1. Nursing to empower…. Empowering nursing….
The Mental
Capacity Act (MCA)

2. MCA Project
Work across Birmingham, Sandwell and Solihull Clinical Commissioning Groups
To support implementation of Mental Capacity Act & Deprivation of Liberty Safeguards
Develop a suite of resources to support implementation / best practice
Identify best practice
Identify local issues, barriers and challenges
Public and patient engagement / awareness

3. Nursing to empower….
Empowering nursing….

4. Nursing to empower….
‘Empowerment means the freedom to choose where and when one has treatment, and also implies that patient’s should retain autonomy and responsibility for decision making during their treatment’
[Malin and Teasdale 1991]

5. This is the same as the MCA
Mental capacity is about making choices – mental capacity refers to a person’s ability to make a decision
Making choices is about information – but it can be about impulse
Making choices is personal – we all do it differently

6. What does this mean in practice?
How do I empower my patients?
Get to know how your patient’s communicate
Give information in your patient’s preferred communication method
Refer / seek advice from specialist services – Speech Language Therapy etc.
Get to know your patient’s preferences / history
Involve your patient’s family, friends and carers
Encourage independence
Respect choice / gain consent
Talk to your colleagues when you have a concern about your patients ability to make a decision

7. Some simple nursing solutions
Tools an resources to help you in your role:
About Me
Hospital Passports

8. This is the same as the MCA
We all have the right to decide and make our own decisions
We have the right to make choices that may appear unwise to others – we’re all unique, we value different things
We must give information about decisions in our patient’s preferred method of communication
Gives us ways to retain autonomy or choice and control in the future, such as LPAs and Advance Decisions
But when we are unable to make decisions, these decisions must be made in our best interests

9. ….& is reflected in the new NMC Code
New Nursing and Midwifery Code from March 2015
First theme is Prioritise people:
Treat people as individuals and uphold their dignity
Listen to people and respond to their preferences and concerns
Make sure that people’s physical, social and psychological needs are assessed and responded to
Act in the best interests of people at all times
Respect people’s right to privacy and confidentiality
1.3 avoid making assumptions and recognise diversity and individual choice
2.3 encourage and empower people to share decisions about their treatment and care
2.5 respect, support and document a person’s right to accept or refuse care and treatment
3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care
4.1 balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment
4.2 make sure that you get properly informed consent and document it before carrying out any action

10. Empowering nursing….
Nurses play a vital role in empowering patients, and when there are concerns that a patient may not be ale to make a decision for themselves, you will:
See your patients everyday
See them at different times of day - mental capacity can fluctuate
Know your patients, know how they communicate, who they are, what their preferences are
Have built a rapport with your patients
Liaised with their family, friends and carers
Your contribution is invaluable!
There are some myths around mental capacity, for example: only doctors can assess capacity

11. Some of the best practice is being driven by nurses
Nurses assessing capacity and making best interests decisions
Safeguarding nurses leading the implementation of MCA DoLS in hospitals
Dementia friendly wards – change being led strong nurse leadership
Deprivation of liberty in the community – assessments and applications being completed by nurses
Learning Disability Healthcare Facilitation
Specialist Nursing – CPNs at National Deaf MH Unit
There are some great local examples of all of the above

12. Don’t:
Get worried when you hear mental capacity terminology – it’s easier than you think
Be worried about getting it wrong, mental capacity isn’t always black and white, mental capacity can change, the process is as important as the outcome – ask for support

13. Do:
Think about what makes your patient unique – who they are, the way they communicate
Respect choice / gain consent
Value your contribution
Get to know Safeguarding Lead and / or Learning Disability Lead Nurse
Take a mental capacity prompt card

14. Further information:
SCIE MCA Resources
My next patient has a learning disability