemporary ethical concerns. Values conduct human life priorities and form the world we live in. They act as one of the most basic parts of human life. Ethical values are inseparable components of the society and, as a result, nursing profession.[ 7, 8]

Discovery of basic values and reaching an agreement on clinical ethical values are essential with regard to constant changes in nurses' social class and role.[ 9] Nurses' awareness of their values and the effect of these values on their behavior is a core part of humanistic nursing care.[ 10] They need to tailor their function to the value system and cultural beliefs of their service recipients.[ 11] Values originate from cultural environment, social groups, religion, lived experiences, and the past. Social, cultural, religious, political, and economic considerations influence individuals and their value system,[ 6] and ultimately, health, education, social strategies, and patients' care. Numerous documents have been prepared in nursing texts and literature concerning these values and clarification of their traits.[ 7, 9, 12, 13, 14, 15, 16]

Recognition and definition of nursing ethical values in various communities can help nurses have mutual understanding in international level. It can also bring nurses closer to reach a common meaning of care in patients with different cultures. However, there is a paucity of research particularly in the Iranian context to deeply explore nursing ethical values. Therefore, in the first step, the main aim of the study was to identify and explore nursing ethical values reflected in nursing texts. This search was then used to prepare code of ethics and clinical guidelines for Iranian nurses, along with other documents and evidences. Results of other aspects of the study have been reported in other articles from the researchers.

MATERIALS AND METHODS

This study is a part of a bigger study conducted in the Isfahan University of Medical Sciences. A literature review was carried out in 2010 to determine ethical values and related definitions in nursing systems of various countries.

In this literature review, the York University four-step approach was applied. These steps are as follows: Forming questions and determining search strategies, extracting synthesis, providing quality assessments and applying study evaluation tools, and suggesting methods to analyze and data synthesis.[ 17]

Search strategy

The study tried to answer the following questions:

What nursing ethical values are determined and offered in this study?

What is the definition of each value?

In this literature review, all published articles in English language from 1995 to 2010, as well as articles in Persian from 1996 to 2010 were searched by separated keywords and then keywords in combination, respectively. AND/OR was used combination and collection of various key words together. A manual search was also adopted and the references of the articles were studied as well. The search yielded about 82 articles whose titles and abstracts were studied. The articles not meeting the inclusion criteria were left out. Inclusion criteria were: Articles published in English or Persian and those articles on nursing ethical values in patients' care. At this stage, 37 articles were excluded and 45 were selected and comprehensively reviewed. In the next stage, the articles were completely studied with regard to inclusion criteria and their answers to the questions of the present study.

Finally, 17 related articles were selected and considered for the study. Data were extracted through firstly writing down the detected values and their definitions in the related articles. Then, the research team compared the findings and recorded them in a table, and selected the best definition of each value among the suggested definitions. Finally, after comparison of the names and words, a unique definition for each value was achieved based on the trait of definition.

Research team checked all selected articles concerning assessment of quality based on criteria of study quality evaluation tool. This tool was designed by the research team with regard to the study goal. Two questions were considered with respect to the various research methods employed in the selected articles. The questions were as follows:

Does the article express nursing ethical values?

Does the article contain a clear and specific definition for the expressed ethical values?

In order to increase study credibility, the abstracts were studied by researchers individually and the obscure points were discussed by the research team. In case of a disagreement to include an article in the study, a third member of the research team conducted further investigations, the obscure points were discussed in the group, and a final decision was made.

In the stage of data combination, all textual obtained data from the selected articles were classified and completely described. After textual data had been extracted and studied critically, the traits were separated and finalized based on the obtained definition for each value or ethical concept and finally a unique definition was obtained. Each obtained defined value has been explained in the section "Discussion." These defined values suggested appropriate answers to literature review questions.

Articles methodological traits

The articles were from 12 countries: Four from US, two from Canada, five from European countries (Belgium, England, Finland), and six from Asian countries (Iran, Japan, China, Thailand, and Taiwan).

Reviewed articles included two quantitative studies, eight qualitative studies, three literature reviews, two philosophical inquiries, and two action research philosophical methods. Various sampling methods had been precisely employed in these studies. 1360 subjects comprised the recruited subjects in these 17 articles. In two quantitative descriptive studies, 922 clinical nurses and nursing students had been randomly selected through census sampling. In qualitative researches, the participants comprised 438, randomly selected through purposive sampling. The number of participants ranged between 20 and 300 individuals. In most of these qualitative studies, the participants included clinical nurses accompanied by nurse educators.[ 9, 18, 19, 20] In one study, the participants were just clinical nurses, and in another,[ 21] they were just nursing students.[ 22]

The data were mostly collected through individual interviews which were, in some cases, the only source of data and in some other cases accompanied by other methods. The data had been collected by different methods: One by individual interviews and group discussion,[ 20] one by individual interview and observation,[ 18] one by narration and individual interview,[ 19] one by group discussion and narration,[ 22] and finally, in only one by group discussion.[ 9] In two studies, data had been collected through literature content analysis;[ 10, 13] in two, by applying intervention;[ 16, 23] in two other, through literature review;[ 7, 24] and finally, in two studies, the data had been collected through philosophical inquiries.[ 6, 25]

In two quantitative studies adopted to collect data, standard tools had been employed. In the study of Weis (2000), Nurses' Professional Values Scale (NPVS) with confirmed reliability and validity had been utilized.[ 26] Rassin (2008) used nursing code of ethics related to International Nursing Association to evaluate nurses' professional values as well as the Rokeach Values Survey with confirmed reliability and content validity to assess nurses' personal values.[ 15]

Quality appraisal

The selected articles were reviewed concerning their quality. Application of a systematic literature scientific method in the present literature review study let the research review the articles based on research questions, research project, data collection method, data analysis method, data credibility, ethical considerations, and the results.

In quantitative studies reviewed, standard questionnaires had been adopted for data collection, data analysis method had been clearly defined, and the necessary permissions had been obtained from university and other needed institutes to respect ethical considerations. The results were also in the direction of research questions.

In qualitative studies, research methodology and data analysis had been clearly stated, and participants' consents had been obtained to respect ethical considerations. Various methods had been employed for credibility: Data collection from various methods,[ 19, 20, 22] precise transcription, and data recheck and conformability with participants and colleagues.[ 18, 19, 20]

Data analysis methods of the studies, conducted based on philosophical research methodology and action research, had not been clearly mentioned, but their results were related.

General traits of reviewed studies

General traits of reviewed studies in the context of nursing ethical values have been presented in Table 1 . The reviewed articles had investigated nurses' ethical values from different aspects.

Table 1

RESULTS

In various studies, the values had been differently introduced and defined. Most of the reviewed articles had focused on common nursing ethical values.[ 22] In some, several values and in some other, only one value had been introduced and defined. Konishi (2009) had only studied the value of harmony in nursing and had suggested that as one of the most fundamental values in Japan.[ 13] Verpeet (2003) had defined values as nurses' responsibility against their patients, profession, other health team members, and society.[ 10] Naden (2004) in his study to define components of human dignity indicated braveness, responsibility, respect, commitment, and ethical desires.[ 18] Wros (2004) reported a significant difference in ethical value of decision making among the nurses in two countries.[ 19] Trailer (2004) claims that respect to the patients has the highest priority among codes of ethics and acts as a basic value to design the nursing ethical codes which include three main elements of respect, reliability, and mutuality.[ 25]

Shih (2009) reported that 75% of the participants had indicated taking care of the patients and their related individuals and altruism as the most common nursing values. Other values in his study were provision of holistic professional and appropriate care, promotion of personal and professional competency, disease prevention, health promotion, promotion of interpersonal communication skills, and receiving fair reward.[ 9]

Weis (2000), through factor analysis, introduced eight factors for professional values of which the most important one was nurses' role in care and dimension of commitment.[ 26] Pang (2009) stated nursing professional values in seven themes of altruism, care, respecting the dignity, trust, accountability, independency, and justice.[ 20] Mahmoodi (2008) indicated responsibility, having mental and emotional communication, value, and ethics criteria such as honesty in work, mutual respect, religious margins and confidentiality, justice and fairness.[ 21] Shaw (2008) and Fahrenwald (2005) in our studies, in a different way, investigated application of five nursing professional values in nursing education, including altruism, independency, respect to dignity, nursing interventions' integrity, and social justice.[ 16, 23] Horton (2007) stated that personal and organizational values have effects on nursing and introduced values such as responsibility, honesty, patients' participation, integrity and humanity protection, patients' independency, deep humanistic relationship, dignity, hope, passion, teamwork, differentiation, versatility, altruism, nurturing, integrity and support, reciprocal trust, sound knowledge, clinical competence, communications, unity, homogeneity, coordination, self-sacrifice and devotion, self-protection, privacy preservation, creativity, aesthetics, management, economizing, braveness, commitment, ethical attitude, personal orientation, judgment, freedom, individualism, acknowledgment, and personal success.[ 7] Two studies had stated detection of ethical values as the basis for collection of codes of ethics.[ 24, 27]

DISCUSSION

In all of the articles studied in the present literature review, patients' dignity and respect had been stated as the most frequent value indicated in 12 articles, equality and justice in 8 articles, and altruism and precise care and making appropriate relationships were indicated in 6 articles, respectively.

Comparison and finalization of the obtained data concerning nursing ethical values in patients' care yielded 10 values mostly indicated in the articles: Human dignity, altruism, social justice, autonomy in decision making, precision and accuracy in caring, responsibility, human relationship, individual and professional competency, sympathy, and trust. The 10 obtained values in this literature review and their definitional traits are presented subsequently.

Human dignity

Respecting human dignity was the most common value indicated in the reviewed articles. Respect to individuals including the persons, their families, and the society has been mentioned as an important nursing ethical value. Dignity respect has been defined with definitional traits as consideration of human innate values, respecting patient's beliefs and preservation of their dignity and privacy during clinical procedures, and communication with the patients, and contains understanding the patients and devoting to fulfill clients' needs.[ 15, 16, 18, 20, 22, 23, 24, 27] Pang (2009) argues that nurses should accept that people deserve respect and dignity in action. They should practically cover patients' body parts if exposed and keep patients' secrets confidential.[ 20]

This value has been suggested in most of the articles possibly as a result of humanistic nature of nursing profession in helping others. This value had been emphasized in all articles of Asian countries, reflecting cultural similarities in these countries. This value has also been indicated in most of the codes of ethics in various countries all over the world.

Social justice

Justice is an ethical value suggested in nursing literatures. Social justice has been defined by the traits which, in addition to consideration of individuals' dignity and respect, focus on equal access to health services and the right of being fairly treated and cared free of economic, social, and cultural status.[ 9, 10, 15, 16, 20, 21, 23] Social justice had been the indication in most of the countries and had been defined as fair distribution of resources and provision of individuals' equal treatment and care.

Verpeet (2003) stated that equality means access of all individuals to health services. She claims every individual in Belgium is supposed to have equal right of receiving equal nursing care.[ 10]

Altruism

Altruism is a common nursing value in various countries. It has been defined with traits of consideration of human as the axis of attention and focus in nursing, helping others and provision of the utmost health and welfare for the clients, their families, and the society, selflessness, and self-devotion.[ 6, 9, 13, 15, 16, 18, 22, 23, 27] Therefore, altruism is defined as focusing on clients as a human and struggling to preserve their health and well-being. Pang (2009) debated that based on the principle of altruism, nurses should have spirit of selflessness and helpfulness toward others.[ 20]

Autonomy in decision making

Independency in decision making is a value suggested in some studies as a nursing ethical value. Nurses have defined its traits as having right of independency in decision making, right to accept or reject suggested treatments, interventions, or care. In addition, autonomy in decision making necessitates giving appropriate and adequate information to the clients and, if necessary, to their families.[ 13, 15, 23] So, autonomy in decision making occurs when nurses let patients be informed, free, and independent to decide on the diagnosis, treatment, and prevention through giving them appropriate information.

Konishi (2009) debates that conscious adult patients should themselves decide. With regard to nursing profession, nurses should provide the patients with information, explain suggested interventions, and let them free to either accept or reject oncoming procedures so that they and their families can make a decision about their condition.[ 13]

Precision and accuracy in caring

Precise and accurate care has been indicated as a nursing ethical value. Based on this definition, this sort of care is a precise, safe, appropriate, multidimensional, and kind care given to the patients by nurses. This is also thoughtful, based on adequate clinical skills and nursing knowledge to fulfill clients' needs, promote their health, and relieve their pain and suffering. It is also based on standards and results in patients' safety and satisfaction.[ 6, 9, 15, 23, 24, 27] In this regard, Shih (2009) states that holistic and appropriate professional care is to prevent diseases, promote health, and make the feeling of comfort and safety for the patients.[ 9]

Responsibility

Responsibility has been defined as a nursing ethical value. It is defined with traits of commitment, feeling responsible for the duties toward patients, and respecting the patients' rights for decision making.[ 15, 18, 19, 21, 24, 26, 28] Based on this definition, nurses are responsible for giving evidence-based care, best clinical function, and applicable and valid research, and are accountable for their actions and duties. Verpeet (2005) argues that nurses are responsible for promotion of patients' well-being, having a holistic approach toward them and completing their duties.[ 28]

Human relationship

Human relationship has been indicated as a nursing ethical value with traits of mutual respect, trust, and reliance which are accompanied by patients' confidentiality and privacy. It can be verbal or non-verbal and defined through having honesty in words and practice, sympathy and mutual understanding, courtesy, and friendliness.[ 9, 15, 19, 21, 25]

In this regard, giving care is possible only through making humanistic, efficient, and effective relationship, a relationship based on mutual respect and understanding.

Individual and professional competency

Individual and professional competency as a nursing ethical value has been defined with traits of struggling to make nursing as a profession, feeling the need to acquire personal and professional competency so that nurses can grow and develop in the direction of advances and new technology. Personal competency and development of the nurses result in acquiring up-to-date knowledge and promotion of clinical skills and practical abilities, and the ability to give more holistic and comprehensive care. Promotion of personal and professional competency comes true when nurses make a background for the best patients' care by trying to give evidence-based care, and their empowerment for participation in activities in relation with other health team members and interpersonal and inter-professional skills development.[ 7, 9, 15, 20, 24] Pang (2009) debates that participation in continuing professional development suggests that individuals should preserve their competency in their activities and participate in professional continuing education programs throughout their occupational life.[ 20]

Sympathy

Sympathy has been indicated as a nursing ethical value with traits of understanding patients' and their families' needs and giving care based on making a fair communication.[ 6, 19] In some cultures, such as Japanese, nurses share patients' physical and mental pains and sufferings.[ 19]

Trust

Trust has been indicated as a nursing ethical value and is defined by traits of honesty in words and practice. Nurses should gain patients', their families,' and society's trust through understanding patients' situation and status and appropriate conformation with them.[ 15, 20, 23, 24] Based on this definition, gaining clients' trust and reliance comes true when nurses are honest in their words and practice, and gain individuals' trust and reliance by doing their duties appropriately.

CONCLUSION

This study showed that nursing ethical values in patients' and clients' care are similar in many cases due to a common core in humanistic and spiritual approach of nursing profession, which is taking care of a human. Values such as human dignity, kindness and sympathy, altruism, responsibility and commitment, justice and honesty, and personal and professional competency were similar in most of the cultures.

Despite the similarities in ethical and professional values among various countries, it is essential to detect and highlight these values in each country, for example, in Iran, with regard to the prevalent social, cultural, economic, and religious conditions. Detection and declaration of nursing ethical values in each country can be a valuable, scientific, valid, and essential document to design nursing codes of ethics. This search was used to prepare proposed code of ethics and clinical guidelines for Iranian nurses. Findings of this study search must be considered within its limitation. An attempt was made to conduct a search as vast as possible. However, it might be possible that we could not access to all articles available in the period of the search.

ACKNOWLEDGMENT

The authors would also like to acknowledge the Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, for supporting this work.

Footnotes

Source of Support: Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences

Conflict of Interest: None

REFERENCES

1. Jhonstone MJ. 4th ed. Sydney: Churchill Livingstone Publisher; 2004. Bio Ethics: A Nursing perspective; pp. 120-4. [ Google Scholar]

2. Chitty KK, Beth BP. 5th ed. St Louis: Saunders Elsevier; 2007. Professional nursing concepts and challenge; pp. 522-5. [ Google Scholar]

4. Abaszadeh A, Abedi HA, Sharif F, Ghofrani F. A model of develop and assess of nursing ethical performance. Journal of Teb va Tazkieh. 2001;47:59-66. in Persian. [ Google Scholar]

5. London: Nursing and Midwifery Council of England; 2004. England Nursing and Midwifery Council. The NMC code of professional conduct: Standards for conduct, performance and ethics. [ Google Scholar]

8. Tschudin V. Translated by Baligh N. Tehran: Medical Ethics Research Center; 1994. Ethics in Nursing the Caring relationship; p. 242. in Persian. [ Google Scholar]

17. Centre for Reviews and Dissemination, University of York; 2008. Centre for reviews and dissemination. Systematic Reviews CRD's guidance for undertaking reviews in health care. [ Google Scholar]

21. Mahmoodi Shen G, Alhani F, Ahmadi F, Kazemnejad A. A qualitative study: Ethical thematic in nursing life style. Journal on Medical History and Ethics. 2008;2:63-78. in Persian. [ Google Scholar]

22. Macmillan SS. MSN Thesis. University Microfilms International, Florida: Florida Atlantic University; 1994. Nursing values as the basis for practice of graduate students in nursing; p. 75. [ Google Scholar]

27. Ottawa: Canadian Nursing Association; 2008. Canadian Nursing Association. Code of ethic for registered nurse in Canada; p. 64. [ Google Scholar]

Articles from Iranian Journal of Nursing and Midwifery Research are provided here courtesy of Wolters Kluwer -- Medknow Publications

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Nursing ethical values and definitions: A literature review

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Ethical values offer a framework for behavior assessment, and nursing values influence nurses' goals, strategies, and actions. A literature review was adopted in order to determine and define ethical values for nurses.This literature review was ...

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The Royal College of Nursing- Human Rights and Nursing 

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The Royal College of Nursing- Human Rights and Nursing 

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This document explains how human rights play an important part of nursing.

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Mary is 89 and is being cared for in a nursing home since falling at home 12 weeks ago. She was admitted to hospital following the fall with a fractured neck of femur (hip) and underwent surgery. Following her admission, Mary;s family have stated that she is becoming less able to care for herself and has become more forgetful. Her nearest relative is her grand-daughter who lives 50 miles away and is only able to visit Mary once a week.
Mary has always wanted to stay at home but during a meeting with a social worker, occupational therapist, doctor, nursing staff and Mary's family it was agreed that Mary would be discharged to a nursing home with a long term plan of final discharge to a residential care facility.

What professional, legal and ethical issues are raised by this case?

Thinking of professional values what do you think nurses would do in this situation?

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In this situation we must judge what is right for Mary and her family. Mary has said that she has always wished to stay at home, however, it may not be possible for her live by herself due to her failing memory and her fractures femur. The social worker, occupational therapist, doctor, nursing staff and Mary's family have agreed that Mary would be discharged to a nursing home with a long term plan of final discharge to a residential care facility. This suggests that Mary is not in control of where she lives and who she lives with. This may raise a ethical issue as Mary's control has been taken away and her desire to live at home has been ignored.

Nurses in this situation will have to consider what is best for both Mary and her family, Mary may want to stay with her family but her family may not be able to give Mary the care she needs, therefore moving Mary to a residential home, near her family maybe what is best for Mary, as her family will still be able to visit Mary but Mary will be getting the care she deserves from the care home. This will make sure that Mary's physical, social and psychological needs are assessed and responded to and will be acting in Mary's best interests. Also everything that is happening to Mary should be explained clearly to her, and she should be involved in all decision making when it comes to her care and well being.

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The NMC Code, (2010) states that you must always "Listen to people and respond to their preferences and concerns" and to achieve this the nurse must "respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care". Therefore if Mary does have the capacity (which it was not said otherwise) to make decisions for herself then she should have a say in her care and whether she is going to live at home or in a residential care home which was decided by the multi-disciplinary team. The Mental Capacity Act (2005) states that "you will be assumed to have capacity, unless you have had an assessment showing you don't".

Nurses in this situation would always have to act in the best interests of the patient. This is also one of the requirements in the NMC Code, (2010). The code states that in order to act in the best interests of the patient you must "keep to all relevant laws about mental capacity that apply in the country in which you are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process".
Therefore I feel the nurse and the rest of the multi-disciplinary team  would have to decide whether Mary should be living in a residential care home that is so far away from her family or if the care that she is going to receive there is going to be the main best interest for Mary or if maybe living at home and receiving care within her home such as carers and meals on wheels etc would be a better option for Mary as living at home is something that Mary has said she wants.

References
Nmc.org.uk, (2010) The code [online] Available from https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [accessed 6th November 2016]

Mind.org.uk, (2013) Mental Capacity Act [online] Available from http://www.mind.org.uk/information-support/legal-rights/mental-capacity-act-2005/#.WB81-GV5C1s [accessed 6th November 2016]