London: The Stationery Office.House of Lords Select Committee on the Mental Capacity Act (2013) Reports and Associated Evidence. Over the duration of this four-year Honours Degree course, students will develop the professional knowledge, skills and attitudes necessary to meet the specific needs of people with intellectual disabilities. Medical Care, 49, 1047-1053. This approach was used by Rondeau et al. Twigg, S., Duffield, C., Bremner, A., Rapley, P., & Finn, J. Retrieved from:  doi: 10.1111/jan.12040. 5 March 2012. doi: 10.1111/jan.12118. Always follow the principles of the Mental Capacity Act, If there is any doubt about mental capacity, a legal mental capacity assessment should be undertaken when a decision is needed and recorded, Mental capacity assessments should be done by the person directly concerned with the patient at that time, Patients should be given as much help as possible to complete stage 1 of the assessment, A patient who lacks mental capacity cannot give or refuse consent; the person concerned with the their care must make a best interests assessment. Nursing intellectual capital theory is composed of two interdependent concepts, nursing human capital and nursing structural capital. However, further theoretical work is required to refine some measures of the concepts, specifically those associated with the employer support for nurse continuing professional development and nursing structural capital concepts (Covell & Sidani, 2012). Duffield, C., Diers, D., O’Brien-Pallas, L., Aisbett, C, Roche, M., King, M., & Aisbett, K (2011) Nursing staffing, nursing workload, the work environment and patient outcomes. The Academy of Management Review, 23(2), 242-266. In summary, before patients can consent to care or treatment, they must have mental capacity. Boston: Butterworth Heinemann. This means the patient broadly understands why the blood test is necessary and what it will involve. Her areas of expertise are in quantitative research methods, intervention design and evaluation, and measurement. Nursing Outlook, 52, 11-16. Nursing Administration Quarterly, 31(1), 22-26. Bramhandkar, A., Erickson, S., & Applebee, I. Journal of Advanced Nursing. Thus to ensure that a continuing education activity has the greatest impact on patient care and costs, it is recommended that the assessment, planning, and evaluation of continuing education activities and their impact occur at the nursing unit level. Because nursing knowledge is an intangible organizational asset, conducting research to determine its contribution to the quality of patient care is challenging. In other words, the patient has the mental capacity to give the nurse valid informed consent, for example, to take a blood sample. Nursing intellectual capital reflects the knowledge of registered nurses and knowledge resources available on inpatient care units as that is where there is the greatest concentration of registered nurses providing care to hospitalized patients (Covell, 2008; Dumay, 2012; Grantham et al., 2007) within an organizational setting. The presence of nurse educators or specialists to assist registered nurses with clinical decision-making and knowledge and skill development has been found to positively influence the quality of patient care. A patient able to complete stage 1 has mental capacity (about that specific decision, at that time); inability to complete any of the four processes in stage 1 means the patient lacks mental capacity if this is because of an impairment of or a disturbance in the functioning of the mind or brain (because of delirium, intoxication, dementia, learning disability or unconsciousness for example). Covell C.L., & Sidani S. (2013). Anyone buying a car would want to understand which car they were buying, how much it would cost and how it was to be used - the same applies to health and social care. laptops, iPads, personal digital assistants), Financial assistance from the organization for registered nurses to attend continuing professional development activities, Paid and unpaid time off for registered nurses to learn, such as study leaves, Availability of replacement staff for registered nurses when away from the unit to learn, Availability of clinical educators or consultants to assist registered nurses with clinical decision-making and knowledge and skill development. Intellectual capital theory provides for such an understanding and is the focus of this discussion. Expand your horizons. : CD007019. It is operationalized as the hours per patient per day, skill mix and registered nurse-to-patient ratio (Covell, 2008). Mentoring and its impact on intellectual capital. New York: John Wiley & Sons. Most of the intellectual capital research, conducted in the field of business such as Fortune 500 companies, report on the perceptions of intellectual capital and does not directly measure knowledge within organizations. Despite the fact that the MCA has been in force since October 2007, a number of staff in hospitals and care homes admit they do not use it or do not record its use. Grand theories as barriers to using IC concepts. Organizations with high intellectual capital have been found to outperform organizations with less intellectual capital as measured by stronger financial returns and financial performance (Bramhandkar et al., 2007; Youndt et al, 2004). Applied Nursing Research 24, 244-255. 7.11 Capacity is a legal concept that describes the level of intellectual functioning a person requires to make and accept responsibility for important decisions that often have legal consequences. However, compliance should not be confused with consent. (Davidson, 2007; Reidinger, 2010; Thomka, 2007); use of information technology (Poe, 2011; Simpson, 2007); creation of quality work environments for registered nurses (Weston, Estrada, & Carrington, 2007); and patient safety (Hadaway, 2010). (2013). For consent to be valid, the person giving it must have the mental capacity to understand what they are consenting to; it is the same as any other contract or agreement. It represents a set of behaviors and beliefs demonstrated by the organization that promote and value the education of registered nurses after they enter the profession (Kramer & Schmalenberg, 2004). Specifically the concepts and mechanisms of nursing intellectual capital theory are similar to many of the Forces of Magnetism such as Force 6: Quality of Care; Force 8: Consultation and Resources; and Force 14: Professional Development (Messmer & Turkel, 2011). (2009) and Covell & Sidani (2013) provided evidence that hospitals may be able to reduce turnover by investing in the continuing professional development of registered nurses. A meaningful conceptualization for relational capital has not yet been developed for nursing; it may be reflected in informal or collaborative knowledge translation strategies. The Electronic Journal of Knowledge Management, 5(4): 357-362. In other words, a form of ‘nursing evidence’. Intellectual capital: Realizing your company's true value by finding its hidden brainpower. Thomka, L. A. Nurse managers may be able to use this information to make decisions regarding the type of continuing professional development to provide to the nursing staff, identify mentors for new graduates or newly hired staff, and complete patient assignments and performance appraisals. Note: In Canada and in the UK, a person with intellectual disability and mental health disorder is often referred to as having "dual diagnosis". Covell C.L., & Sidani, S. (2012). Building intellectual capacity is perhaps one of the most exciting things we come together for as professionals, clinicians, scholars and students. As an intangible organizational asset, intellectual capital includes the knowledge of individual employees or groups of employees who are deemed critical to a company's continued success, and organizational structures that contain information about processes, customers or other information that contributes to improved business performance or profits (Dumay, 2012; Sullivan, 1998). The propositions should also be retested with data from different contexts and countries to confirm the study’s findings. This suggests that healthcare organizations that make greater investments in developing their nursing human capital by providing continuing professional development opportunities for their registered nurses are more likely to retain registered nurses. It is operationalized in: Human capital investment is the investment by organizations in the development of employees’ knowledge and skills through training and development initiatives (Bontis & Fitz-enz, 2002). Nurse staffing is defined for the nursing intellectual capital theory as the supply of registered nurses and mix of registered nurses who possess the knowledge and skills to competently meet the care needs of patients on the unit. Messmer, P.R., & Turkel, M.C. Care planning and delivery form an essential part of everyday practice for all intellectual disability nurses. In nursing, intellectual capital is the stocks of nursing knowledge available within a healthcare organization. The MCA does not say that everyone who has a stroke automatically lacks mental capacity - it is clear that a diagnosis alone cannot be used to judge mental capacity (MCA s.2(3)(b)). Intellectual capital or its related concepts, human capital and structural capital, have been used to frame discussions in the nursing literature related to recruitment and retention of registered nurses (Collins & Collins, 2006; Faulk, 2007); marketability of registered nurses’ knowledge and skills (Hudspeth, 2006; Shirey, 2006); leadership and mentorship of registered nurses It proposes meaningful interrelationships among characteristics within the work environment, such as nurse staffing levels; employer support for nurse continuing professional development; nursing human capital; and the quality of patient care and the recruitment and retention of registered nurses (Covell, 2008). The first step is to clarify the decision for which the patient’s consent is needed (for example, that a blood test is necessary) and then check whether at the time consent is needed, the patient is capable of all the processes in stage 1 of the assessment (Box 2). (2012). Nursing intellectual capital theory is a middle-range theory as it is composed of a limited number of concepts and propositions which can be measured and tested in different contexts (Fawcett, 1998). Tuffrey-Wijne I, McEnhill L (2008) Communication difficulties and intellectual disability in end-of-life care. Profiting from intellectual capital: Extracting value from innovation. Thus, in order to ensure safer patient care, nurse managers may consider employing a high number of registered nurses with specialty certification (Kendall-Gallagher & Blegen, 2009; Newhouse, Johantgen, & Pronovost, 2005). Performance outcomes are achieved by investing in human capital resources which will produce future returns for the organization by creating intellectual assets or improving performance (Sullivan, 1998). This relationship signifies that units with higher levels of nursing human capital (i.e., have highly educated and experienced nursing staff) have better quality of care. (2012). Retaining registered nurses, thus reducing turnover, is essential to control human resource costs (O’Brien-Pallas et al., 2006). The relationship between nurse staffing and quality of care in nursing homes: a systematic review. Reaping the benefits from intellectual capital. Thompson, G. N., Estabrooks, C. A., & Degner, L. F. (2006). Building nursing intellectual capital for the information age. This has resulted in limited empirical evidence of the impact of nursing knowledge on patient or organizational outcomes. Due to rising costs of healthcare, determining how registered nurses and knowledge resources influence the quality of patient care is critical. Retrieved from Bland-Jones, C. (2008). 336. For nursing, structural capital is the structural resources that contain nursing knowledge and are used to support registered nurses in the application of their knowledge and skills in the delivery of patient care. In other words, they must have carried out the legal assessment and have decided what is most likely to be the right outcome. Intellectual capital assets... have been found to be positively associated with business performance or future outlook for the organization. Kendall-Gallagher, D., & Blegen, M.A. Dumay, J.C. (2012). Kramer, M., & Schmalenberg, C. (2004). This is not because they are being badly advised or misled by health professionals, but because they have a condition or an impairment in the functioning of their mind or brain (MCA s.2(1)) that is limiting their ability to understand or weigh up information involved in making the decision. In healthcare organizations, nursing human capital is reflected in nurse staffing. Even if a patient does not have the mental capacity to give or withhold consent, you may still take a blood sample for testing or deliver other treatment/care if you assess this to be in the patient’s best interests. Innovative in its conceptualization of the work environment as a major influencing factor on the development and use of the collective nursing staff’s human capital, nursing intellectual capital theory is explanatory in nature. The theory also proposes that nursing structural capital is directly related to quality of patient care outcomes. (AAT NQ40244). Thank you for your thoughtful and enlightening letter. While challenging and at times exhausting, it is nonetheless always rewarding. Intellectual capital assets including organizational systems, structures and routines that are developed from the organization’s human capital have been found to be positively associated with business performance or future outlook for the organization (Bontis & Fitz-enz, 2002; Youndt et al., 2004). However, not all patients ne… (2006). New York, U.S.A.: Currency Doubleday. Stewart, T. (1997). Strength in nursing leadership: The key to the evolution of intellectual capital. Adjusting for inflation. Registered nurses have reported they require financial assistance and time off work in order to attend continuing professional development activities (Schweitzer & Krassa, 2010). The theory of intellectual capital has been adapted to nursing and is proposed as a guide to research in this area. The impact of nurse turnover on patient, nurse, and system outcomes: A pilot study and focus for a multicenter international study. The revised questionnaire could be used to conduct studies to compare and contrast the validity of the two types of data (i.e. The wealth of knowledge: Intellectual capital and the twenty-first-century organizations. Competence and certification of registered nurses and safety of patients in intensive care units. After all, we are a profession that builds intellectual capacity for the explicit purpose of improving the human condition. Nurse staffing is the supply and the mix of registered nurses who possess the knowledge, skills and experience to competently meet the care needs of patients on the unit (American Nurses Association, 2002). Clinical Nurse Specialist, 20(4), 179-182. McGillis Hall, L. (2003). Both studies investigated the relationship between investment in nursing human capital and registered nurse recruitment and retention. Intellectual capital profiles: An examination of investments and returns. Effects of nurse staffing and nurse education on patient deaths in hospital with different nurse work environments. A patient who lacks mental capacity may be compliant when being offered treatment, for example by extending an arm for a blood sample to be taken. Nurse managers may find that facilitating registered nurses’ participation in ongoing learning activities enhances their knowledge and skills, which may lead to the retention of experienced and knowledgeable registered nurses, better quality patient care, and lower orientation costs. (1998). The Health Care Manager, 25(3), 213-220. Essentials of a magnetic work environment. The code of practice accompanying the act (Department for Constitutional Affairs, 2007) says at paragraph 4.38 that the mental capacity assessment should be carried out by the person directly concerned with the patient when the decision needs to be made (for example, a nurse who needs to take a blood-pressure reading). It must be adhered to whenever there is doubt about a patient’s mental capacity and a decision is required about their care or treatment. In this article, we review the nursing intellectual capital theory and discuss its implications for research and practice. Nursing Administration Quarterly, 31(1), 36-42. While the study conducted by Covell and Sidani (2013) attempted to measure the actual intellectual capital available within hospitals by using data from hospital departmental databases, researchers were limited by the type of data available within the participating hospitals. It is operationalized as the proportion of registered nurses with degrees, proportion of registered nurses with specialty certification, hours of continuing education registered nurses attend per year, years of registered nurse professional experience, years of registered nurse unit tenure or seniority, and years of registered nurse experience in clinical specialty. The study concentrated on fluid and crystallized intelligence. Managing an organizational learning system by aligning stocks and flows of knowledge: An empirical examination of intellectual capital, knowledge management, and business performance. If the decision is about life-sustaining treatment, do not be motivated by a desire to bring about the patient’s death. Policy, Politics, & Nursing Practice, 7(3), 169-179. A. Vessey (Eds. Covell and Sidani (2013) tested the newly developed middle-range theory of nursing intellectual capital. Fawcett, J. Systematic review and meta-analysis. Rondeau, K.V., Williams, E. S. & Wagar, T.H. A person cannot be judged to lack mental capacity simply because they make an unwise decision. Intellectual capital and organizational performance: An empirical study of the pharmaceutical industry. Covell, C. L. (2009). This is particularly important for specialty areas where it has been estimated that replacing an experienced specialty registered nurse can exceed the nurse’s salary for one year (Bland-Jones, 2008). Nursing intellectual capital theory was developed to address this theoretical gap. Nursing Administration Quarterly, 3(1), 89-90. BSc (Hons) in Intellectual Disability Nursing. Stewart, T. A. 4 Years. nurse staffing levels) and their potential influence on the registered nurses’ ability to attend educational activities (Covell, 2009). All health professionals working in hospitals and care homes should understand when and how the act should be used and feel confident doing so.