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Article
Publication date: 8 August 2016

Chris Lennard

The purpose of this paper is to examine the dilemma at the heart of nursing care – the striving for empowerment of people in nurses’ care with the responsibility to protect…

1759

Abstract

Purpose

The purpose of this paper is to examine the dilemma at the heart of nursing care – the striving for empowerment of people in nurses’ care with the responsibility to protect vulnerable adults from harm. In doing so, it argues that in difficult and borderline cases, capacity assessment is complex and ultimately based on a judgment involving interpretation, and welcomes the views of clinicians who have challenged the procedural test of capacity in the Mental Capacity Act (MCA).

Design/methodology/approach

It presents an illustrative study of a person with acquired brain injury (ABI) resident in a nursing home, who had been assessed under the MCA and judged to have capacity regarding health and welfare decisions, who subsequently displayed a persistent and impulsive desire to leave the unit without thought of risk and vulnerability to herself, prompting safeguarding concerns, and a reassessment of her capacity.

Findings

The paper asserts that supporting people with ABI during capacity assessments, as the MCA decrees, in a very structured way can create a false sense of “capacity”. It maintains that executive impairments in ABI, being difficult to assess in formal settings, are best undertaken over time, in real-life settings, with evidence from third parties. It welcomes the MCA’s desire to protect individual autonomy and avoid undue paternalism, through ensuring people are not deemed to lack capacity simply because they make an unwise decision.

Originality/value

But it goes on to argue that in ABI it is often the fact of unwise decision making that is the prominent factor and main concern, particularly in regard to impulsive decision making. If nurses have to make a judgment as to how unwise decisions made with decision-making capacity are to be distinguished from unwise decisions made without it in people with ABI, then, the author concludes, a major area of difficulty for nurses is ascertaining when the presumption of capacity should be challenged, an area that an updated code of practice needs to clarify.

Details

The Journal of Adult Protection, vol. 18 no. 4
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 9 February 2015

Chris Lennard

The purpose of this paper is to give a brief background to the Deprivation of Liberty Safeguards (DoLS), and studies which factors Best Interests Assessors consider when making a…

4490

Abstract

Purpose

The purpose of this paper is to give a brief background to the Deprivation of Liberty Safeguards (DoLS), and studies which factors Best Interests Assessors consider when making a judgement on Deprivation of Liberty. It examines some of the reasons why professionals may be under-using DoLS, including lack of knowledge, complex processes and paperwork, and the pejorative nature of the word “deprivation”, and looks at a possible way forward.

Design/methodology/approach

The paper looks at the evidence to the House of Commons and House of Lords Committees on the Mental Health Act and Mental Capacity Act, as well as previous and current research papers. It examines the nuances of difference between restriction and deprivation, and the cumulative impact of several restrictions, which may, in fact, amount to a deprivation, illustrated by case studies from the author's own practice.

Findings

It makes the case that health and social care professionals should err on the side of caution, by making precautionary DoLS applications, arguing that MCA DoLS is a forerunner of good practice, and that good care planning allied to judicious application of the MCA leads to better, more robust and more defensible decision making.

Originality/value

And it points the way to a possible future, citing the recommendations of the Select Committee on the MCA for a clearer link between DoLS and the principles underpinning the MCA, and for simplifying and clarifying the legislative provisions and the associated paperwork.

Details

The Journal of Adult Protection, vol. 17 no. 1
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 4 November 2014

Chris Lennard

As a healthcare professional caring for people who lack capacity, the author has noted a wide variation in knowledge and awareness by staff of the Deprivation of Liberty…

Abstract

Purpose

As a healthcare professional caring for people who lack capacity, the author has noted a wide variation in knowledge and awareness by staff of the Deprivation of Liberty Safeguards (DoLS). The purpose of this paper is to examine the DoLS and the background to their coming into being, describes their operation and qualifying requirements, and the continuing problems with their application nationwide.

Design/methodology/approach

Utilising a literature search of government papers, official reports of statutory bodies, and critical studies, it examines the central criticisms of DoLS, particularly the lack of a clear statutory definition of deprivation of liberty, and reports on the wide variation in knowledge of the legislation by staff in health and social care, and uneven application of the safeguards nationwide.

Findings

It cites evidence from studies showing that even professionals with high levels of expertise in the field find the legislation confusing, and presents testimony from legal experts that case law has failed to clarify the issues for professionals.

Originality/value

Finally, it argues that the legislation is now too complex to successfully amend, and tentatively suggests that, pending a government review to make the process more understandable, health care professionals make ‘precautionary’ applications for DoLS. The author argues that, notwithstanding its faults, the process is a worthwhile exercise in care planning and ensuring that people's care is in their best interests and the least restrictive available.

Details

Social Care and Neurodisability, vol. 5 no. 4
Type: Research Article
ISSN: 2042-0919

Keywords

Content available
Article
Publication date: 4 November 2014

Declan McNicholl

489

Abstract

Details

Social Care and Neurodisability, vol. 5 no. 4
Type: Research Article
ISSN: 2042-0919

Content available
Article
Publication date: 9 February 2015

Bridget Penhale and Margaret Flynn

160

Abstract

Details

The Journal of Adult Protection, vol. 17 no. 1
Type: Research Article
ISSN: 1466-8203

Article
Publication date: 8 August 2016

Bridget Penhale and Margaret Flynn

– The purpose of this paper is to provide an update for readers on recent issues relating to adult safeguarding, together with signposting of papers in this issue of the journal.

Abstract

Purpose

The purpose of this paper is to provide an update for readers on recent issues relating to adult safeguarding, together with signposting of papers in this issue of the journal.

Design/methodology/approach

A review of recent media, news and policy related items was undertaken and key findings are reported.

Findings

A range of findings and information pertinent to adult safeguarding is presented in the paper for readers to consider.

Practical implications

Some of the issues and perspectives presented in the paper may be of relevance for professional practice and readers may wish to disseminate such aspects to colleagues in order to inform practice initiatives.

Originality/value

The paper provides an update and overview of recent topics that are linked to adult safeguarding and protection and draws these together in an accessible format.

Details

The Journal of Adult Protection, vol. 18 no. 4
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 11 April 2018

Clare Lynette Harvey, Shona Thompson, Eileen Willis, Alannah Meyer and Maria Pearson

The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost…

1536

Abstract

Purpose

The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.

Design/methodology/approach

The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.

Findings

The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.

Originality/value

The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.

Details

Journal of Health Organization and Management, vol. 32 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 8 January 2018

Ebenezer Toyin Megbowon and Abbyssinia Mushunje

The purpose of this paper is to analyze food security status and its determinants among households in the Eastern Cape Province of South Africa.

Abstract

Purpose

The purpose of this paper is to analyze food security status and its determinants among households in the Eastern Cape Province of South Africa.

Design/methodology/approach

The analysis is based on the General Household Survey which was conducted in 2014 where 3,033 households were sampled from the province. Specifically, this study examines the determinants of food security proxy by dietary diversity (24-hour recall) using descriptive statistics, Poisson regression. A frequency count of food groups consumed household dietary diversity score was used as the explained variable.

Findings

The descriptive analysis shows that, although 61.7 percent of households in the study area have a high dietary diversity score, however, food group giving micronutrients are less consumed as food groups having cereals (maize), beef, sugar and oil was mostly consumed. Results on the marginal effect of Poisson regression indicate that household head characteristics (age, gender, education, marital status, and employment status), pension receiving households and geographical location significantly influence household dietary diversity.

Originality/value

This study advocates for the intensification of rural development and food security programs, formal and informal education for household heads, female empowerment and dietary enlightenment for households in order to promote the consumption of diverse diets and more healthful food groups.

Details

International Journal of Social Economics, vol. 45 no. 1
Type: Research Article
ISSN: 0306-8293

Keywords

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