Examining concepts of capacity

Please follow APA format, add citations and references from the articles. Document will be verified for plagiarism and AI use. Thank you! 

Please read the instructions. Although I may be interested in your opinions and personal experiences outside of the class; however, for the sake of this class, I am not. Your postings should not express agreement, absolutes, opinion, or place a value on your peers comments. I asks that you simply expand from the scientific literature based on the postings.

 

Postings should not appear like journalism, chats, or social media. 

Topic: Examining concepts of capacity

You have been requested to determine decisional capacity on a patient. Please access the peer-reviewed literature to learn about the topic and to assist you in answering important practice questions. In the future, you may need to access the scientific literate to solve clinical problems. This exercise is meant to assist you in answering practice questions through the use peer-reviewed, scientific literature. 

In the discussion board, please assist your peers in answering these or any relevant clinical questions that may arise with regard to capacity?

What is capacity?

What are types of capacity?

How do you determine capacity?

Are there scales or assessment tools and how reliable are they?

Who can determine capacity?

What current theories on capacity?

What are common practice dilemmas associated with determining capacity?

How will this knowledge affect your individual practice?

Explore the topic. Please cite two articles that you have found to assist with the questions. Be original. If you come across something valuable, interesting, or relevant, please share. 

All responses or postings are required to be written in a scholarly manner and should not exceed two paragraphs, single spaced. All references must be cited correctly in APA style. Please observe conventions of APA style as outlines in chapters two and three of the APA manual. Cite and reference peer-reviewed articles only. Do not cite the APA manual.  Do not exclusively "recycle or reuse" your own articles or those of your peers for multiple postings. I am not looking for whether your agree or disagree. I am not interested in opinions. Your posts must be scholarly and in the APA style, not las with journalism or social media. 

You must search and cite two original peer-reviewed articles from the literature as your original discussion post (about 250 words). You will then offer two brief (100 words) responses to your peers with at least one original peer-reviewed article.

The rubric. 

2 points  not gained for incorrect or improper APA 

2 points  not gained for failure to post initial discussion 

1 points  not gained for failing to hand in a discussion response

Please provide a peer response from each discussion posts you can find below. 100 words each with at least one original peer-reviewed article.

Discussion 1

Decisional capacity is a determination of whether a patient can make a particular healthcare decision at a point in time. Assessment should look at the patient’s ability to understand information, reason about available options and risks, and choose a choice. A psychiatric diagnosis, treatment denial, or a disagreement in choice does not establish incapacity. The clinician should identify how delirium, psychosis, mania, intoxication, or cognitive impairment, affects abilities for specific decision making.

Evaluation can improve consistency when capacity is uncertain. The Aid to Capacity Evaluation has the interview focused on treatment, alternatives, risks, and factors interfering with informed choice, giving a practical method for comparing assessments with provider decisions (Etchells et al., 1999). Assessment is important because incapacity can remain unrecognized during routine care. At least 40% acute medical inpatients are estimated to lack capacity, yet treatment teams determined incapacity in a minority of interviewed patients (Raymont et al., 2004). In practice, findings regarding insight should be documented along with reasoning and choice. Efforts to improve capacity through simple explanations, treatment of symptoms, interpretation service, and reassessment. This approach protects autonomy while supporting substitute decision making only when functional impairment prevents informed consent.

References

Etchells, E., Darzins, P., Silberfeld, M., Singer, P. A., McKenny, J., Naglie, G., Katz, M., Guyatt, G. H., Molloy, D. W., & Strang, D. (1999). Assessment of patient capacity to consent to treatment.  Journal of General Internal Medicine, 14(1), 27–34.  https://doi.org/10.1046/j.1525-1497.1999.00277.xLinks to an external site.

Raymont, V., Bingley, W., Buchanan, A., David, A. S., Hayward, P., Wessely, S., & Hotopf, M. (2004). Prevalence of mental incapacity in medical inpatients and associated risk factors: Cross-sectional study.  The Lancet, 364(9443), 1421–1427.  https://doi.org/10.1016/S0140-6736(04)17224-3Links to an external site.

Discussion 2

Decision-making capacity is best understood as a functional clinical assessment rather than a diagnosis or legal status. Capacity is determined by the treating clinician responsible for the patient's care, whereas competency (or legal incapacity) is determined by a court (Appelbaum, 2007). Contemporary practice is largely guided by the four-abilities model, which evaluates whether a patient can understand relevant information, appreciate how that information applies to their own situation, reason through treatment options, and communicate a consistent choice (Appelbaum, 2007). This model emphasizes that capacity is both decision-specific and time-specific, meaning that patients may possess capacity for one healthcare decision but not another, or their capacity may fluctuate with conditions such as delirium, mania, intoxication, or psychosis (Palmer & Harmell, 2016). Consequently, the presence of a psychiatric diagnosis alone should never be interpreted as evidence of incapacity.

   One of the greatest challenges in clinical practice is balancing respect for patient autonomy with the ethical obligation to protect patients from harm. Capacity assessments become particularly difficult when patients refuse recommended treatment despite apparently understanding the associated risks or when psychiatric symptoms partially impair, but do not completely eliminate, decision-making abilities (Palmer & Harmell, 2016). Structured assessments and careful documentation are therefore essential to minimize bias and ensure that capacity determinations remain based on functional abilities rather than disagreement with a patient's decision (Appelbaum, 2007). As a future PMHNP, this framework reinforces the importance of performing systematic capacity evaluations, recognizing that capacity can change over time, and maximizing patient autonomy whenever possible before considering surrogate decision-making or involuntary treatment. Applying an evidence-based approach to capacity assessment promotes ethical practice while protecting patients' rights and supporting legally sound clinical decision-making.

References

Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment.  The New England Journal of Medicine, 357(18), 1834–1840. https://doi.org/10.1056/NEJMcp074045

Palmer, B. W., & Harmell, A. L. (2016). Assessment of healthcare decision-making capacity.  Archives of Clinical Neuropsychology, 31(6), 530–540.  https://doi.org/10.1093/arclin/acw051Links to an external site.