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Please use this identifier to cite or link to this item: http://hdl.handle.net/10265/845

Title: An analysis of processes and strategies used by qualified nurses in assessing the mental capacity of acutely and critically ill hospitalised adult patients
Authors: Kenkre, Joyce
Gill, Paul
Jones, Sian
Keywords: nurses
nursing
patient care
mental health
hospital
adult patients
Issue Date: 19-Jul-2016
Citation: Jones, S. (2016) An analysis of processes and strategies used by qualified nurses in assessing the mental capacity of acutely and critically ill hospitalised adult patients. Unpublished PhD thesis, University of South Wales.
Abstract: Introduction: Mental capacity is the ability to understand, reason, and exercise choice by making informed decisions. Acute and/or critical illness may impact upon the decision making abilities of hospitalised adult patients. Assessment of patients for reduced, fluctuating or absent capacity gives the healthcare team the legal authority to assess best interests and to make treatment decisions without consent under this justification. Qualified nurses are the ever-present professional group in acute and critical care settings. They may initiate assessments of mental capacity which may be influential in the ways that the decision making of patients is facilitated or substituted. There are, however, few studies that focus on processes employed by them in this area in fast-moving clinical settings, although it is recognised that physical illness may have a significant impact upon capacity status. Aim: To explore processes and strategies used by qualified nurses in assessing the mental capacity of acutely and critically ill hospitalised adult patients. Methods: A qualitative grounded theory approach was used, informed by the methodological pathway of Corbin and Strauss (2008), to explore assessment processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales. Data were collected through a series of digitally recorded, semi-structured interviews which were transcribed verbatim. Data were analysed leading to a central category Findings/Discussion: Informal, intuitive, nurse-led processes were used to assess the mental capacity of patients which resulted in an articulation of “something not quite right” and which combined processes for the assessment of the physiological and mental capacity status of patients. A dynamic, holistic approach was evident which recognised the need to support the rights, dignity and autonomy of patients. This suggested the assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi-professional assessment was necessary and ongoing, and in which qualified nurses had a co-ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care. Conclusion: This study has provided an insight into nurse-led assessment processes that appear to be hidden due to their informal and instinctive nature. Processes appear to be holistic, patient-centred and dynamic. The developed theory, Nurse Managed Patient Focused Assessment and Care, provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness. This framework may inform clinical practice in this area and can serve as a basis of an assessment tool. It may also inform programmes of education for nurses in the need to enhance critical analysis of what has been identified as a fundamental role of the qualified nurse.
URI: http://hdl.handle.net/10265/845
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