Specialist community dementia nurses are an appropriate sample to investigate longer-term decision-making and end-of-life care planning. Implemented in 2007, the Mental Capacity Act (MCA) provides opportunities for assisting with planning and making decisions on others' behalf, and may be expected to be entrenched within clinical practice. We conducted follow-up qualitative interviews with 15 community-based dementia nurses to detect changes and developments in views and practices of the MCA. Thematic analysis identified recurrent themes and developed into a coding framework. At Time2, there was greater awareness of general and specific principles of MCA and greater confidence in using it. There was greater involvement in discussing planning finances, less so in end-of-life-care. Some participants were concerned about lack of understanding amongst other professionals and felt more public awareness was required. Supplementary training, opportunities for mentoring and supervision may develop greater confidence among dementia practitioners and support their roles in informing and advising people with dementia and carers.
AveyardH.WoolliamsM. (2006) In whose best interests? Nurses’ experiences of the administration of sedation in general medical wards in England: An application of the critical incident technique. International Journal of Nursing Studies43: 929–939.
2.
BraunV.ClarkeV. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology3: 77–101.
3.
BurtonJ.HopeK. (2005) An exploration of the decision-making processes at the point of referral to an Admiral Nurse team. Journal of Psychiatric and Mental Health Nursing12: 359–364.
4.
CastilloL. S.WilliamsB. A.HooperS. M.SabatinoC. P.WeithornL. A.SudoreR. L. (2011) Lost in translation: The unintended consequences of advance directive law on clinical care. Annals of Internal Medicine154: 121–128.
5.
Corden, A., & Miller, J. (2007). Time and change: A review of the qualitative longitudinal research literature for social policy. Social Policy and Society, 6, 583--592.
6.
Department of Health (2001) National Service Framework for Older People, London, UK: Department of Health.
7.
Department of Health (2009a) Living well with dementia: The National Dementia Strategy, London, UK: Department of Health.
8.
Department of Health (2009b) Safeguarding adults: Report on the consultation on the review of No Secrets, London, UK: Department of Health.
9.
GraneheimU. H.LundmanB. (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today24: 105–112.
10.
HallM. I. (2009) Capacity, vulnerability, risk and consent: Personhood in the law. In: O’ConnorD.PurvesB. (eds) Decision-making, personhood and dementia: Exploring the interface, London, UK: Jessica Kingsley Publishers.
11.
HenningsJ.FroggattK.KeadyJ. (2010) Approaching the end of life and dying with dementia in care homes: The accounts of family carers. Reviews in Clinical Gerontology20: 114–127.
12.
HirschmanK.KapoJ.KarlawishJ. (2006) Why doesn’t a family member of a person with advanced dementia use a substituted judgment when making a decision for that person?American Journal of Geriatric Psychiatry14: 659–667.
13.
HopeT. (2010) Ethical issues and dementia: The Nuffield Report. Clinical Ethics5: 3–6.
14.
HunterS.Levett-JonesT. (2010) The practice of nurses working with older people in long-term care: An Australian perspective. Journal of Clinical Nursing19: 527–536.
15.
IliffeS.WilcockJ.HaworthD. (2006) Family obstacles to shared care for patients with dementia: A qualitative study. Family Practice23: 353–362.
16.
KeadyJ.Ashcroft-SimpsonS.HalliganK.WilliamsS. (2007) Admiral nursing and the family care of a parent with dementia: Using autobiographical narrative as grounding for negotiated clinical practice and decision-making. Scandinavian Journal of Caring Sciences21: 345–353.
17.
KwokT.TwinnS.YanE. (2007) The attitudes of Chinese family caregivers of older people with dementia towards life-sustaining treatments. Journal of Advanced Nursing59(3): 256–262.
18.
LivingstonG.LeaveyL.ManelaM.LivingstonD.RaitG.SampsonS.…CooperC. (2010) Making decisions for people with dementia who lack capacity: Qualitative study of family carers in UK. BMJ, 341–341.
19.
MasonC. M.CaufieldC. R.KishinevskyL. (2010) Sweeping changes to New York's Powers of Attorney. Care Management Journals11(4): 220–226.
20.
MaxminK.CooperC.PotterP.LivingstonG. (2009) Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients. International Journal of Geriatric Psychiatry24: 1367–1375.
Nuffield Council on Bioethics (2009) Dementia: Ethical issues, London, UK: Nuffield Council on Bioethics.
24.
Quinn, C., Clare, L., McGuiness, T., & Woods, R. T. (2012). Negotiating the balance: The triadic relationship between spousal caregivers, people with dementia and Admiral Nurses. Dementia, published online 8 April 2012. DOI: 10.1177/147/301212437780.
25.
SamsiK.ManthorpeJ. (2010) ‘I live for today’: A qualitative study investigating older people’s attitudes to advance planning. Health and Social Care in the Community19(1): 52–59.
26.
SamsiK.ManthorpeJ.RapaportP. (2011) ‘As people get to know it more’: Experiences and expectations of the Mental Capacity Act 2005 amongst local information, advice and advocacy services. Social Policy and Society10(1): 41–54.
27.
SamsiK.ManthorpeM.NagendranT.HeathH. (2012) Challenges and expectations of the Mental Capacity Act 2005: An interview-based study of community-based specialist nurses working in dementia care. Journal of Clinical Nursing21(11–12): 1697–1705.
28.
SolimanA. (2003) Admiral Nurses: A model of family assessment and intervention. In: KeadyJ.ClarkeC.AdamsT. (eds) Community mental health nursing and dementia, Maidenhead, UK: Open University Press.
29.
TilseC.WilsonJ.SetterlundD. (2009) Personhood, financial decision-making and dementia: An Australian Perspective. In: O’ConnorD.PurvesB. (eds) Decision-making, personhood and dementia: Exploring the interface, London, UK: Jessica Kingsley Publishers.
