Best interests decisions for people with advanced dementia: a qualitative study of nurses’ perspectives in England

Murphy, Jayne St Claire

Abstract

In the United Kingdom (UK), there are 907,900 people aged over 65 with dementia, 546,500 of whom would be classed as having severe dementia (Wittenberg et al 2019). Advanced dementia is now recognised as a leading cause of death in the UK and across the world (Sampson et al 2018). There is a gradual but insidious decline in a range of abilities and a subsequent reliance on family or formal caregivers to meet the needs of the individual and this reliance on others often leads to people with advanced dementia not being involved in decision-making (Miller, Whitlatch and Lyons 2016). The Mental Capacity Act (MCA) (2005) was implemented in 2007 and sought to provide a secure framework in which all parties concerned can make best interests decisions about care for people who may lack capacity (Ryan et al 2009; Graham and Cowley 2015). Unfortunately, widespread failure to adhere to the MCA is common (Wade and Kitzinger 2019).
A case study approach was utilised to provide in-depth analysis of Best Interests Standards as part of the MCA (2005) and best interests decision-making. In order to explore nurses’ thoughts and feelings about best interests decision-making, two vignettes were utilised, depicting two situations where treatment decisions were required to explore the research question:
• What factors do nurses consider when determining best interests for patients with advanced dementia?
Thematic analysis of the results identified four key areas; that participants overall accepted the criticism presented about the MCA and best interests, that there was evidence of both explicit and tacit knowledge of the legislation through the discussion that participants initiated. Participants also referred to clinical experience to support their responses and fourthly, person-centredness influenced responses about what should happen to the characters in the vignettes. Recommendations from the study are to promote advance care planning, to consider alternative approaches to education and to share experience in best interests meetings to improve outcomes and address the ongoing criticisms.

Citation

Murphy, J. S. C. (2023). Best interests decisions for people with advanced dementia: a qualitative study of nurses’ perspectives in England. (Thesis). Keele University

• Thesis Type: Thesis
• Deposit Date: Oct 12, 2023
• Publicly Available Date: Oct 12, 2023
• Award Date: 2023-10