Drink and Drugs News DDN September 2018 - Page 13

More on mental health at www.drinkanddrugsnews.com CLiniCaL eye A sense of purpose Nurses have to be resilient in the most difficult situations, says Ishbel Straker The act does apply to people with alcohol and drug problems; a person can be assessed as lacking capacity because of intoxication. matter of life and death. The most crucial example of this is the review of the death of ‘Carol’, who was beaten to death by two teenage girls in Teesside. They were among a number of people who were regularly exploiting Carol’s vulnerability and using her property through coercion. The review into her death suggests that it is important to assess both decisional and executive capacity. This concept has been proposed by Braye, Orr and Preston- Shoot (2011). A person has decisional capacity when they can understand, retain, use and weigh up the information needed to make a decision. This is covered by the Mental Capacity Assessment outlined in the act. However, executive capacity is the ability for a person to actually carry out that decision, which can be impaired by alcohol misuse. For an individual such as Carol or Joe, the assessment of executive capacity is unlikely to be straightforward. When more sober they may appear able to take rational decisions, but repeated history shows they are never able to put these decisions into effect. Do they have the executive capacity to manage situations, for example where unwanted people are entering their property? In part, the problems highlighted here are about training and understanding. Every local authority area in the country should be bringing professionals together to ensure a shared understanding of how the act applies to people with alcohol and drug problems. However, the notion of executive capacity is not mentioned in the act. There is a need to consider new guidance on the act, or even revised legislation, i f we are going to protect some of the most vulnerable people in our communities. Mike Ward is senior consultant for the charity formed by the merger of Alcohol Concern and Alcohol Research UK, www.alcoholresearchuk.org. His next article will look at criminal behaviour orders. www.drinkanddrugsnews.com IN LATE JUNE, a children’s nurse was arrested in connection with 17 neonatal deaths and 15 collapses between March 2015 and July 2016. These incidents occurred at a hospital in Chester – however, at the time of writing this column, the concern had also spread to her connection with another hospital. When I heard about this tragic situation, my thoughts went to the parents of the babies and also to the staff who had worked with this nurse. Investigations are an unpleasant experience at the best of times for all involved – especially those who may have blown the actual whistle in the first place, suspected for some time that conduct was questionable, and had done their best to support before realising they were left with no choice. A close family member has recently qualified as a nurse. She made the decision to go into the profession because of her caring nature and practical spirit. Yet I fear this is being significantly damaged by repeated poor practice that she is having to witness, and her attempts to support and gently report to her line manager to no avail. We have spent time discussing at what point this may become a whistleblowing situation and I can see her sadness at this seemingly fast approaching reality. We have talked about this not being the reason she went into nursing, and her disappointment at not being free to get on and look after her patients because she is dealing with so many other issues. After a period of reflection, I have come to the realisation that part of being a nurse is to maintain a professional standard and yes, when our colleagues let us down that is incredibly frustrating. Yet it still remains our duty to elevate this standard in whatever way we can. The Nursing and Midwifery Council (NMC) tells us this is our duty according to the Code and so we have an obligation – one that, if we don’t fulfil, can also result in our own conduct coming into question. This is a heavy weight for a professional to carry and one that our colleagues in the field, who may not be nurses, need to recognise. When it looks like we are being finicky or difficult, they need to realise we have a duty that we are registered to fulfil. Ishbel Straker is a clinical director, registered mental health nurse, independent nurse prescriber and board member of IntNSA ‘We have an obligation – one that, if we don’t fulfil, can also result in our own conduct coming into question’ September 2018 | drinkanddrugsnews | 13