Edna age 82 is just about to bite a chocolate éclair. She is left in tears when a care assistant removes it from her telling her she is on a diet.
Just one of many issues arising within care, whether care homes or hospitals (Dimon 2006); others include more seemingly serious matters such as restraint. Gwendoline Gleeson an 89 year old patient at a nursing home in Australia died of a coronary while physically restrained on the toilet (Paley 2012). There was no medical authorisation for this. There is historical evidence of such issues , for example, when analysing forced treatment in workhouses where families were often separated.
There are political influences behind such situations – people living in workhouses were considered less worthy, which many consider to apply to vulnerable groups of people today; according to the work ethic they are regarded as being “non-contributors”.
There may be other reasons for such actions, including “nurse or carer knows best”, decisions by staff that the patient is confused or unable to make decisions, the carer’s lack of knowledge , failure to involve patients or relatives, inadequate procedures, such as documentation or involvement of specialists; attitudes of carers, fear of carers or managers who may face litigation. Even if patients are not confused, they have still been enforced to adhere to treatment or care, such as a bath, either directly or via manipulation. Such issues are not confined to the UK; there are published cases within the USA and Australia. Indeed, the underlying factor of rights of the patient or relative is linked to banning relatives from visiting or asking patients to leave when they complain. Is the issue in reality rights? Many argue there is no such thing as rights. The problem may be rather a difference in expectation between the care, the one being cared for, and their relatives.
Despite Acts to ensure correct procedures are undertaken, such situations, which may be regarded as abuse, continue in some cases.
A UK study has been undertaken in response to cases of patients being detained, or their rights being opposed according to the inappropriate use of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards ( Morrison 2014). Some cases published within the newspapers, such as Sergeant (2013), indicate this may be done to prevent relatives from being involved within the care of patients if they are considered to be interfering, as an example, or to maintain control of the resident, or to keep the bed full (in cases of care homes and private hospitals). Within the UK, the USA, and Australia, there are cases of relatives being banned from the establishment in response to complaining, or the patient being asked to leave (Dimon 2013). Similar cases particularly occur within mental health facilities . In Australia, this applies to the detention of Aborigines (Georgatas 2013). One may compare this to some cases within prisons, which may also inter prisoners for politically motivated reasons (Jackson 1970). Is the diagnosis of “lacks mental capacity”, in some cases, used as an excuse?
One factor is the difficulty of defining mental capacity for decision making. If I choose not to have a dressing on my leg wound do I lack foresight or sense? A patient needs the information in order to make an informed decision.
There is a need for an independent advocate for patients within hospitals, care homes and any other healthcare establishment, including prisons. This especially applies to the most vulnerable patients, such as the mentally ill or individuals with learning difficulties.
Nurses and care staff are confronted by such dilemmas on a daily basis, although these issues will arise moreso within areas of longterm care involving the most vulnerable patients. Within specialist areas such as ICU, issues will more likely involve clinical decisions, such as medication.
Dealing with these dilemmas challenges skills in decision making, places an onus on person-centred care, record keeping, and liasing with others .
Dimon C (2006) Decisions and Dilemmas in Care Homes Fivepin (book needs updating)
Dimon C (2013) The Commodity of Care Cloister House Press Free updates qualityofnursingcare.webs.com
Georgatas G (2013) Australia’s Aboriginal Children Detained At The World’s Highest Rates 2.5 nationalunitygovernment.org/content/australias-aboriginal-children-detained-worlds-highest-rate
Jackson G (1970) Sole Dad Brother
Morrison S (2014) The Great mental Health Betrayal :Inquiry Slams Appalling Unlawful Detention of Tens of Thousand Vulnerable People The Independent 13.3.
Paley A (2012) Elder and Nursing Home Abuse: A Universal Problem thescavenger.net 13.3
Sergeant H (2013) I had to Rescue my Mum From a Private Hospital as The Nurses There Were so Callous Daily Mail December 2013 p44-45
Carol Dimon copyright 2014