STAFF TRAINING VIDEO: Mental Capacity Assessment - Nurse-led scenario
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
💊 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.
🧑⚕️ 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
💡Apixaban
💡Best Interest
💡Covert Medication
💡Confusion
💡Dementia
💡Medication Adherence
💡Environmental Stress
💡Family Involvement
💡Risk vs. Benefit
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.
Transcripts
mr. Ravens Walter Richard
my name's Celia and I'm gonna be looking
after you today okay right I've just got
your medications here to take can I just
check your wristband what's that then
Richard you do to birth for the first at
10:52 that's correct
correct I've just got one tablet here
for you to take it out for me
Richard it's really important it's a
very important medication the poisoning
they look the doctors prescribed it
somebody see that see it's your name
date of birth and it's it's prescribed
to this just this one tablet to take
it's really important thing they get
lost okay don't get distressed is you're
stressed it's your wife coming in today
Anna's coming in right shall I leave it
and speak to honour and we'll give it to
you when Anna's here will that help she
can explain to you not taking this okay
well don't get distressed I'll come back
later
distressed okay I see leave everything
okay
Oh Phil just the person Oh gone what's
up well it's patient mr. Richards waves
no oh yeah no Richard yeah yeah I can't
gonna take his medication John isn't he
on apixaban yeah yes yeah I've tried to
explain that but he just says he doesn't
know he's an agitator the environment
thinks I'm trying to poison him
oh gosh okay would you say you've got
capacity and I wouldn't know that okay
you know right what I'll do is I'll go
and do a formal capacity of assessment
and in relation to his medications could
you do me a favor canoeing is why found
there and ask her to come in now she
doesn't drive and so she'll probably
need to get a lift so give it a bit of
time but if you can do that I'll pop and
see Richard and take you from there no
problem hopefully okay thanks
are you Richard do you remember me my
name's Phil I'm one of the nurses that
work at the trust nothing MMB we've met
a couple of tablet don't worry we won't
see an easily forgotten how are you
feeling this morning I'm all right
yeah okay and I've just bumped into
Celia who's the nurse looking after you
today a little bit worried because this
morning you didn't take your medications
that you normally take do you remember
it's just that these medications that
you run are really really important and
they keep your heart nice and strong and
and so it stops you having any problems
ongoing and there are some significant
problems that you might have if you
don't take your tablets
yeah like it like a stroke something
like that oh yeah yeah so we keen to
know is it a particular reason why you
don't want to take your tablets aims or
anything we can do to help well just I
just don't know you I don't know you I
don't know any of you yeah look at this
place is this confuse him yeah I just
don't know you okay have you ever been
in a hospital before Richard Adam some
stuff with me let me see the think and
something about the tube yeah oh yeah
that's keep coming in for some tests for
you waterworks I believe in this board
yeah blood in your water yeah okay well
we can get that sort of you but there's
no but we do just in hospital at the
moment and we need to try and get you to
make sure you take your tablets it's
really really important so what I've
done is I Celia if you could ring your
wife Anna yeah a few times at Lovelace's
yes so I think Anna's gonna come in with
her sister Claire and play yeah yep so
I'm gonna have a little chat them about
this medication issue because I'm a
little bit worried about it I want to
make sure that you take the tablets in
the best way that we can sort that out
and I wanna she's lovely
yeah does she help you be the tablets at
home and I helps me with everything does
she believe she's the right woman to
talk to then definitely Anna is the
right woman at all - perfect well I
think she's coming into the sister
Claire Claire yeah so I'll have a little
chat with him first then we'll come over
and I'll chat with you and we'll come up
with some sort of a plan okay yeah yeah
good okay brilliant
all right leave it with me and we'll
come back to you shortly all right okay
lovely thank you
okay
hi Anna I feel nailed nice to see again
yeah lovely to see you thank you so much
for coming in it's not my sister Claire
sorry hi Claire Phil nice to meet you
how you meet you thanks ever so much for
both coming in we've had a bit of a
problem with Richard this morning
Celie the nurse that's looking after
this morning tried to give him his
tablets and he was absolutely having
none of it he not the tablets away and
was really really distressed he said he
thought we were poisoning him and as you
know he's on a picks about alpha li a
critical medication we really need to
make sure and find some way through this
so they can take his tablets while she's
in hospital with us I've was Richard I'm
just trying to find out a little bit
what the problem is maybe he couldn't
remember not taking his medications this
morning he feels very very it's at a
very very strange environment he's not
comfortable at all he doesn't know me
didn't know Seeley and this is all just
kind of all the issues I went through
the risks and benefits of taking the
medications and I'm I'm pretty sure that
he didn't understand or basically
because he can't retain me and four
minutes before yeah I'm in hospital for
his teeth writes anything out of his
ordinary routine right right okay he it
really got much more confused out
there's normal routine yeah yeah got
quite anxious yeah well he said I don't
know who you are I don't know where I am
he was really weird sort of
environmental pressures I think we're
really really difficult they talked
about people poisoning in three boys
near I'm so the same yes morning so it
wasn't anything you did last time it
enabled him to take his tablets and
easily yeah I think we I think we did
the doctor at a time talked to us about
it yeah I used to come in and drive sort
of it's not a problem at home yeah yeah
yeah yeah yeah but then on the time I
couldn't come in so I don't I don't
drive so you know right design on people
bringing me yeah they used to put it in
putting he's got a sweet so I really
yeah really I don't want him type of
strokes no of course yeah having a
medicine or having a stroke and I'd
rather get the medicine perfect yeah
what we sort of call that covert
medication so given covertly in his best
interest okay okay well there's
obviously paperwork to fill in that
there is and everything in hospital so
I've done the capacity assessment on
Richard
and I've diamond to like capacity in
relation to this decision
because he can't retain information and
way up the risks versus the benefits
so what then we go on to have what we
call the best interest discussion which
is exactly what having here part of that
and I don't whether you've done this
when you had is easier ology appointment
and it's to demonstrate that you agree
it's in his best interest to give his
meds covert like yes sir then it to the
following yes probably recognize it for
now it's just your name that your wife
and it you agree it's at his best
interest yeah oh yes that's a lie yeah
okay and this isn't legally binding I
think just basically demonstrating that
we have these conversations and the
important thing is that Richard gets his
medications
and have you filled in or help Richard
to fill in the information about me to
help you document that we have as part
of our dementia care bundle is that is
that I think I did last time II yeah
about what what things that might make
you more anxious and how I hear and how
did yes Rankin it may be when we go
out if I ask Siri to give you one for
this time and we can just put it at the
end of his bed
so people that looking at France garland
it more of a knows little idiosyncrasies
in that kind of thing we can get that
old got lots of them yeah old yeah yeah
so that'd be wonderful and and we can we
know then that that's that's been lovely
okay super well that's great so I said
you were coming in he knows you're
coming in and so if you want to go visit
in now that'd be great
and I notice outside of his Natasha we
don't mind people the opportunity maybe
let me give him his tablets nighttime
here if that's not okay well what I'll
do is when I leave here I'll go and tell
Sealy to sort of medications out and we
can give it to my here and then
hopefully that'll that'll start and he's
in his distress around medications but
as you say it's really important it gets
some soul just kind of do everything we
can so this is like a bit of the back
yeah absolutely yes yes okay yes lovely
okay that's great thank you so much
thank you for coming in as well and then
fierce man did you manage to park just
about okay lovely all right thanks again
and we'll get this sorted and if you can
document that for us that would be a
really lovely thank you thanks very much
funny to see you thank you thank you
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