STAFF TRAINING VIDEO: Mental Capacity Assessment - Nurse-led scenario

MidCheshireHospitals

18 Feb 201908:20

Summary

TLDRIn this dialogue, healthcare staff are managing a confused elderly patient, Richard, who is resistant to taking his prescribed medication. Celia, a nurse, attempts to administer his medication, but Richard refuses, believing he is being poisoned. Phil, another nurse, intervenes, conducts a mental capacity assessment, and speaks with Richard’s wife Anna and her sister Claire. They discuss covertly administering the medication, emphasizing its importance in preventing a stroke. The team devises a plan to reduce Richard's anxiety, with his family’s involvement, ensuring his best interests are prioritized.

Takeaways

😀 Celia, the nurse, is trying to give medication to Richard, but he refuses, feeling distressed and thinking he’s being poisoned.
😟 Richard is on apixaban, a crucial medication, but he is agitated and unsure about taking it due to his confusion.
👨‍⚕️ Phil, another nurse, decides to perform a formal capacity assessment on Richard to determine his ability to make decisions about his medication.
👩‍👦 Richard expresses confusion, saying he doesn’t recognize anyone and feels disoriented in the hospital environment.
👩‍⚕️ Celia contacts Richard’s wife, Anna, asking her to come to the hospital and help with the situation.
👩‍👦 Anna arrives at the hospital with her sister Claire, and both explain that Richard gets more confused and anxious outside his usual routine.
💊 Richard takes his medications at home with Anna’s help, and it is suggested that Anna administers his meds in the hospital to ease his distress.
🧠 Phil concludes that Richard lacks the capacity to make informed decisions about his medication due to his inability to retain and weigh the risks and benefits.
📝 They agree on covertly administering Richard's medication in his best interest, ensuring it’s documented for future care.
👨‍⚕️ Phil ensures that Richard's care will continue smoothly, with Celia informed about the next steps in administering the medication covertly with Anna’s help.

Q & A

Who is the patient mentioned in the transcript, and what is his current situation?
-The patient is Mr. Richard Walter. He is in the hospital and has been refusing to take his prescribed medication due to confusion and distress, believing that the staff might be trying to poison him.
What medication is Richard refusing to take, and why is it important?
-Richard is refusing to take Apixaban, a critical medication for his heart health. It is prescribed to prevent issues like strokes, and it's vital that he takes it as prescribed.
How does Richard's confusion manifest, and what impact does it have on his behavior?
-Richard is disoriented in the hospital environment, feeling confused and unfamiliar with the staff. This confusion leads him to believe that people are trying to poison him, causing him to reject the medication and become distressed.
How do the hospital staff respond to Richard’s refusal to take medication?
-The staff, including Celia and Phil, respond calmly and sympathetically. Phil conducts a formal capacity assessment to evaluate Richard’s ability to make decisions about his treatment. They also plan to involve Richard’s wife, Anna, to help ease his distress.
What is the significance of involving Richard’s wife, Anna, in the situation?
-Anna plays a key role in helping Richard take his medication at home, so the staff believe her presence will comfort Richard and help him accept the medication in the hospital setting.
What steps do the hospital staff plan to take after realizing Richard lacks the capacity to make decisions about his medication?
-After determining that Richard lacks the capacity to make informed decisions, the staff discuss giving his medication covertly (hidden in food, for example) in his best interest. They consult Anna to ensure she agrees with this plan.
What is a ‘capacity assessment,’ and what was its outcome in Richard’s case?
-A capacity assessment evaluates a patient’s ability to understand, retain, and weigh information to make informed decisions. In Richard’s case, the assessment found that he lacks the capacity to decide about his medication due to his confusion and inability to retain information.
What are the legal and ethical considerations discussed in the transcript regarding Richard’s medication?
-The staff discuss the legal and ethical implications of administering medication covertly, which requires a best-interest discussion and documentation. This process ensures that Richard’s well-being is prioritized while respecting his autonomy as much as possible.
How does Richard’s confusion affect his perception of the hospital staff and environment?
-Richard's confusion leads him to mistrust the hospital staff and perceive them as strangers trying to harm him. This causes heightened anxiety and resistance to their efforts to provide care.
What solution do the staff and Richard’s family agree upon to ensure he takes his medication?
-The staff, along with Anna, agree to administer the medication covertly if needed. They will hide the medication in food or drink to ensure Richard receives it without causing further distress.

Outlines

00:00

💊 Administering Medication to Mr. Richard

Celia, a nurse, begins her shift by attending to Mr. Richard, confirming his identity through his wristband and date of birth. She tries to administer a vital medication, but Mr. Richard becomes distressed and refuses, thinking the medication is poison. Celia reassures him and decides to wait until his wife, Anna, arrives to help explain. Richard is visibly anxious, and Celia leaves to consult with her colleague, Phil, about his refusal and how to proceed.

05:01

🧑‍⚕️ Nurse Phil's Capacity Assessment

Phil, another nurse, enters to assess Mr. Richard's capacity to make decisions. Richard expresses confusion about the hospital and a lack of trust in the staff, not recognizing them. He recalls previous hospital visits for tests but struggles with his surroundings. Phil explains the importance of taking the prescribed medication to prevent serious health risks, such as strokes. After discussing with Celia, Phil plans to consult with Richard’s wife, Anna, and her sister Claire, to find a way to ensure Richard takes his medication.

👨‍👩‍👧 Consultation with Anna and Claire

Phil meets with Anna and Claire to discuss the issue of Richard’s refusal to take his medication. They explain that Richard has become confused and distressed in the unfamiliar hospital environment. Phil explains the risks of not taking his critical medication and the need to explore covert methods of administering it, if necessary. Anna agrees that this is in Richard’s best interest, as she does not want him to suffer a stroke. Phil outlines the necessary paperwork to ensure this is done legally and ethically.

📋 Best Interest Discussion and Care Planning

Phil reviews the legalities surrounding covert medication and confirms Anna’s agreement that it’s in Richard’s best interest. He suggests revisiting a 'This is Me' document from previous care, which outlines Richard's anxieties and preferences, to help hospital staff better understand his needs. They plan to place the document at his bedside to inform staff of his behaviors and help reduce his anxiety. Phil reassures Anna and Claire that the team will do everything to make sure Richard receives the necessary care while respecting his preferences.

💼 Next Steps and Reassurance

Phil concludes the meeting by assuring Anna and Claire that they will try to give Richard his medication while he is calm and with familiar faces around, such as Anna. He plans to coordinate with the nurse in charge to make this process smoother. Phil thanks them for their time and efforts, recognizing the importance of their involvement in Richard's care. The meeting ends with a mutual understanding of the next steps to support Richard through his hospital stay.

Mindmap

Keywords

💡Capacity Assessment

A capacity assessment evaluates an individual's ability to make informed decisions, particularly about their medical treatment. In the script, Phil, one of the nurses, mentions that he needs to perform a 'formal capacity assessment' on Richard, indicating concern that Richard may not fully understand the importance of taking his medication due to his confusion and distress.

💡Apixaban

Apixaban is a medication used to prevent blood clots and reduce the risk of stroke, especially in patients with heart conditions. In the video, Richard is prescribed Apixaban, which he refuses to take because he believes the staff might be poisoning him. This emphasizes the critical importance of medication compliance for his health.

💡Best Interest

In medical care, 'best interest' refers to decisions made on behalf of patients who may lack the capacity to make decisions for themselves, aiming to ensure their well-being. In the script, Phil engages in a 'best interest' discussion with Richard’s family to decide how to administer his medication despite his refusal.

💡Covert Medication

Covert medication involves giving a patient their medicine without their knowledge, often by hiding it in food or drink. This is considered when a patient lacks the capacity to consent but needs the medication. In the script, Richard’s family and the medical team discuss using covert medication as a solution to ensure he takes his Apixaban.

💡Confusion

Confusion is a state of disorientation where an individual is unable to understand their environment or circumstances. Richard experiences confusion in the hospital, not recognizing the staff or understanding why he is there, which leads to his refusal of medication. His confusion is a central challenge for the healthcare team.

💡Dementia

Dementia is a decline in cognitive function that affects memory, reasoning, and decision-making. Although the script doesn't explicitly mention that Richard has dementia, his inability to retain information and confusion about his environment strongly suggest cognitive decline, prompting the team to consider covert medication and consult his family.

💡Medication Adherence

Medication adherence refers to the extent to which patients take their medications as prescribed. In the script, Richard’s refusal to take his Apixaban is a key issue, as this medication is critical for preventing strokes. The healthcare team discusses strategies to improve his adherence, including involving his wife and possibly administering medication covertly.

💡Environmental Stress

Environmental stress in healthcare settings refers to the discomfort and anxiety that patients may feel due to unfamiliar surroundings. Richard expresses that he feels out of place in the hospital, contributing to his distress and suspicion of the staff. This stress exacerbates his confusion and resistance to taking medication.

💡Family Involvement

Family involvement is the engagement of a patient’s relatives in their healthcare decisions, particularly when the patient is unable to make decisions independently. Richard’s wife, Anna, and her sister are involved in discussions with the medical team to ensure that Richard takes his medication, highlighting the importance of family support in patient care.

💡Risk vs. Benefit

In healthcare, 'risk vs. benefit' refers to weighing the potential dangers of a treatment against its advantages. The team discusses the risks of Richard not taking his Apixaban (such as stroke) versus the benefit of administering the medication covertly. This assessment helps determine the best course of action in Richard’s care.

Highlights

Celia, the nurse, begins by confirming Mr. Richard’s identity and his prescribed medication before administering it.

Mr. Richard expresses distress, believing that the medication may be poisonous, leading Celia to decide to wait for his wife, Anna, to help explain.

Celia seeks assistance from Phil, another nurse, to conduct a formal capacity assessment due to Mr. Richard's agitation and refusal to take his medication.

Phil speaks to Mr. Richard to assess his understanding and explains the importance of taking his heart medication to prevent conditions like stroke.

Mr. Richard shows confusion, expressing that he does not recognize the nurses or the hospital, further complicating the situation.

Phil learns from Mr. Richard that his wife, Anna, helps him manage his medications at home, which is an important factor in his refusal at the hospital.

Phil informs Celia to contact Anna to visit the hospital with her sister, Claire, to discuss Mr. Richard's situation.

Anna and Claire arrive, and Phil explains that Mr. Richard refused his apixaban medication, which is critical for preventing blood clots.

Anna confirms that Richard is not used to taking medication without her assistance and that he gets confused easily outside his normal routine.

Anna recalls a previous discussion with a doctor about covertly administering medication at home by placing it in his favorite sweets.

Phil explains the legal implications of covert medication administration, highlighting the importance of ensuring it’s in Mr. Richard's best interest.

Phil confirms that Mr. Richard lacks capacity to make the decision regarding his medication, as he cannot retain information or weigh the risks and benefits.

Phil outlines the best interest discussion and asks for Anna’s agreement to administer the medication covertly in the hospital.

Anna agrees that covert medication is in Mr. Richard’s best interest to avoid the risks of a stroke, and Phil begins the necessary paperwork.

Phil suggests using a dementia care bundle to document Mr. Richard’s specific anxieties and preferences, helping staff understand his behavior better.

The plan is set for Anna to assist with giving Mr. Richard his medication, which will hopefully reduce his distress and ensure he gets the treatment he needs.