PMC The medicine partnership ensures safety ansbetter health outcomes and helps reduce cost and wastage for the NHS. (Drew et al. 0000008925 00000 n 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. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! According to Roger Neighbour, author of The inner consultation a book familiar to most generations of GPs, while consultation models are a helpful guide, the key to being a good consulter lies not only in the technique of the consultation, but in the ability to listen and respond to our patients. Many authorities (Butler et al 1998) advise that the prime skills associated with the prescribing process are: Adequate exploration of the patients worries, Adequate provision of information to the patient regarding the natural processes of the disease being treated, The advisability of self-medication in trivial illness, The various alarm symptoms that should be notified to indicate that there may be problems with the treatment. Another person can give the patient reassurance and may also contribute useful information toward diagnosis or management. A review consultation is as important. Pendletons consultation model: assessing a patient. I once said to a patient 'What do you think is wrong?' (Britten et al 2000). 2000 and Shum et al. I have also seen clinics where patients were put into gowns and placed on examination couches before the clinician even said Hello. 4. Outpatient consultations are usually far better for confidentiality and dignity. 2002 Jan-Feb;27(1):37-41. doi: 10.1097/00006223-200201000-00018. 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? 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. However, if one part of the phase is not completed or fails then the consultation in unlikely to be complete and could lead to the wrong diagnosis or treatment (Courtenay and Griffiths 2010). In the best traditions of scientific endeavour, they were subject to a barrage of audits and studies to see how they actually performed. Study for free with our range of nursing lectures! BMC Public 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? Better consultations would reduce the possibility of misdiagnosis and also improve patient outcomes, patient experience, patient safety and staff satisfaction. (Cox et al. Vemuri S, Hynson J, Williams K, Gillam L. BMC Med Ethics. Their clinical reasoning directs the closed questions and focused physical examination. 0 Methods This retrospective before-after study included patients admitted to the medical ICU. I can then anticipate the consultation and appear well briefed to the patient. 4.4/5 on reviews.co.uk. This information can be readily available in well-filed paper notes, but with the under-provision of ward clerks, clinic clerks and secretaries, well organised paper notes are a thing of the past. I do much the same for rounds. Elwyn (et al 2003) took a slightly different approach with regard to the consultation process and prescribing. 0000090363 00000 n 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. The following summary includes the models that I believe are the most useful with a brief explanation, highlights and questions to use in consultations. model from therapy in that in consultation, the consultant works with the consultee to . 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. Taking the three models of interpretative, shared and informed decision-making as examples, we focus on two limitations of the models: (1) neglect of which decisions the patient should be involved in (the framing problem) and (2) how the patient should be involved in decision-making (the nature of reasoning problem). 10 MRS - Management 1: Coping with uncertainty 11 MRS - Management 2: Using community resources 12 MRS - Management 3: Prescribing (a) Technical 13 MRS - Medical Records 14 MRS - Emergency care 1: Initial assessment 15 MRS - Emergency care 2: Management 16 MRS - Professionalism 1: Availability 17 MRS - Professionalism 2: Involvement In fact, all the familiar consultation models, my own included, are unspoken guidelines designed to help doctor and patient each get as much as possible from their encounter. Parental involvement in decision-making about their child's health care at the hospital. Promotion of critical thinking by using case studies as teaching method. 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. This article will discuss some of the more common consultation models in use today and their relative advantages and disadvantages. 2005 Mar-Apr;53(2):59-65. doi: 10.1016/j.outlook.2004.11.005. Resources can be used in the consultation to aid communication when choices need to be made, for example, The Medicine for Children (2018) provides patient friendly leaflets (although it could be argued that they are not necessarily child friendly) when exploring views and negotiating a contract, around the choice of medication, it provides clear explanation of the medication for example, how the medication can be given ie tablet, or liquid? "rz*omar$/zLh*'X7y+D? This is likely to be reflected in greater patient satisfaction, greater compliance with instructions generally and improved outcomes and again, in the words of the authors fewer lawsuits. Keep in mind that discussion is a critical part of the classroom experience in graduate school, but discussion that is demeaning of others and . Risk communication in the clinical consultation. Info: 1861 words (7 pages) Nursing Essay I prepare for clinic a week in advance by typing an MS Word document that contains known diagnoses, medications and recent results. since 2003, Your NursingAnswers.net purchase is secure and we're rated 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. In broad terms, decision-making models vary in the respective roles that doctor and patient take in the final selection of treatment. Patient Educ Couns. The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. Bookshelf As a non-medical prescriber, it is essential that consultation skills are effective to. FOIA . ) HR;0Siq0\TRRp|"m(e5n(T Lph>&9FghA4Fg;37#gll8Fx6{xR^1|'#Ns;uXZOuQ. I propose 10 quality indicators that would be simple to measure and could be used to improve clinical consultations. 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. 2012 Jul;32(5):611-3. doi: 10.1016/j.nedt.2011.06.009. Sophie Cook is clinical reviews editor, BMJ. 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. endstream endobj 56 0 obj<>stream (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. 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. Consultations are a vital part of assessment and diagnosis during the patients journey, it is imperative for the practitioner to carry this out in a holistic and systematic manner in order to promote wellbeing and therefore creating a safe and evidence based management plan tailored to each patient (Nutall and Rutt-Howard 2015). 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. BMJ Opinion provides comment and opinion written by The BMJ's international community of readers, authors, and editors. The evidence is that a proper refreshment break is needed every 2 hours if we are to maintain performance in high-level mental activity. HHS Vulnerability Disclosure, Help Some of the literature that compares nurse and GP consultations is also looked at, as is the concept of diagnosis by nurses. Published: 11th Feb 2020. Careers. Promoting critical thinking and academic writing skills in nurse education. certain components are accepted and those which are unsuitable are rejected. I also try to make myself put my mobile phone onto silent, switch off the email on the computer and make the room (or ward) as quiet as possible. and transmitted securely. Summarising both the events and the emotional content is a useful way to demonstrate empathy. 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. 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. 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. <]>> 2022 May 16;23(1):52. doi: 10.1186/s12910-022-00788-7. 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. 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. Meaning what does happen and what should happen during a consultation. MEAD, N., BOWER, P. and HANN, M., 2002. 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. This terminology reflects not only a change in emphasis but also a change in attitude of the prescriber. According to the 5 Dynamic report, I performed effortless with Excite and Execute Dynamic groups. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. 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. This model centres on the patient's story using empathy to address the patient's questions. It is even easy to overlook checking the chest X-ray. He was an absolute wonderful writer and had a great amount of patience with me as well as following all directions very accordingly. 2022 Jun 22;23(1):62. doi: 10.1186/s12910-022-00801-z. I may experience some challenges in Explore and Examine Dynamic group. Kurtz SM and Silverman JD. Is there a crisis in clinical consultations? 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. Discussion focuses on critical theoretical elements associated with. %%EOF None of the others have been given a copy of the referral letter. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. Critical Analysis Of A Consultation Model Essay. ILLINGWORTH, R., 2010. In my previous hospital, I had to have 10 software applications open for an outpatient (office) consultation and the paper notes too! The Non Medical Prescriber (NMP) is still developing as a role, which is now fundamental in AP due to increased demands and reduced resources, especially in the role of autonomous practice in primary care and OOH services. 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). 2003. Revising a diagnosis is a major psychological effort and again the clinician's mind must be free for high-level clinical reasoning. In modern healthcare, the clinical consultation is almost completely overlooked and ignored. Split into six phases in a logical manner, the aim is to complete each phase. With a busy surgery, targets to meet, and growing paperwork demands, its easy lose sight of the task at hand and to forget to listen. Patients priorities must be our priority. The clinician is doing two high-level mental activities simultaneously: attentive listening and clinical reasoning. 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. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. The clinician has decided on a likely or definite diagnosis and recommended a treatment plan. 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? 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. 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). In 2019, the patient should have online access to, at least, referral letters, clinic letters, discharge summaries and test results. 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. The Calgary-Cambridge referenced observation guides: An aid to defining the curriculum and organising the teaching in communication programmes. This essay has been submitted by a student. 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. Another way to improve your consultation skills is to video your consultations and watch them. 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