Scenario 2 by https://padlet.com/alexander_phillipsa/dqsth8eofbz4 Made with wonder en-us 2016-11-06 13:15:01 UTC 2025-12-01 01:33:20 UTC hello@padlet.com Legal Aspects alexander_phillipsa https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135599956 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] ]]> 2016-11-06 13:27:55 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135599956 Ethical Issues  brickellh https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135601801 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.]]> 2016-11-06 13:57:02 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135601801 Scenario alexander_phillipsa https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135602202 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? ]]> 2016-11-06 14:03:46 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135602202 The Royal College of Nursing- Human Rights and Nursing  brickellh https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135623490 This document explains how human rights play an important part of nursing.]]> 2016-11-06 18:43:34 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135623490 Nursing ethical values and definitions: A literature review -Nursing ethical values and definitions: A literature review - M Shahriari (2013)  brickellh https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135623600 This article explores ethics and values within nursing]]> 2016-11-06 18:45:21 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135623600 Health care ethics  brickellh https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135631776 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. ]]> 2016-11-06 20:24:43 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135631776 Professional values laurenneil123 https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135634140 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]]> 2016-11-06 20:49:41 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135634140 The Nursing and Midwifery Code  brickellh https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135636555 2016-11-06 21:17:59 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135636555 orambr https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135649365 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.]]> 2016-11-06 23:50:45 UTC https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135649365 harrisre3 https://padlet.com/alexander_phillipsa/dqsth8eofbz4/wish/135685405 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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