Case Studies

Case 14: Dementia combined with learning disability

Henry is 66 years old, has a moderate learning disability and has had recent life-changing surgery. He has a history of previous mini-strokes and also has epilepsy. He has recently been diagnosed with dementia.

• 1. What are some of the challenges for the acute health care professionals?

  Show Answer

  Correct answer:

  • Lacks capacity to make own decisions
  • Behaviour - challenging to staff/disruptive to staff and other patients/shouting/non-compliant with care/cot sides used all the time
  • Develop pressure sores

  Poor decision making could result in the following:

  • Patient not being consulted or being involved in making his own choices.
  • Patient not understanding the way staff communicate with him.
  • No clear care plan in place.

• 2. What are the key issues for healthcare professionals to consider?

  Show Answer

  Correct answer:
  

  Patient choice - Lack of mental capacity does not mean the right to choice should be restricted. Patient choice and independence should be promoted.

  Mental capacity - Patient perceived to lack capacity to consent and make decisions before any formal test had been performed. Mental Capacity Act 2005 states that all adults on admission have mental capacity unless it is proven otherwise. Therefore, no one may consent on patients' behalf if they have not yet been deemed to not have capacity.

  Psychological abuse - When dealing with challenging patients, some nursing staff can forget that the language they use can be perceived as abuse. The No Secrets document helps to define psychological abuse, and state that humiliation, blaming, intimidation are actions that can be constituted as abuse. Also under the Human Rights Act (1998), patients have right to freedom from degrading treatment. Isolation and restriction of social interaction can also indicate a form of psychological abuse.

  Restriction of freedom - Use of cot sides without patient consent could signify false imprisonment under the Human Rights Act (1998). Local policy should be followed, and state that consent must be obtained before using cot sides. If used in best interests this should be well documented. The Deprivation of Liberty Safeguards state that when acting in the best interests of the patient, the least restrictive methods on patient independence should be used.

• 3. What are some of the ethical considerations?

  Show Answer

  Correct answer:
  

  Justice - Nursing staff should respect patients 'personal space', and patients should be able to decide how personal information about them is used, for example with referrals.

  Beneficence and non-maleficence - Nurses have a duty to do good for their patient, and should safeguard their health and well-being. This includes advocating for patients who may not have the ability to speak out for themselves.

  Autonomy - Recognise patients as individuals and protect their basic human rights such as the right to know, the right to privacy and right to receive treatment and appropriate care.