Drink and Drugs News DDN September 2018_V2 | Page 13

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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.
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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