The purpose of this assignment is to select a particular legislation and to relate it to the role of the nurse by drawing on relevant literature as well as learning log entries. The legislation chosen for this assignment is the Mental Health Act MHA (1983) and the reason is because of the chosen field for practice. Under this Act, individuals suffering from mental illness can be admitted and detained into psychiatric hospital for treatment against their will (Dimond, 2011). This particular law has a number of sections, since this assignment is about exploring the role of the nurse, the focus of the discussion will be on section 5(4) which is about nurses holding power.
Occasionally, doctors are not immediately available on the wards hence this section was introduced in order for nurses of the ‘prescribed class’ (see appendix 1a) to detain informal inpatients suffering from a mental disorder whilst they were a menace to themselves or others of up to 6 hours or until the responsible physician arrives (Fennel, 2009).
Before applying this section, the nurse’s role is to undertake a thorough assessment including a risk evaluation. However, in urgent cases the Code of Practice of the Act backs up the sectioning without carrying out appropriate assessment (DH, 1999). The nurse should consider the expected time of the doctor against how eager the patients wants to leave. Nevertheless, the majorities in those situation nurses bring into play their good communication and persuasion skills and succeed in convincing the patient to wait until the doctor arrives for their treatment (Dickinson, 2007). However, when not feasible the nurse should predict the effect it could have on the patient. For example, if the patient is demonstrating signs of anxiety or distress nurses should consider the consequences (see appendix 1b) to them and others if leaving the hospital (Dickinson, 2007).
Alternatively, if all the measures undertaken are exhausted and the patient is still adamant that they want to leave the hospital, then the nurse should use the section 5(4) of the Act by completing form 13 (see appendix 2) and hand over to managers or MHA administrator without delay. The nurse must ensure the patient is well informed about why they are being detained as stipulated by the Care Quality Commission (2010). In addition, the reason for the patient’s detention should be explained and their rights both expressed orally and in writing. Furthermore, it is a statutory duty for the nurse to notify the patient’s next of kin (Dimond and Barker, 2001). For example in practice when a patient saw their close one visit them on the ward half of their worry disappeared and was able to calm down hence the step taken by the nurse helped the patient to feel reassured creating a safe environment for everyone.
Last but not least, it is extremely important for the nurse to document all the information in the nursing and medical notes as said by NMC guidelines for records and record keeping (NMC, 2009). Moreover, nurses should complete an incident form and send it to the risk manager which he in turn will take the appropriate measure in regards to the outcome. In addition, when handing over nurses should notify the fore coming shift of whoever is detained under that section (Dickinson, 2007). On arrival of the doctor the holding power ceases and an explanation is given to the latter of when and why the section was used. Finally, Form 16 should be completed and sent to the hospital manager.
To conclude the fundamental role of the nurse according to the NMC, (2009) is to safeguard the patient and the public at all times. Obviously if a patient is at risk of harming himself and others and the nurse was to do nothing, then clearly it would be a breach of the professional contract and an abdication of responsibility.
1a ‘Prescribed class’ registered nurses
(i) Registered Nurse Level 1 Mental Health
(ii) Registered Nurse Level 2 Mental Health
(iii) Registered Nurse Level 1 Learning Disability
(iv) Registered Nurse Level 2 Learning Disability
(Source from Dickinson, 2007)
1b Consequences of the patient leaving the hospital and the likelihood of:
– The patient self-harming or committing suicide
– The patient acting in a violent manner
– Any evidence of disordered thinking
– The patient’s current behaviour and in particular,
any changes in their usual pattern of behaviour
– Any recent disturbances on the ward
– Any recently received messages from relatives or friends
– Any relevant involvement of other patients
– The patient’s known unpredictability
– Any other relevant information from members of the
multidisciplinary team (MDT)
(Source from DH, 1999).
Examples of Form 13 requiring nurses to indicate by deletion their ‘class’
Corrected descriptions of nursing qualifications on the statutory Form 13 would be as follows:
a) In Pt 3 (first level nurse trained in the nursing of persons suffering from mental disorder)
(aa) In Pt 4 (second level nurses trained in the nursing of persons suffering from mental illness)
b) In Pt 5 (first level nurse trained in the nursing of persons suffering from mental disorder)
(bb) In Pt 6 (second level nurse trained in the nursing of persons suffering from mental disorder)
c) In Pt 13 (nurses qualified following a course of preparation in mental health nursing)
d) In Pt 14 (nurses qualified following a course of preparation in learning disability nursing)
(Source from Dickinson, 2007)
Care Quality Commission. (CQC), (2010) Monitoring the use of the Mental Health Act in 2009/10. London: TSO. Department of Health and Welsh Office. (DH), (1999) Mental Health Act 1983 Code of Practice. Norwich: TSO.
Dickinson, T. (2007) Section 5(4) of the Mental Health Act 1983: the art of applying the Act. British Journal of Nursing, 2007, Vol 16, No 20.
Dimond, B. (2011) Legal Aspects of Nursing and Health Care. London: Pearson Education.
Dimond, B. and Barker, F. (2001) Mental Health Law for Nurses. Sixth Edition. London: Blackwell Offices.
Fennel, P. (2009). Mental Health The New. Bristol: Jordan Publishing Ltd.
NMC, Nursing and Midwifery Council (2009). Record Keeping Guidance for Nurses and Students: London: HMSO.