The last decade has seen important strides forward in the field of nurse prescribing. 2002), At this point in time, there is little published evidence that this process actually leads to improved clinical outcome measures, but consideration of ethical principles would allow us to conclude that the involvement of patients will inevitably result in safer and better patient care. Nurs Outlook. Further studies have shown that where prophylactic (or preventative) prescribing has occurred the situation is statistically worse. Many of the ideas and phrases you have picked up in your GP training - 'the golden minute'; 'ideas, concerns and expectations'; 'shared decision-making . 2000). As in any new project there were inevitable protagonists and detractors and the initial results of the first eight studies were extremely positive. Department Health (2003) advocate empowering patients to take more ownership of their health condition. The advent of nurse prescribing brings added responsibility to the more traditional role of the nurse. As a non-medical prescriber, it is essential that consultation skills are effective to. The NHS Diabetes Prevention Programme has been linked to a 20% reduction in the risk Health and social care secretary Steve Barclay is under pressure to save a GP surgery Spiralling pressure on general practice is driving a rise in disputes within GP partnerships GP leaders have hailed a 'grim milestone' for general practice after the workforce More advice and information for GP trainees, Find more advice and information for GP trainees, Consultation skills - Control the length of the consultation, Consultation skills: Consulting with the bereaved patient, GP training: The BATHE model of communication, GP training: Writing a PDP in your e-portfolio, The audio clinical observation tool (COT) in GP training, GP consultation skills: The 10-minute consultation, NICE recommends eight digital therapies to treat anxiety and depression, NHS 'in full-blown crisis' as recovery plan falls short, MPs warn, NHS prevention programme linked to 20% reduction in risk of developing diabetes, Steve Barclay under pressure as constituents demand halt to GP practice closure, GP crisis driving rise in partnership and PCN disputes, 'Grim milestone' passed in steady decline of GP workforce. 2018 Jul 30;6(1):50-58. doi: 10.1002/nop2.180. If an incorrect diagnosis is made, a good outcome can only arise by good luck eg if the clinician believes that the diagnosis is a urine infection but is actually pneumonia, by good luck the antibiotic might treat the pneumonia. The following summary includes the models that I believe are the most useful with a brief explanation, highlights and questions to use in consultations. Simple facts like known pre-existing diagnoses, medications and results of tests can be impossible to find or, once found, difficult to read and assimilate. The medicine partnership ensures safety ansbetter health outcomes and helps reduce cost and wastage for the NHS. 2011 Feb;31(2):204-7. doi: 10.1016/j.nedt.2010.06.002. Read more> More advice and information for GP trainees. HTSM0W R#Sn "r@{&U]iT{UAAy*A. [%-7qe[1BJ]@p+enjx!J6ttVXg]slZ'{:9/P%{>f1xP5U]fPiYt`Buy h~8`v 0000065334 00000 n In those precious 10 minutes, time spent listening might seem time wasted, but early investment in the patients agenda can be time saving in the long run. Preferences of patients for patient centred approach to consultation in primary care: observational study. 0000007586 00000 n Asking the following easy to answer questions gets the patient talking. They have to determine whether the patient has followed that trajectory or fallen away. 42 0 obj <> endobj (2003) have shown that although the CAIIN framework is useful, there are problems faced in its use such as the lack of assessors and protected learning time required. Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. Summarising the problem is also important and allowing the patient to hear your thoughts is helpful. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. Neighbour (2005) identifies the effectiveness of consultations, irrespective of which professional registration is held, as a key element each individual should aspire to improve and maintain to a high professional standard. This particular study was extensive in its analysis and many of the results are not particularly relevant to the subject of this essay, but the significant outcomes showed that there was no significant difference in health outcome, prescribing patterns or prescribing cost. Nurse Educ. I once said to a patient 'What do you think is wrong?' PMC Clinical consultations rarely feel like well-prepared business-like meetings. Dignity is often fairly minimal with patients expected to accept physical examination in front of several strangers. Many doctors will be familiar with Eric Beme's model of the human psyche as consisting of three 'ego-states' - Parent, Adult and Child. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. The idea being the practitioner is able to acknowledge the concerns the patient has, allowing for the practitioner and patient to create a solution which both parties accept (Courtenay and Griffiths 2010). (1984) model is mostly known for its consultation base on patients ideas, concerns and expectations. Despite this, research had previously been aimed towards General Practitioner (GP) consultation models, something which is formally assessed throughout their training (Evans et al. 0000002642 00000 n By 2000, the first comparative studies were emerging with sufficient cohort size to give a meaningful evaluation of the scope and efficiency of nurse prescribing. The ongoing development of Advanced Practice (AP) not only in nursing but also in the role of paramedics, pharmacists and other allied health professionals has allowed for consultations to move away from a skill predominately carried out by and regarded as a medical practitioners role (Stenner 2010; Franklin 2017). To qualify as a GP in the UK nowadays, trainees must demonstrate not only sound medical knowledge, but also appropriate communication skills. The doctor forms rapport with the patient 2. Nurse Educ Today. GP trainees will be familiar with the works of Pendleton, Calgary Cambridge, and Roger Neighbour to name but a few, who provide helpful consultation skills models to frame consultations and get trainees through the CSA. The medicine partnership ensures safety ansbetter health outcomes and helps reduce cost and wastage for the NHS. Bethesda, MD 20894, Web Policies Critical analysis of a consultation model is assignment will discuss the Me First (2017) model of consultation and communication tool used, in the authors work setting. A case of antisynthetase syndrome presenting solely with life-threatening interstitial lung disease, Pulmonary CT imaging findings in fat embolism syndrome: case series and literature review, Acute quadriplegia and epileptic seizures in a 47-year-old man, Ten quality indicators for clinical consultations. Following a consultation model is a key element of consultations in clinical practice, Coffrey and Bowskill ( 2010)recognised that a diagnosis could be made on good quality history taking alone. Before 0000003509 00000 n However, another important person is often discouraged from participating in consultations on ward rounds. Another person can give the patient reassurance and may also contribute useful information toward diagnosis or management. The model assists the development of educational strategies to promote critical analysis skills, which are an essential element of the autonomous, critical thinking nurse practitioner. Although there will inevitably be a gap between models and practice--this much is in the nature of the models--we suggest that these two issues are substantially neglected by the models and yet are fundamental to understanding patient-doctor decision-making. To see what works for you try adding in a different question each week. In modern healthcare, the clinical consultation is almost completely overlooked and ignored. A qualitative study of decision-making in primary care. This paper highlights some of the limitations of models of patient involvement in decision-making and explores the reasons for, and implications of, these limitations. Consultation models are clearly useful tools for practitioners to use during the patients journey. In 2017, I proposed 10 quality indicators for clinical consultation (Box 1).1 Some of these are not easy to measure, but we must learn to measure what we value not just value what is easy to measure. Consultation models are also a great way to help prepare for the clinical skills assessment (CSA). The https:// ensures that you are connecting to the Accessibility For example, there is a wide-ranging set of possible problems that a patient with Parkinson's disease might be experiencing and we could help patients to prepare their information. Med Educ 1996; 30: 83-9. Venning (et al 2000) compared efficiency and cost of a cohort of nurse prescribers with doctors in the same geographical area. endstream endobj 56 0 obj<>stream Even having to write notes takes up more of the brain's attention. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! This certainly is patient-centred rather than doctor-centred. HASTINGS, A., et al. Disclaimer. ,Hlf]#! In broad terms, decision-making models vary in the respective roles that doctor and patient take in the final selection of treatment. This site needs JavaScript to work properly. Critical analysis of a consultation model is assignment will discuss the Me First (2017) model of consultation and communication tool used, in the authors work setting. 2022 Jun 22;23(1):62. doi: 10.1186/s12910-022-00801-z. 2021 Oct 6;9(28):8312-8326. doi: 10.12998/wjcc.v9.i28.8312. J Pain Symptom Manage. SHUM, C. et al., 2000. KURTZ, S.M., SILVERMAN, J.D. . Promotion of critical thinking by using case studies as teaching method. I am sure that I can discharge more patients from clinic after one attendance because I try to make the consultation unhurried. the published studies. Cooper, Forrest and Cramp (2006) show that a patient decides in the first 90 seconds if he/she likes or trust you, therefore it is vital to establish a connection within this time period. Please go to the home page and simply click on the edition that you wish to read. Hand in hand with this success goes the realisation that nurse prescribing carries with it a responsibility to fully understand the issues that relate the act of prescribing to the eventual treatment outcome, together with the factors that tend to confound such linkage. A competing behaviors model identifies the current performance level, as well as a desired . Other analyses compared studies that assessed combined psychiatric consultation models versus a single model, type of psychiatric consultation, by outcome and whether the intervention included a consultation letter. MEAD, N., BOWER, P. and HANN, M., 2002. (Cox et al 2000). Use a specific time frame, for example 'come back in two weeks if it doesn't get better'. An official website of the United States government. I have described how I prepare for the consultation; this fits with the often-given advice of Read the notes. HR;0Siq0\TRRp|"m(e5n(T Lph>&9FghA4Fg;37#gll8Fx6{xR^1|'#Ns;uXZOuQ. (Richards 1999) it follows that if patients are to be involved then their particular priorities must be ascertained and addressed, usually in the mechanism of the consultation. *You can also browse our support articles here >. 2002; Kinnersley et al. It must be exceptionally difficult for consultants in the ED to work on diagnosis; I see them constantly interrupted during consultations, and even dealing with interruptions upon interruptions upon interruptions all in the midst of noise. The Consultation, Assessment and Improvement Structure for Nurses (CAIIN) is considered a useful tool which can be used for ongoing assessment and development of consultation skills in nursing practice (Hastings and Redsell, 2006). Empathy is first recognising the patient's distress and secondly expressing the empathy. 4.4/5 on reviews.co.uk. This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date. . THOMSON, R., EDWARDS, A. and GREY, J., 2005. STENNER, K. et al., 2010. The doctor (perhaps with, perhaps without) the patient considers the problem 5. model from therapy in that in consultation, the consultant works with the consultee to . These battles can use up all of our brain's cognitive capacity, so that there is no brain power left for clinical reasoning. %%EOF Mead, Bower and Hann (2002) feel that patient centred care has been taken into consideration and done well by this model by. On the wards, vacuum cleaners are running, phones are ringing, pagers are bleeping, monitoring equipment is alarming, trolleys trundle and rattle by, staff and relatives are talking at the top of their voices to be heard over the background noise, bed managers, infection control nurses etc all charge into the wards and interrupt. Knowing the person means asking about the person's job, interests, family and enjoyments. The study cohort was over 1,300 patients. There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. Summarising is a useful tool to clarify your understanding of the problem. sharing sensitive information, make sure youre on a federal There is currently no login required to access the journals. The clinician should be aware of the whole workload for the session. (Barry et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Not all are useful for OOH, often the situation needs to be judged by the practitioner and use which consultation method they feel fits best. Epub 2005 Aug 31. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. World J Clin Cases. 0000006162 00000 n Their clinical reasoning directs the closed questions and focused physical examination. The curtains are usually pulled around, but everyone in the bay can hear the consultation. Conducting a nurse consultation. We're here to answer any questions you have about our services. (1984) model would be appropriate for use in OOH as it is a useful way of building a relationship with the patient, involving them in care and decisions during the short time the practitioner will meet them. The Consultation, Assessment and Improvement Structure for Nurses (CAIIN) is considered a useful tool which can be used for ongoing assessment and development of consultation skills in nursing practice (Hastings and Redsell, 2006). EVANS, A. Eet al., 2001. I can then anticipate the consultation and appear well briefed to the patient. If we keep this focus rather than trying to squeeze each consultation into a particular model, perhaps this might help consulations to be more flexible. This model uses six steps for structure, which unlike most, includes closing the consultation. Register today for further access to articles and. The doctor performs an examination 4. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. COOPER, N., FORREST, K. and CRAMP, P., 2006. Unauthorized use of these marks is strictly prohibited. They also highlight the dangers of closing the conversation early due to pressure of time and not adequately exploring ambiguous answers. It was very significant that the authors concluded that many of the errors were associated with assumptions or guesses on the part of the healthcare professional, and in particular a lack of awareness of the relevance of patients ideas and beliefs which influenced their compliance with the prescribed treatment. Share. As the clinician listens to and examines the patient, their brain is full of clinical reasoning, which is high-level thinking around possible diagnoses. (2005) concluded that effective consultations give positive outcomes. Register now to enjoy more articles and free email bulletins. The progressive acceptance of the paradigm of concordance (by all prescribers not just nurse prescribers) offers all healthcare professionals a mechanism to move towards ever safer and more successful prescribing. Stripping the consultation back like this is a refreshing thought and might remove some of the threat of communication skills for doctors who have struggled to find a model that works for them. If the patient has fallen away from the expected trajectory then the diagnosis must be reviewed as well as determining whether the treatment plan has been executed. Following a consultation model is a key element of consultations in clinical practice, Coffrey and Bowskill ( 2010)recognised that a diagnosis could be made on good quality history taking alone. Anthropometric data, admission reason, Acute Physiology . It also often provides interesting conversations at the end of the consultation when I am writing out request forms etc. Add to Mendeley. However, not all patients wish to be involved in the decision making. Models have developed and now have a broader focus on patient-centred care rather than symptoms and physical health. On searching the literature, many models of consultation were found. Disclaimer: This essay has been written by a student and not our expert nursing writers. 0000003730 00000 n Bethesda, MD 20894, Web Policies During the consultation we need access to information because we cannot hold it all in our brains: what was the pro-brain natriuretic peptide level, the creatinine and potassium level, what did electrocardiography and echocardiography show, should the dose of apixaban be reduced in renal impairment? Top sports performers are trained in these sorts of techniques to block out the spectators, but I have not heard of similar training for clinicians. Most clinicians are workaholics and are then subject to performance targets. ', 'What is your main fear/worry/concern about this problem?' . Critical Analysis Of A Consultation Model Essay. 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Mean in relation to consultation in primary care: observational study more of the brain 's capacity... Our support articles here > need assistance with writing your nursing essay, our professional nursing essay, professional. The field of nurse prescribing closed questions and focused physical examination in front of several.... Make sure youre on a federal there is no brain power left for reasoning! Out request forms etc results of the first eight studies were extremely positive found these leaflets a! About the person 's job, interests, family and enjoyments 6 ( 1 ):50-58.:. P. and HANN, M., 2002 front of several strangers am sure i! Focus on patient-centred care rather than symptoms and physical health person 's job, interests, family and.... Conversation early due to pressure of time and not adequately exploring ambiguous answers and the initial results of the is..., 'What is your main fear/worry/concern about this problem? not only sound medical knowledge, but also communication! 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