Medical decision-making capacity (MDMC) is inherent to the legal and ethical principles of respect for autonomy and is an essential element of informed consent. Qualitative and quantitative evidence to support a final decision of capacity should be the gold standard. General hospital policies and state laws mandate that a licensed provider make the final determination of capacity, but they do not specifically mandate who is responsible for those assessments. When a patient s decisional capacity fluctuates, the role of the nurse in a hospital setting is valuable because they have the most direct contact with the patient. Objective: Determine receptiveness of nursing staff to assessing capacity, to gather feedback on the Aid to Capacity Evaluation (ACE) tool, and to ascertain awareness of capacity by sixty nurses working on progressive care, trauma orthopedic, and medical/surgical units. Method: This project was completed at a Midwestern academic level I trauma center. Nurses on a medical/surgical, orthopedic trauma, and progressive care unit participated. Education about MDMC and the ACE tool were given to nurses verbally and in writing. They were asked to utilize the Aide to Capacity Evaluation (ACE) tool to assess patients whom they believed lacked decision-making capacity. After four weeks the nurses completed an evaluation. Results: Thirty nurses (50%) responded. Over 70% of those respondents used the tool at least once. 63% agreed that the format helped to systematically evaluate a patient and they found it easy to incorporate into practice. Overall, 73% of respondents would welcome more education about capacity. Conclusion: Given a standardized tool in conjunction with proper and continuous education, bedside nurses are in an optimal position to identify mental changes early, alert the provider so steps can be taken to optimize mental capacity, and assist with assessment of capacity with minimal disruption of care. Implementation of a tool such as the ACE can ensure accurate, reliable, and consistent assessments. Furthermore, providers would benefit from the extra time to gather information and complete focused assessments to make a determination of capacity with confidence.

中文翻译：

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住院患者能力评估的循证方法

医疗决策能力 (MDMC) 是尊重自主权的法律和伦理原则所固有的，也是知情同意的基本要素。支持最终决定能力的定性和定量证据应该是黄金标准。一般的医院政策和州法律要求有执照的提供者最终确定容量，但它们没有具体规定谁负责这些评估。当患者的决策能力发生波动时，护士在医院环境中的角色是有价值的，因为他们与患者有最直接的接触。目的：确定护理人员对评估能力的接受程度，收集对能力评估援助 (ACE) 工具的反馈，并确定 60 名从事渐进式护理的护士对能力的认识，创伤骨科和医疗/外科单位。方法：该项目在中西部学术一级创伤中心完成。医疗/外科、骨科创伤和渐进式护理单位的护士参加了会议。以口头和书面形式向护士提供有关 MDMC 和 ACE 工具的教育。他们被要求使用能力评估助手 (ACE) 工具来评估他们认为缺乏决策能力的患者。四个星期后，护士完成了评估。结果：30 名护士 (50%) 做出了回应。超过 70% 的受访者至少使用过一次该工具。63% 的人同意该格式有助于系统地评估患者，他们发现它很容易融入实践。总体而言，73% 的受访者欢迎更多关于能力的教育。结论：鉴于标准化工具与适当和持续的教育相结合，床边护士处于最佳位置，可以及早识别心理变化，提醒提供者以便采取措施优化心理能力，并协助评估能力，最大限度地减少护理中断。ACE 等工具的实施可以确保准确、可靠和一致的评估。此外，提供者将受益于额外的时间来收集信息和完成重点评估，从而自信地确定容量。ACE 等工具的实施可以确保准确、可靠和一致的评估。此外，提供者将受益于额外的时间来收集信息和完成重点评估，从而自信地确定容量。ACE 等工具的实施可以确保准确、可靠和一致的评估。此外，提供者将受益于额外的时间来收集信息和完成重点评估，从而自信地确定容量。