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

Summary

In 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.