Ethical and Legal issues

Question 1

Is an ADRT legally binding

Answer 1

Yes

Question 2

Is an advanced statement legally binding

Answer 2

No

Question 3

What is an LPA

Answer 3

Individual appointed to make decisions on pt behalf if capacity is lost

Question 4

What are the 6 principles of safeguarding investigations

Answer 4

Empowerment 
Protection 
Prevention 
Proportionality 
Partnership 
Accountability

Question 5

Safeguarding Ix - empowerment

Answer 5

Decisions are led by patient and investigations are carried out w/ informed consent

Question 6

Safeguarding Ix - protection

Answer 6

Those in immediate/continued danger are protected from harm

Question 7

Safeguarding Ix - proportionality

Answer 7

Proportional intervention will be made that = the least intrustive appropriate to risk presented

Question 8

Safeguarding Ix - partnership

Answer 8

Solutions delivered by services, which detect + report neglect + abuse
Health + social care

Question 9

OSCE station on safeguarding - what must be covered

Answer 9

Communication skills: clarification, checking and summarising
Establish facts RE abuse
Psychological factors incl drugs and alcohol
RF for abuse
Exploration of carer stress
Correct Mx - Rx, social services support, pt needs to stay in hospital, consultant will need to review

Question 10

Escalation of concerns to safeguarding NUH

Answer 10

1 - Ensure pt immediate safety
2 - Inform nurse manager
3 - Request exam by reg + completion of body map
4 - does pt have caring responsibilities, is another vulnerbale person involved?
5 - Inform NUH safeguarding team
6 - Phone adults safeguarding referral to social services within 24hrs
7 - Inform family Rx has been make
8 - Carefully document discussion in med notes
9 - Complete incident form
10 - do not discharge until MDT agree approp safety plan

Question 11

What are the 4 ethical principles

Answer 11

Non-malificence
Beneficence
Automony
Justice

Question 12

Non-malificence

Answer 12

Harm to pt should be avoided or minimised

Question 13

Beneficence

Answer 13

Health professionals should always try to act to pt’s benefit

Question 14

Autonomy

Answer 14

pt has right to self determination, which should be respected at all times

Question 15

Justice

Answer 15

Healthcare professionals should always act fairly

Question 16

WHat 3 things is justice subdivided into

Answer 16

Legislative (specified in statute or by legal precedent)
Rights based - based on agreed principles of inalienable human rights
Distributive - based on fair and equitable distribution of available resources across society

Question 17

‘Benefits’ of diagnosis of dementia (5)

Answer 17

Ascertain Tx preferences 
Make will/LPA/Advanced directive 
Plan for disability 
Right to know their diagnosis 
Better support and access to help psychological adjustment

Question 18

Suggested guidelines for disclosing diagnosis (9)

Answer 18

Use MDT approach to answer Q
Consider telling pt and carer together 
Allow time to talk + answer q 
Arrange follow up meetings for discussions 
Discuss disease progression 
Agree care plan 
Prov educational materials 
Prov list of community resources/contacts 
Arrange further support

Question 19

What is testamentary capacity

Answer 19

Ability to make a will

Question 20

Driving + dementia

Answer 20

Legally obliged to tell DVLA once diagnosed

DVLA will investigate using GP, psych reports + driving assessment

Question 21

2 outcomes of driving + dementia

Answer 21

New license valid for 1 y

License revoked

Question 22

MHA 1983

Answer 22

Protects rights of pt w/ mental disorder without consent if necessary. COvers only Tx for mental disorder.
= to control

Question 23

MCA 2005

Answer 23

Empowers + protects people 16+ who lack capacity.
To make decisions
To assist, support + enable
Covers Tx for physical and mental conditions

Question 24

What is the 2 stage test of assessing capacity

Answer 24

1 - Is there impairment/disturbance in the functioning of persons mind/brain
2 - Is the impairment/disturbance sufficient for person to lack capacity to make the decision (understand/retain/weigh up/communicate)

Question 25

What are the 5 principles of the MCA

Answer 25

1 - Presume capacity until proven otherwise
2 - Right for indiv to be supported to make their own decisions
3 - Should not be assumed