https://padlet.com/dickinsondl/35hfb8uhk20c en-us 2017-04-25 10:48:13 UTC 2017-05-04 11:40:46 UTC hello@padlet.com tamplinl https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059413 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 under went 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 cause ? Thinking of professional values what do you think nurses would do in this situation? ]]> 2017-04-25 10:56:52 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059413 shiptonlm https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059601 2017-04-25 10:58:04 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059601 dickinsondl https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059631 is it ethical for her family to have such a large impact on her care plan?

is the care being person centered?

]]> 2017-04-25 10:58:21 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059631 sorensonme https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059655 Has she got the capacity to make her own choices?

Mary is still sound of mind so in fact she can refuse to live in the nursing home. The only way that her family can legally make decision for her is by obtaining guardianship (by court order if Mary does not want a guardian)
http://www.wales.nhs.uk/sites3/documents/816/leaflet%2013%20%2d%20section%2037.pdf]]> 2017-04-25 10:58:36 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059655 dickinsondl https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059660  NMC....To Act in The Best Interests of People at all times
4 Act in the best interests of people at all times To achieve this, you must: 4.1 balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment Nursing and Midwifery Council 4.2 make sure that you get properly informed consent and document it before carrying out any action 4.3 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, and 4.4 tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care.
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf]]> 2017-04-25 10:58:39 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059660 dickinsondl https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059754 2017-04-25 10:59:16 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059754 sorensonme https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059795 powerpoint
references needed
Proof all points/statements made]]> 2017-04-25 10:59:26 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168059795 selvaescuderom https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168060489 To which extent can she be placed in a care home without her consent?

Social services have a responsibility to provide care to vulnerable adults such as Mary. Mary's needs have to be met and assessed and should be given suitable equipment that can help her keep her independence at home. If social services believe that Mary's care needs can't be met at her home then she can be placed in a suitable place where her care needs can be carried out. This can either be in a nursing home, care home , residential home etc. 

Mary is getting forgetful so, social services may produce a care plan on a patient who has dementia. This would involve them persuading Mary to go to the care home. However, Mary doesn't want to leave her home. What happens then? It will be difficult for social services to balance Mary's safety, safety of others and Mary's freedom. 
In this case, the Mental Health Act 1983 for England and Wales will be carried out. Social services will force Mary to go to hospital , this is known as 'sectioning' . This will give permission for Mary , who is at risk , to be taken somewhere safe without her permission. However, this step is only taken in extreme conditions. 

This can be hard for the family members to see there mum be taken away . Mary's nearest relative is her granddaughter who lives a while away . She is only able to visit once a week which is not enough to be able to provide enough care. In order to meet Mary's wishes , her family could arrange paid carers to visit her and care for her. http://lx.iriss.org.uk/sites/default/files/resources/Frequently%20asked%20legal%20questions.pdf]]> 2017-04-25 11:03:58 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/168060489 miriam0590 https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169641057 Since it is our responsibility to act in the best interest of the patient and ensure her rights and wishes are taking into consideration we may advocate for Mary's choice. At the same time her choice may endanger her health and this is why we need to find a balance. It was agreed with the multidisciplinary team that Mary cannot care for herself on her own so the nurse may propose other alternatives like the family hiring a home stay carer. As well as directing the family towards resources in the area/benefits to help cover the cost for this need.
The nurse could act as an advocate and tell the family and the multidisciplinary team about Mary's interest.]]> 2017-05-03 11:19:05 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169641057 sorensonme https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169647408 Marys family could have her best interest at heart, they want her to go into a caring committed and compassionate environment which she would not get living at home on her own. Her family do not have the competence a carer would have looking after Mary, sending Mary to a care home requires courage as they may not want her to leave her home although they did lack communication when deciding to send Mary to a nursing home. The family could argue Mary is developing dementia as she is becoming forgetful and therefore they did not feel she had the capacity to make the decision. The family would have also taken the advice of medical professional in the meeting to assist in their design

]]> 2017-05-03 11:58:25 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169647408 sorensonme https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169649185 Mary has not been diagnosed with dementia therefore 'becoming forgetful' is not a ground to base ones decision on and not including Mary in the meeting as her mental capacity should give her personal autonomy
Mary might be able to cope with the new ambience. She might not cooperate with the staff and not take her medicines or eat anything which will affect her health. if she doesn't have a good diet it will make her weak and she will end up having  degenerative diseases such as cardiovascular and cerebrovascular disease. (http://www.who.int/nutrition/topics/ageing/en/index1.html)

Marys wish is to stay at home so therefore morally her family should respect her wishes and assist her in doing so regardless of their opinions, it could be argued the quality of Mary's life is better than a possible longevity of life in a nursing home in which she will not enjoy.

The family may have alterer motives as to why they are sending mary to a nursing home, there is no mention of Mary's husband in the scenario therefore we can presume there may be an inheritance. The family may have beneficial financial gain in moving mary out of the house ]]> 2017-05-03 12:07:05 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169649185 sorensonme https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169651060 A nurse would refer to the NMC code and 6Cs to help and guide Mary and the family to reach a decision together. 

According to the NMC a nurse must treat people as individuals and uphold their dignity as well as listen to people and respond to their preferences and concerns- in mary's situation we must analyse that mary would be able to receive the care she needs at home without undue delay and work in a partnership to deliver this care and recognise that she may be able to contribute to her own health and wellbeing. It is a Nurses duty to assess someones physical, social and psychological needs and respond to this- this raises the question if Mary is well enough to live at home or if she needs professional care.

One must also raise concerns immediately if they believe a person is vulnerable or at risk and needs extra support and protection, as a nurse you may feel Mary's family is not acting in her best interests and you may need to step in and take the necessary ,measures to prevent this.

]]> 2017-05-03 12:16:04 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169651060 shiptonlm https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169672584 In 2011 the UK Government introduced a policy titled 'No decision about me, without me' (Coulter, A & Collins, A, 2011) Where healthcare professionals were expected to promote patient choice and aid decision making. Patient's are to be informed and involved in all aspects of care. This policy reflects standards of professional conduct for nurses outlined in the NMC (2015) in particular, 'Nurses are to act in partnership with those receiving care'. Mary has not been deemed to not have capacity, in which case she has the right to be fully informed and involved in where and how she receives her care. By allowing Mary to be as involved in the decision making process as possible, nursing staff are doing their upmost to promote Mary's autonomy in a way that is empathetic; which is in line with the nurses code of conduct (NMC, 2015) 

REFERENCES!
Coulter, A & Collins, A (2011) Making Shared Decision-Making a Reality: No decision about me, without me. London: The King's Fund

Nursing and Midwifery Council (2015) The NMC Code of Conduct: Standards for Conduct, Performance and Ethics. London: Nursing and Midwifery Council.


(By laura) ]]> 2017-05-03 13:38:41 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169672584 shiptonlm https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169692509 (not sure which category this fits under sorry)
To have a 'Best Interest Meeting' where the healthcare professionals make the decisions about care without Mary's consent they would have to establish two things: 
(a)' has an impairment of, or a disturbance in the functioning of, the mind or brain; and 
 
(b) lacks the capacity to make the decision(s) for themselves at this time.'  (Department of Health, 2005)

If Mary is deemed to have capacity and she is not involved in the decision making, then are we as nurses acting with true beneficence and non-maleficence?

REFERENCES!
Department of Health (2005) Best Interest Decision Making Meetings, Available at:
https://www.cornwall.gov.uk/media/3630674/Best-Interest-Meeting-Guidance-summary.pdf [Accessed 03.05.2017 @ 15:46]


(By laura)]]> 2017-05-03 14:36:30 UTC https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169692509 murrayal1 https://padlet.com/dickinsondl/35hfb8uhk20c/wish/169695389 A nurse should act as an advocate for the patient (NMC, 2015) as they will often have a closer therapeutic relationship with the patient than other health professionals. This often means that patients are much more likely to confide to their nurse about the decisions being made about their care. The nurse can use this relationship as an advantage to act as the advocate for the patient, but they must remember to also keep their professional boundaries (NCSBN, 2014). The nurse in Mary’s case would have acted as an advocate for her but would also have to balance Mary’s wishes to stay at home with the care needs that she has. An option for at home care may have been discussed in the multi-disciplinary meeting. This may not have been possible due to the level of care that Mary may need and she may have a high risk level of falling at home. A nurse with a good therapeutic relationship with a patient would be able to use this to explain the decisions made by the multi-disciplinary team and answer all the questions Mary may have about her care.

Ncsbn.org, 2017, Ncsbnorg. [Online]. [3 May 2017]. Available from: https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf
In-text citation: (Ncsbn.org, 2014)

Nursingtimes.net, Lally, J.Macphail, S, Palmer, D, Blair, E,Thomson, R. 2011. Nursing Times.net. [Online]. [3 May 2017]. Available from: https://www.nursingtimes.net/enabling-patients-to-share-decisions-about-their-care/5034253.article

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