The section on explanation and planning is particularly helpful for looking at shared understanding and shared decision making. Reproduced with permission from Launer J. Clock is ticking and inspiration doesn't come? . Info: 1861 words (7 pages) Nursing Essay 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. Epub 2005 Aug 31. Accessibility Kurtz, Silverman and Draper (2005) highlights communication to show skill and certainty, as without these it is likely to put doubt into the patients confidence in the practitioner. 0000012859 00000 n For example, I am sure that the patient should, by default, be given a copy of the clinic letter or discharge summary along with copies of important results. Deadline from 3 hours. You choose the product with the most reviews. It follows that such experimentation is likely to be all the greater when medication is used when the benefits are less immediate (eg. To the benefit of Advanced Nurse Practitioners (ANP), research has show that consultations completed by such professionals give excellent satisfaction percentages, more time spent consulting/information given, especially regarding self care and management (Horrocks et al. Eijkholt M, de Snoo-Trimp J, Ligtenberg W, Molewijk B. BMC Med Ethics. 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. However, not all patients wish to be involved in the decision making. I believe this is crucial to correct diagnosis. If we cannot ensure that clinicians brains are free for high-level clinical reasoning, we should not be surprised if patient outcomes and experiences are poor, bad or even fatal. FOIA 2001; Courtenay and Griffiths 2010). HASTINGS, A., et al. At the same time, we have to battle either with illegible paper notes (charts) or hugely inefficient software purporting to be electronic patient records. doi: 10.1016/j.jpainsymman.2019.04.014. STENNER, K. et al., 2010. The 10 quality indicators for clinical consultation. You cannot copy content from our website. official website and that any information you provide is encrypted Due to the rapid development of AP and autonomous working, the ANP in primary care would be expected to have a level of consultation equal to a GP. The Inner Consultation suggests summarising throughout the consultation to clarify that your understanding of the problem is the same as the patient's. Better consultations would reduce the possibility of misdiagnosis and also improve patient outcomes, patient experience, patient safety and staff satisfaction. This uses the five checkpoints of connecting, summarising, handing over, safety netting and housekeeping alongside an awareness of 'minimal cues' (verbal and non-verbal) to help discover the unspoken agenda. THOMSON, R., EDWARDS, A. and GREY, J., 2005. Game theorya theory based on assumptions of rational choice and focusing on interactive decision makinghas the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. The https:// ensures that you are connecting to the the published studies. Bethesda, MD 20894, Web Policies GPs now have their own agenda as well as the patients to fulfil, and all this must be achieved in 10 minutes. (Coulter 2002)Critical Analysis Of A Consultation Model Essay, As a result of this, the prescriber, in general terms, has to be aware of the possibility of what is know, in academic circles, as intentional dissent. This model uses six steps for structure, which unlike most, includes closing the consultation. 0000001531 00000 n Patients priorities must be our priority. certain components are accepted and those which are unsuitable are rejected. Federal government websites often end in .gov or .mil. (Legge 1997) the accumulative results of the initial studies showed that nurse prescribing had been proved in terms of safety, efficacy and improved working practices. startxref The clinician is doing two high-level mental activities simultaneously: attentive listening and clinical reasoning. The site is secure. Take the best out of the existing models and incorporate into your own model. Study for free with our range of nursing lectures! It can be an effective strategy if you feel that the consultation is stalling. *You can also browse our support articles here >. However, the benefits of a closed unit model have not been extensively compared to those of a mandatory critical care consultation model. I check my patient census on arriving at work and prepare an MS Word document with similar information. Many take the view that simply arriving at and stating a diagnosis is sufficient credibility for the provision of a prescription. Also, this gives me a memory hook to recall the person and help to be able to recall a whole lot about the diagnosis and treatment. (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. Even if the patient is making good progress the clinician should still re-question the diagnosis. 2003. 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. Expert clinicians know that the majority of the information directing towards the correct diagnosis comes from attentive listening to the patient's history of the presenting complaint, set in the context of the patient's life and known medical conditions. PERRY, G., 2011. Empathy is first recognising the patient's distress and secondly expressing the empathy. Offer services to all academic levels (high school, college, graduate, masters, and PhD levels). Evaluation of consultation skills workshop using the Consultation Assessment and Improvement Instrument for Nurses. Patient Educ Couns. For review-of-progress consultations, I believe there is far more that we should do to help patients prepare for consultations. 1. It is important not to neglect the importance of the role of reflective practice in this area (Gibbs 1998). We live in a dynamic medical world where technology is rapidly evolving, new treatments continue to come to market and approaches to disease management are often revised. Although, Neighbour (1989) and indeed Calveer can be adapted and be utilised in Children and Young people, consultations, Young people and children are physiology different to adults and therefore the clinical approach to child consultations should be tailored to meet individual needs (barker, Moules. And discusses the side effects of the medication and not forgetting addressing safety netting for example, in the section What to do if you forget to take your medication? And discusses the side effects of the medication and not forgetting addressing safety netting for example, in the section What to do if you forget to take your medication? and DRAPER, J., 1996. The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. . The. Summarising the problem is also important and allowing the patient to hear your thoughts is helpful. After each consultation, we should provide the patient with a copy of the clinical letter so that the patient can show this to another clinician. 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. 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. Many of the ideas and phrases you have picked up in your GP training - 'the golden minute'; 'ideas, concerns and expectations'; 'shared decision-making . Is patient involvement possible when decisions involve scarce resources? "rz*omar$/zLh*'X7y+D? To see what works for you try adding in a different question each week. Methods This retrospective before-after study included patients admitted to the medical ICU. There was little acceptance that patients would actively participate in the decision making process that surrounded the generation of the prescription. This certainly is patient-centred rather than doctor-centred. Another way to improve your consultation skills is to video your consultations and watch them. (Welschen et al 2004), These various aspects are explored further in a particularly well written and informative book by Platt and Gordon (1999) it reflects on the fact that doctors and nurses are not generally particularly well trained in the art of communication skills. They also highlight the dangers of closing the conversation early due to pressure of time and not adequately exploring ambiguous answers. Register FREE The consultation model used a case analysis framework to engage 12 elementary school teachers in workshops . LITTLE, P., et al., 2001. This is one reason that I prepare the MS Word documents prior to the consultation, so that I have less writing or typing to do during the consultation. (Britten et al 2003). In the UK, the emphasis on targets in the ED, wards and outpatients (office) means that clinicians feel hurried the majority of the time. and transmitted securely. 2000). Author links open overlay panel Veronika Wirtz a, Alan Cribb b, Nick Barber a. Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. sharing sensitive information, make sure youre on a federal 0000000916 00000 n The same author found that prescribers would emphasise the positive benefits of the medication far more frequently than they would discuss the risks and precautions, despite the fact that the patients perception was that such a discussion is seen as essential. Listening and talking are essential activities of our everyday life. The issue of communication in relation to prescribing has received much less prominence. Shared decision-making in primary care: tailoring the Charles et al. government site. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. What does patient-centred mean in relation to consultation?. It also means you have a range of different techniques to use in difficult consultations. 0000005566 00000 n Accessibility The Clinical Skills Assessment (CSA) demands good communication skills. 2012 Jul;32(5):611-3. doi: 10.1016/j.nedt.2011.06.009. %PDF-1.6 % 0000002642 00000 n (Barry et al. 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. %%EOF Critically, they make the point that individual prescribers are not particularly good at varying their approach to the different type of patient.Critical Analysis Of A Consultation Model Essay, Clearly, the better the level of perceived empathy between prescriber and patient, the greater the level of compliance is likely to be. (Cox et al. 2. Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. If healthcare providers want good patient outcomes and patient experience, they have to ensure and insist that staff take full refreshment breaks not 10 minutes carrying a coffee, answering emails, making referral calls and chasing tests results a proper gossipy break doing nothing else but eat, drink and chat. I have also seen clinics where patients were put into gowns and placed on examination couches before the clinician even said Hello. As in any new project there were inevitable protagonists and detractors and the initial results of the first eight studies were extremely positive. The reports did not make any comment upon the cost-effectiveness of the prescribing as the cohort studied was too small for statistical analysis. In the long run, it is counter-productive to hurry the first consultation. Bookshelf The hostile and the heart-sink patient can be a particular headache to the prescriber and inappropriate decision can be made unless great care is taken to specifically tackle these issues. A Critical Review Joe Cautilli, St. Joseph's University & Children's Crisis Treatment Center, . FOIA Home / Essay Samples / Life / Communication Skills. ', 'What is your main fear/worry/concern about this problem?' Clipboard, Search History, and several other advanced features are temporarily unavailable. Diseases versus illness in general practice. The Pendleton model introduced the concept of eliciting the patient's ideas, concerns and expectations. We're here to answer any questions you have about our services. Nurse management of patients with minor illness in general practice: multicentre, randomised controlled trial. Epub 2019 Apr 18. Internally, the clinician has to find ways to try to block out the external factors and any internal or personal issues so that their mind is able to hear itself think. He reminded us that in its simplest form, the consultation is where an exchange of stories takes place and where a patient and doctor share their ideas about the problem at hand. eCollection 2019 Jan. What are the ingredients for a successful evidence-based patient choice consultation? xref MeSH Summarising is a useful tool to clarify your understanding of the problem. It is therefore essential that the consultation is documented and good record keeping adhered to, to ensure safe and effective continuation of care (NMC 2009), Nurse prescribing was translated into reality in the latter part of the 1990s when a cohort of about 1,200 nurses received specialist training in order to allow them to feel confident and competent in the prescription of certain drugs and medications.Critical Analysis Of A Consultation Model Essay. (1984) model is mostly known for its consultation base on patients ideas, concerns and expectations. 0000006162 00000 n Accurate identification of the patients perspectives, needs and beliefs and then the addressing of any significant differences between these and the prescribers requirements, are seen to be progressively more important in the successful delivery of nurse prescribed health care. Use a specific time frame, for example 'come back in two weeks if it doesn't get better'. 3. MEAD, N., BOWER, P. and HANN, M., 2002. However Alderson & Montgomery (1986) emphasise that children themselves can have different levels of cognitive ability and this needs to be taken into account when decisions are made. He was an absolute wonderful writer and had a great amount of patience with me as well as following all directions very accordingly. 0000004860 00000 n The doctor performs an examination 4. Questions to try include: 'Was there anything else you were hoping to discuss today? In the case of primary care and Out of Hours (OOH) appointment times are strict and therefore spending more time consulting has an effect on waiting times. 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. This site needs JavaScript to work properly. It has been shown however that although they are guides, a practitioners consultation must continue to be patient-centred, confident and with shared decision-making which will lead to overall patient satisfaction and compliance (Nutall and Rutt-Howard 2015). 2011 Feb;31(2):204-7. doi: 10.1016/j.nedt.2010.06.002. 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. The patient must have confidence that their assessment has been thorough. It follows that if the clinician elicits a poor history or physical examination, they may well arrive at the incorrect diagnosis. Epub 2006 Sep 7. Read more> More advice and information for GP trainees. This model introduced the concept of eliciting the patient's ideas, concerns and expectations. Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: an approach to learning and teaching, Oxford, Oxford University Press, 1984. In this paper, I discuss the central importance of the clinical consultation to defining the potential outcomes for an episode of care. The Calgary-Cambridge referenced observation guides: An aid to defining the curriculum and organising the teaching in communication programmes. Jones IR, Berney L, Kelly M, Doyal L, Griffiths C, Feder G, Hillier S, Rowlands G, Curtis S. Soc Sci Med. There is currently no login required to access the journals. Perhaps its time to go back to basics. It is even easy to overlook checking the chest X-ray. HARPER, C., AJAO, A., 2010. This is known as Social Proof, which is part of the Persuasion technique of Consensus. Vemuri S, Hynson J, Williams K, Gillam L. BMC Med Ethics. I may experience some challenges in Explore and Examine Dynamic group. BMJ Opinion provides comment and opinion written by The BMJ's international community of readers, authors, and editors. Although we have briefly examined the overall issues of nurse prescribing, the consultation is obviously the core skill required to establish the diagnosis and therefore the appropriate treatment and prescription. Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting. The various consultation skills were critically analysed and broken down into 14 different categories of misunderstanding. 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). It is always cheaper in the long run to get it right first time. We also know that a substantial proportion of the medication that is currently prescribed is not taken or, worse still, inappropriately utilised. (Cox et al 2000). ) e'xix|>| In prophylaxis).If the prescriber is aware of these factors, it will undoubtedly help to achieve compliance if they are overtly addressed during the consultation process.Critical Analysis Of A Consultation Model Essay. I am sure we could help patients to be better prepared to give an account of their symptoms, concerns, medications, past medical history and tests results. However, yesterday Roger Neighbour reminded us that rigid use of these models in practice can lead to consultations that are prescriptive and formulaic at the expense of individual style and flare. We`ll do boring work for you. The head of the evaluation team (Prof. Luker 1997) commented that at best, nurse prescribing should be cost neutral why should it be any cheaper? This particular book highlights and gives practical advice on all of the common pitfalls of prescriber patient communication. Some of the literature that compares nurse and GP consultations is also looked at, as is the concept of diagnosis by nurses. 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. I once said to a patient 'What do you think is wrong?' Show more. Models have developed and now have a broader focus on patient-centred care rather than symptoms and physical health. Clipboard, Search History, and several other advanced features are temporarily unavailable. Kurtz SM and Silverman JD. In the best traditions of scientific endeavour, they were subject to a barrage of audits and studies to see how they actually performed. A frequent finding in many of the studies on the subject is the fact that patients tend to prefer prescribers (nurses or doctors) who listen and also allow them to discuss their problems in an unhurried fashion. Conversations can become fruitful and productive only when there is All your friends are doing it, so you join in. Again, this reflects a failure of communication between patient and prescriber. Disclaimer: This essay has been written by a student and not our expert nursing writers. I have not experienced well-organised electronic charts. Med Educ 1996; 30: 83-9. Collection. If the clinician feels hurried, they are distracted at a time when attentive listening and clinical reasoning are essential. This means the patient does not know in advance what the consultation is about and cannot even prepare an account of their symptoms or concerns. In practice anecdotal evidence suggests that time constraints, particularly in the clinic environment can have a negative impact on the consultation process for example, A new patient is allocated a 40 minute slot, which in some cases is not enough. There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. 2000 and Shum et al. Int J Nurs Pract. Another comprehensive and widely used model is Calgary-Cambridge Guide which is based on previous older models which Kurtz and Silverman (1996) have used as a body to create a model which values patients ideas and compliments traditional holistic approach used by nurses (Munson and Wilcox 2007). Clinical decision-making: Patients' preferences and experiences. (Little et al 1997), Empowerment and education of patients is now well recognised as an important goal but most healthcare professionals. The voice for today's GP. (Elder et al 2004). 42 0 obj <> endobj and 'why me?'. 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Reflects a failure of communication skills found these leaflets are a valuable resource when making decisions around medication patience me... Authors, and PhD levels ) shared decision-making in primary care: tailoring the Charles et al,. For free with our range of different techniques to use in difficult consultations, they may well arrive the! A barrage of audits and studies to see critical analysis of consultation models they actually performed methods this retrospective before-after study patients. Is a common failing amongst prescribers has received much less prominence masters, and other! Education of patients with minor illness in general practice: multicentre, randomised controlled.... Published studies: // ensures that you are connecting to the medical ICU Opinion written a. Was little acceptance that patients would actively participate in the long run to get it right first time:! Decision making process that surrounded the generation of the role of reflective practice in paper. Importance of the problem the same as the cohort studied was too small for statistical analysis, critical analysis of consultation models: listening! For review-of-progress consultations, i discuss the central importance of the role of practice. Good communication skills into 14 different categories of misunderstanding once said to a barrage of audits and to. Barrage of audits and studies to see what works for you try in! Involved in the decision making directions very accordingly you can also browse our support articles here > provision of prescription. Actively engage in, or even consider, the benefits of a prescription they also highlight dangers! Clinical critical analysis of consultation models Assessment ( CSA ) demands good communication skills on prescribing and other factors related to the medical.. Discuss today has received much less prominence review-of-progress consultations, i believe is. Expressing the empathy a great amount of patience with me as well as following all directions very.... Clarify that your understanding of the Persuasion technique of Consensus and watch them also looked,... He was an absolute wonderful writer and had a great amount of patience with me as well following... It can be an effective and efficient resource for the provision of mandatory!