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Assisted decision-making and interprofessional collaboration in the care of older people: a qualitative study exploring perceptions of barriers and facilitators in the acute hospital setting
- Authors:
- DONNELLY Sarah, et al
- Journal article citation:
- Journal of Interprofessional Care, 35(6), 2021, pp.852-862.
- Publisher:
- Taylor and Francis
In recent years, there has been a move toward a more human rights-based approach to the issue of supported and assisted decision-making (ADM) with legislative changes strengthening the formal right for older people to participate in care planning and decision-making. Ireland’s Assisted Decision-Making (Capacity) Act, 2015 breaks from traditional views of capacity to consider the uniqueness of each decision in relation to topic, time and place for those with impaired or fluctuating capacity. This study set out to explore experiences of assisted decision making (ADM) in acute care hospitals in Ireland and to identify the barriers and enablers to ADM for older people and people with dementia from the perspective of different Health and Social Care Professionals (HSCPs) involved in their care. The researchers carried out 26 semi-structured audio-recorded interviews with a convenience sample of HSCPs working in two acute hospitals and subsequently confirmed the results. HSCPs identified several barriers to, and enablers of, ADM in acute hospitals that were categorized into three key themes: Building meaningful engagement with older people and their family carers; barriers and enablers associated with interprofessional collaboration and barriers and enablers associated with the environment. The findings suggest that despite concrete policy and legislative underpinnings to ADM, this was not always evident in practice and suggests the need for specialized education and training on ADM in practice settings. (Edited publisher abstract)
How are people with dementia involved in care-planning and decision-making? An Irish social work perspective
- Authors:
- DONNELLY Sarah, BEGLEY Emer, O'BRIEN Marita
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(7-8), 2019, pp.2985-3003.
- Publisher:
- Sage
In recent years, there have been national and international policy advances around capacity and decision-making and an apparent burgeoning rights-based approach to the issue, all of which have the potential to impact on the experience for people with dementia in Ireland. There is little evidence however on whether these policies and principles are being translated into practice and whether traditional paternalistic approaches to decision-making are being challenged. To gain insight into current practice, research was undertaken with social workers working with older people in Ireland; reporting on the involvement of people living with dementia in care-planning processes. Data collection included a mixed method approach; an on-line survey of social workers from across the country who reported on their open caseload during the month of June 2015 (N = 38 social workers reporting on the experiences of 788 older people, of which 39% of older people had a formal diagnosis of dementia). In addition, semi-structured telephone interviews were conducted with social workers working in the nine Community Health Organisation areas (N = 21). Findings show that people with dementia were high users of social work services, accounting for 44.5% of the client group. Social workers reported that there were no standardised approaches to how Health and Social Care Professionals involved people with dementia in care planning and decision-making. Overall, people with dementia were more likely to be excluded from decision-making processes due to (i) assumptions that they lacked capacity, (ii) family members preferences that the person was not involved, (iii) communication difficulties, (iv) time constraints, (v) little or no opportunity given or (vi) the person delegated decision-making to others. Good practices were identified through multidisciplinary team approaches and formal care planning meetings. This research highlights variability in how people with dementia participate in decision-making around their care. It sheds light on existing barriers which challenge the full implementation of the Irish Assisted Decision-Making legislation; highlighting the need for appropriate guidance and education for Health and Social Care Professionals. The findings also show that family dynamics and existing relationships can play a role in how people with dementia participate and are involved. To ensure consistent opportunities for participation, effective practices and approaches to supporting the participation of people living with dementia in care planning needs to be developed and rolled out in all care settings through increased training and adoption of standardised approaches. (Edited publisher abstract)
Understanding sex: the right to legal capacity to consent to sex
- Author:
- ARSTEIN-KERSLAKE Anna
- Journal article citation:
- Disability and Society, 30(10), 2015, pp.1459-1473.
- Publisher:
- Taylor and Francis
This article addresses the right to legal capacity to consent to sex of people with intellectual disabilities. Article 12 of the Convention on the Rights of Persons with Disabilities guarantees the right to legal capacity on an equal basis in all areas of life. This article discusses sex as an area of life in which people with intellectual disabilities are frequently not being granted legal capacity on an equal basis. The article examines current capacity to consent to sex law in Ireland, England and Wales in light of Article 12. It proposes an ‘agreement model’ as a potential alternative that would be Article 12 compliant. (Publisher abstract)
A social approach to decision-making capacity: exploratory research with people with experience of mental health treatment
- Authors:
- MCDAID Shari, DELANEY Sarah
- Journal article citation:
- Disability and Society, 26(6), 2011, pp.729-742.
- Publisher:
- Taylor and Francis
The Irish Government’s impending introduction of legislation on ‘mental capacity’ has provided an impetus to explore decision-making capacity from the perspective of people with experience of mental health treatment. The aim of this research was to explore the views of individuals with direct experience of mental health treatment about decision-making capacity. Eight individuals with direct experience of mental health treatment were interviewed using a semi-structured topic guide. While acknowledging that there are times when mental or emotional distress can interfere with the capacity to make decisions, participants described how their capacity can be reduced by a set of social and environmental factors. These factors include: the lack of treatment options available from which to choose; lack of trust of the information provider; inaccessible information; the effects of medication that literally ‘stops your ability to think’; lack of empathy with mental or emotional distress; and lack of time to process information. Participants highlighted the issue of power and powerlessness when describing how incapacity is determined within mental health services. The way participants described decision-making capacity suggests it is not only affected by the person themselves, but also affected by their social relationships and their environment. This is similar to the social model of disability.
How are people with dementia involved in care-planning and decision-making? An Irish social work perspective
- Authors:
- DONNELLY Sarah, BEGLEY Emer, O'BRIEN Marita
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, early cite 15 March 2018,
- Publisher:
- Sage
In recent years, there have been national and international policy advances around capacity and decision-making and an apparent burgeoning rights-based approach to the issue, all of which have the potential to impact on the experience for people with dementia in Ireland. There is little evidence however on whether these policies and principles are being translated into practice and whether traditional paternalistic approaches to decision-making are being challenged. To gain insight into current practice, research was undertaken with social workers working with older people in Ireland; reporting on the involvement of people living with dementia in care-planning processes. Data collection included a mixed method approach; an on-line survey of social workers from across the country who reported on their open caseload during the month of June 2015 (N = 38 social workers reporting on the experiences of 788 older people, of which 39% of older people had a formal diagnosis of dementia). In addition, semi-structured telephone interviews were conducted with social workers working in the nine Community Health Organisation areas (N = 21). Findings show that people with dementia were high users of social work services, accounting for 44.5% of the client group. Social workers reported that there were no standardised approaches to how Health and Social Care Professionals involved people with dementia in care planning and decision-making. Overall, people with dementia were more likely to be excluded from decision-making processes due to (i) assumptions that they lacked capacity, (ii) family members preferences that the person was not involved, (iii) communication difficulties, (iv) time constraints, (v) little or no opportunity given or (vi) the person delegated decision-making to others. Good practices were identified through multidisciplinary team approaches and formal care planning meetings. This research highlights variability in how people with dementia participate in decision-making around their care. It sheds light on existing barriers which challenge the full implementation of the Irish Assisted Decision-Making legislation; highlighting the need for appropriate guidance and education for Health and Social Care Professionals. The findings also show that family dynamics and existing relationships can play a role in how people with dementia participate and are involved. To ensure consistent opportunities for participation, effective practices and approaches to supporting the participation of people living with dementia in care planning needs to be developed and rolled out in all care settings through increased training and adoption of standardised approaches. (Edited publisher abstract)