HTSM0W R#Sn "r@{&U]iT{UAAy*A. [%-7qe[1BJ]@p+enjx!J6ttVXg]slZ'{:9/P%{>f1xP5U]fPiYt`Buy h~8`v We've received widespread press coverage National Library of Medicine The way that prescribers will often duck issues where they feel uncomfortable or feel that their knowledge is not particularly sound, or perhaps fail to respond to the distress signals sent out (either verbally or non-verbally) by the patient. He emphasised the importance of listening and allowing patients to tell their story while reassuring them that they have your attention. 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. 2001; Courtenay and Griffiths 2010). Based on these principles, Roger Neighbour says there are four simple rules to get through a consultation; pay attention, give receipts, summarise, and think aloud. (Elwyn et al. 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. The more you practice, the more your model will become automatic so you can concentrate on what the patient is saying. Disclaimer. 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. <]>> Neighbour (1989) check point of consultation emphasises the need to be on the same wavelength as the patient and Me first (2017)communication tool does this effectively as it is specifically designed as a child orientated tool. 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. PMC 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. A 71-point model and a useful template with lots of different consulting strategies. This article will discuss some of the more common consultation models in use today and their relative advantages and disadvantages. Conversations can become fruitful and productive only when there is All your friends are doing it, so you join in. Patient understanding is rarely checked as it is usually assumed after the prescriber has given the prescription. The Me First tool encourages discussion with both parent and child to empower them to make informed choices.Critical Analysis Of A Consultation Model Essay, [contact-form-7 id="141" title="Appointment Form"], Lasting Trauma Among Aboriginal Peoples Essay, Custom written, plagiarism free papers written from scratch, Free revisions provided you stick to the original instructions, Our writers have high academic qualifications, We have expert writers in all areas of medical, nursing and pharmacy fields. and DRAPER, J., 2005. These battles can use up all of our brain's cognitive capacity, so that there is no brain power left for clinical reasoning. Register FREE The doctor (perhaps with, perhaps without) the patient considers the problem 5. As I get older and more experienced, I find myself writing less and less during the consultation, so my brain is free to listen, observe and think more. From the point of the patient this means the models differ according to the degree to which the patient is able to take part in, and shape, the choice of their treatment (see Fig. 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. Even if the patient is making good progress the clinician should still re-question the diagnosis. 0000009641 00000 n PMC 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. Soc Sci Med. I once said to a patient 'What do you think is wrong?' It is not just the act of writing out the prescription that is important, but it is the understanding of the processes and dynamics of the interactions that are taking place between prescriber and patient that are the fundamental key to good prescribing practice (Kuhse et al 2001). 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). Dignity is often fairly minimal with patients expected to accept physical examination in front of several strangers. Unauthorized use of these marks is strictly prohibited. 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? ) e'xix|>| As the clinician listens to and examines the patient, their brain is full of clinical reasoning, which is high-level thinking around possible diagnoses. 2000 and Shum et al. . ) %PDF-1.6 % There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. 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). Disclaimer. If you are still unable to access the content you require, please let us know through the 'Contact us' page. The section on explanation and planning is particularly helpful for looking at shared understanding and shared decision making. We welcome submissions for consideration. 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. SHUM, C. et al., 2000. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! I prepare for clinic a week in advance by typing an MS Word document that contains known diagnoses, medications and recent results. We also know that a substantial proportion of the medication that is currently prescribed is not taken or, worse still, inappropriately utilised. Consultation models are used in healthcare as a framework and guide for the practitioner when in contact with a patient, this can be at any point of contact through the patients journey (Harper and Ajao 2010; Nutall and Rutt-Howard 2015). All rights reserved. Duberstein PR, Kravitz RL, Fenton JJ, Xing G, Tancredi DJ, Hoerger M, Mohile SG, Norton SA, Prigerson HG, Epstein RM. 8600 Rockville Pike 2001). We also suggest that the fundamental problem that lies behind these limitations is insufficient attention to, and explicitness about, the dilemmas of professional ethics, which are played out in the professional-patient relationships that the models are supposed to represent, particularly with respect to the issue of expert and lay accountability. LITTLE, P., et al., 2001. . Nurs Outlook. Consultation models are not rules; they are learning aids to help you develop your own consultation skills. xb```K\ ce`a860x!@^0xf#oJ=E^[?+HdY(9B,EnT!9.ks e&@i0q4PMJI^@Ze"J*W0Ef2,fci::V11sy] 8!H3c WmK The aim of the consultation is to develop a therapeutic relationship with the patient and their family and to ensure accurate history taking in order to reach an accurate diagnosis. No plagiarism, guaranteed! This model sees the consultation entirely from the patient's perspective using a series of questions such as: 'what has happened?' The https:// ensures that you are connecting to the Accessibility Models have developed and now have a broader focus on patient-centred care rather than symptoms and physical health. 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? National Library of Medicine Questions to check understanding include: 'Could you tell me what you understand the problem to be so I can check I have explained it okay?'. Add to Mendeley. Many doctors will be familiar with Eric Beme's model of the human psyche as consisting of three 'ego-states' - Parent, Adult and Child. Diseases versus illness in general practice. Clinicians follow a structured approach to consultations, formalized in consultation models, one aim of which is to assist the clinician in negotiating the complexity of the interaction between. MeSH This site needs JavaScript to work properly. Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations. On searching the literature, many models of consultation were found. It follows that such experimentation is likely to be all the greater when medication is used when the benefits are less immediate (eg. Would you like email updates of new search results? Int J Nurs Pract. However during my career, I have been expected to do a clinic along with about six other doctors and patients all in a room like a railway station waiting room (this was in one of the top hospitals in London). 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. This essay has been submitted by a student. Summarising both the events and the emotional content is a useful way to demonstrate empathy. In the UK, the emphasis on targets in the ED, wards and outpatients (office) means that clinicians feel hurried the majority of the time. In summary, this leaves a situation which is open to misinterpretation, uncertainty as a result of unadressed worries and for patients to be ambivalent towards the medication that they have been prescribed. This means that I must not be interrupted or I will lose my chain of thought and forget important points when I compose the clinic letter. Choose your writer among 300 professionals! Vemuri S, Hynson J, Williams K, Gillam L. BMC Med Ethics. doi: 10.1016/j.jpainsymman.2019.04.014. The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. 2002 Jan-Feb;27(1):37-41. doi: 10.1097/00006223-200201000-00018. Questions to try include: 'Was there anything else you were hoping to discuss today? To overcome this barrier, the Specialist Nurse is a key point of contact for the patient and their families and follows up patients consultations with support and advice around diagnosis, safety and medication management (Epilepsy Action 2018). This meant that there was not a ready supply of information into the consultation. Promoting critical thinking and academic writing skills in nurse education. 0000003509 00000 n Copyright 2003 - 2023 - NursingAnswers.net is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. Revising a diagnosis is a major psychological effort and again the clinician's mind must be free for high-level clinical reasoning. 2. Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. The Inner Consultation suggests summarising throughout the consultation to clarify that your understanding of the problem is the same as the patient's. Clinical consultations rarely feel like well-prepared business-like meetings. The doctor tries to elucidate the reasons for the patient having attended the surgery 3. Epub 2010 Jul 23. treatment plan with appropriate strategies, client progress, analysis of counselor countertransference (self . 0000118000 00000 n The aim of this case study is to illustrate how prescribing decisions can be enhanced through the use of systematic consultation, reflection on practice and relevant information seeking. I know many clinicians who never take lunch and, at the extremes, may work 14 hours without even going to the toilet. The success of this venture would strongly argue that it will progress further still in the future. FOIA Do you have a 2:1 degree or higher in nursing or healthcare? In my previous hospital, I had to have 10 software applications open for an outpatient (office) consultation and the paper notes too! I argue that the process of clinical consultation defines the possible outcomes. 0000008715 00000 n and 'why me?'. HASTINGS, A., et al. 2021 Oct 6;9(28):8312-8326. doi: 10.12998/wjcc.v9.i28.8312. The evidence is that a proper refreshment break is needed every 2 hours if we are to maintain performance in high-level mental activity. To overcome this barrier, the Specialist Nurse is a key point of contact for the patient and their families and follows up patients consultations with support and advice around diagnosis, safety and medication management (Epilepsy Action 2018). It is important not to neglect the importance of the role of reflective practice in this area (Gibbs 1998). HARPER, C., AJAO, A., 2010. endstream endobj 56 0 obj<>stream The doctor forms rapport with the patient 2. Share. Pendletons consultation model: assessing a patient. An official website of the United States government. A skilled advanced clinical practitioner (ACP) in this area has the potential to make a significant contribution to several fundamental outcomes: patient satisfaction, patient concordance with prescribed therapies/interventions, overall diagnostic accuracy and overall patient outcomes. 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. . Nurse management of patients with minor illness in general practice: multicentre, randomised controlled trial. The creators themselves did point out that a practitioner (in this study, medical) was shown to interrupt a patient within 18 seconds of the beginning of the consultation. World J Clin Cases. The Helmann's Folk model centres on the patient's story using empathy to address the patient's questions. (2005) concluded that effective consultations give positive outcomes. Consultation models are clearly useful tools for practitioners to use during the patients journey. Before Kurtz SM and Silverman JD. Applying the Calgary-Cambridge model. This model looks at the process of the consultation from initiating the session, gathering information, providing structure to the consultation, building a relationship, giving information by explanation and planning, and closing the session. Patient-doctor decision-making about treatment within the consultationA critical analysis of models. Patient Educ Couns. 2007 Aug;13(4):203-8. doi: 10.1111/j.1440-172X.2007.00629.x. BMJ Opinion provides comment and opinion written by The BMJ's international community of readers, authors, and editors. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Register today for further access to articles and. ILLINGWORTH, R., 2010. Study for free with our range of nursing lectures! (Elwyn et al.2000), The paper by Cox (et al.2000) found that it was common practice for prescribers to initiate the discussions about just what medication there were going to prescribe, rarely refer to the medicine by name and equally rarely refer to how a newly prescribed medication is perceived to differ in either action or purpose, to those previously prescribed. 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. RCP members and fellows (using their login details for the main RCP website) are able toaccess the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:https://cme.rcplondon.ac.uk, Copyright 2021 by the Royal College of Physicians, DOI: https://doi.org/10.7861/clinmed.2019-0263, Sign In to Email Alerts with your Email Address, The process of clinical consultation is crucial to patient outcomes and safety: 10 quality indicators. 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. Even having to write notes takes up more of the brain's attention. 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). 4. 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). (2001) has shown that compared to a biomedical consultation, patient satisfaction is greater when using a patient-centred approach and their is the preferred method when attending a primary care practitioner. There is a lot of debate in healthcare about whether we should measure process or outcome. Home / Essay Samples / Life / Communication Skills. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. The reports did not make any comment upon the cost-effectiveness of the prescribing as the cohort studied was too small for statistical analysis. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the NursingAnswers.net website then please: Our academic writing and marking services can help you! This is a critical . Critical Analysis Of A Consultation Model Essay. Shared decision-making in primary care: tailoring the Charles et al. 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. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. Concordance with medication and consultations with pharmacists . I believe this is crucial to correct diagnosis. Postgrad Med J 2017;93:58. It follows that if the clinician elicits a poor history or physical examination, they may well arrive at the incorrect diagnosis. eCollection 2019 Jan. What are the ingredients for a successful evidence-based patient choice consultation? 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). Time pressures, Qof targets, the need to keep up to date with endless guidelines or protocols, a new breed of highly knowledgeable consumers, and an older patient population with more comorbidities give GPs a tough time.
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