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Research shows that when health professionals work in partnership with the patient and involve them in their care as much as possible, more appropriate decisions are made about their care (NICE 2016). Patients have the right to be involved in their care and have a say in what happens in their lives. The Care Act (2014) states that the patient must participate as fully as possible in decisions relating to their care and support (CQC 2016) . If they lack the mental capacity to be involved in their care, then an advocate should be appointed to the individual to ensure that decisions are made in their best interests.

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2 nd principle from the RCN;

Under the Mental Health Act, the family have the right to have Mary’s mental health/capacity assessed to see whether she is capable of making her own decisions. If not, we as nurses, would work together with Mary’s family (who would make decisions on behalf of her) to make sure Mary gets the treatment that benefits her the most.

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Due to the question in Mary’s mental capacity, nurses would act as an advocate (if needed) to Mary to make sure her autonomy and self-determination are respected.

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17 th standard from the NMC Code;

There is concern about whether Mary is as independent as she was before the fall and how she has become more forgetful. I think as nurses, we have to respect what her preferences and needs are but also acknowledge whether she has the mental capacity to know what is best for her. It is evident that Mary is becoming more vulnerable and that she is in need of extra support, whether that be nurses/carers visiting Mary at home or discharging her into a residential care home.

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Mental Capacity Act 2005
Despite Mental health conditions, it doesn’t mean that the individual lacks capacity to make a specific decision. The MCA aims to empower and protect individuals who may lack mental capacity to make their own decisions regarding their care and treatment.

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In this situation, a Nurse may listen to Mary's concerns and preferences associated with the issue and then act as an advocate for Mary during the meeting, particulaly if Mary is not present. 

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In this situation, a Nurse may listen to Mary's concerns and preferences associated with the issue and then act as an advocate for Mary during the meeting, particulaly if Mary is not present. 

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A Nurse would support Mary during the process of being discharged and moving into a residentialsetting, which may include explaining things clearly to put Mary's mind at ease (effective use of the 6Cs is needed here). 

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A Nurse would support Mary during the process of being discharged and moving into a residentialsetting, which may include explaining things clearly to put Mary's mind at ease (effective use of the 6Cs is needed here). 

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NHS AND COMMUNITY CARE ACT - Home care, day care and respite care were developed to help people live in their own homes. 

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NHS AND COMMUNITY CARE ACT - Home care, day care and respite care were developed to help people live in their own homes. 

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Was Mary present at the meeting - a clear ethical issue? 

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Was Mary present at the meeting - a clear ethical issue? 

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Unless detained under the Mental Health Act, Mary's permission and consent is needed in regards to living in a residential home on a long-term basis