Based on this mental state review, it would be reasonable and appropriate to determine that this patient is incapable of making informed or logical medical decisions. Of the four capacity criteria listed above, he demonstrated none. A patient who does not have decision-making capacity cannot refuse or consent to treatment [7]. Once this lack of capacity has been determined and documented, the medical provider is legally authorized to perform sedation, restraint, venipuncture, and other tests or treatments deemed appropriate. The process of formal capacity assessment is very important from a professional and possibly legal point of view. Therefore, any assessment should be subject to accurate records and documentation. This allows you to objectively record the discussions that took place and provide evidence of the decisions made at that time. There is no „right“ way to assess a patient`s mental performance in all scenarios (Lamont et al., 2013). The degree of assessment of capacity is generally related to the importance of the clinical decision.
For example, when a patient is asked if they are happy to be physically examined, verbal consent is considered appropriate because of the minimal likelihood of side effects and the non-invasive nature of the examination. However, for more complex procedures or procedures, a more detailed discussion of the negative and positive effects of the intervention should be conducted and obtained in writing and with oral consent. An example of a more detailed need for capacity assessment may be related to a patient undergoing surgery, where there may be great risks associated with the procedure itself. In some cases, a patient whose capacity is in doubt may refuse to participate in an assessment. This is a delicate situation and, as a nurse, you need to be able to handle it sensitively and in relation to the patient. In most cases, a reasonable and sensitive discussion of why the assessment is necessary may be sufficient to convince the patient to agree. They should explain the consequences if a patient refuses to submit to a capacity assessment, including whether decisions made may be challenged by medical or legal staff in the future. However, it is important to remember that if the patient refuses, they cannot be forced to undergo a capacity assessment and their wishes must be respected (Bingham, 2012). Documentation of capacity assessments should be done in patient notes, and specific forms often need to be completed, depending on local health care policy (Ministry of Health, 2009). Each capacity assessment should be formally completed and recorded in the notes, and then repeated periodically when the patient`s condition has changed. Once the capacity assessment is complete, it is also important for caregivers to communicate it to other staff who may be involved in that patient`s care to reinforce the presence of assessment scores.
This can avoid confusion among staff and differences in how people approach the patient or ask questions about care decision-making. Since capacity can sometimes change over time, it should be assessed at the time consent is required. A person`s ability to make a decision can also change over time. For example, a person in elderly care may have fluctuating capacity due to delirium, certain forms of dementia or mental illness. Due to legal licensing issues, this assessment is not an appropriate task for nurses, licensed practical nurses, technicians or other support staff. Often, psychiatrists are seen as the experts in this assessment, and they may be involved in particularly complex situations that require expert advice. However, these providers are not always available for immediate advice. Therefore, and especially in the emergency room, due to the high visual acuity of physical or mental illnesses, a rapid assessment of capacity may be required immediately. Therefore, any physician, medical assistant or registered nurse can and should be able to assess and determine capacity. Consent – ethical issues – ethical practice – human rights – informed consent – legal issues – mental capacity law – professional This section aims to illustrate how capacity assessment can be carried out in practice and should serve as a useful discussion scenario.