The best pieces make a single topical point. 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. Bookshelf Mostly, the information in the notes is truth but must not be accepted without questioning, at the least the information in the notes tells me what to be sceptical about! Register FREE The reports did not make any comment upon the cost-effectiveness of the prescribing as the cohort studied was too small for statistical analysis. 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). Roger Neighbour explained how a consultation is really about a patient who has a story to tell. 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. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. I believe this is crucial to correct diagnosis. I may experience some challenges in Explore and Examine Dynamic group. (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. 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. Questions to try include: 'Was there anything else you were hoping to discuss today? PMC I read the current admission notes (or hear the junior doctor present the case) and look up test results etc before going to see the patient. Again, this reflects a failure of communication between patient and prescriber. 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. 2000). They also highlight the dangers of closing the conversation early due to pressure of time and not adequately exploring ambiguous answers. 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. Do you have a 2:1 degree or higher in nursing or healthcare? 0000024314 00000 n 0000007586 00000 n Offer services to all academic levels (high school, college, graduate, masters, and PhD levels). 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. These battles can use up all of our brain's cognitive capacity, so that there is no brain power left for clinical reasoning. However, the benefits of a closed unit model have not been extensively compared to those of a mandatory critical care consultation model. and DRAPER, J., 1996. 19 April 2018. Published: 11th Feb 2020. How nurse prescribers influence the role of nursing. The best way to use consultation models is to read them all, see which you like and take the best out of each to develop your own model. 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. Most people cannot even do attentive listening to someone else, let alone high-level thinking at the same time! 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. 0 1. In this way, I can give the patient confidence that at least I know what other clinicians have concluded about their case and I know what to be sceptical about! 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. 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). Even when drug therapy is considered essential (such as insulin and thyroxin) many patients will experiment with dosages and drug-free periods. ILLINGWORTH, R., 2010. Similarly to Pendleton et al. Deadline from 3 hours. Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. This is a combination of external and internal factors. 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. Calgary-Cambridge describes the behaviour and skills required to complete each step. official website and that any information you provide is encrypted 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. This particular book highlights and gives practical advice on all of the common pitfalls of prescriber patient communication. It provides a definition and conceptualization of critical thinking and critical analysis, and highlights the differences, similarities and interrelationships between them. We are under pressure to see more and more patients, to record more and more notes, to complete more and more pro formas, to meet relentless performance targets, follow guidelines and fill in the most recent form that is meant to avoid some recent harms in the systems of care or provide statistics to management. Significantly, all of these 14 categories were associated with potential or even actual less than optimal, Outcomes as they resulted in either inappropriate prescribing or inadequate treatment adherence. They can be especially useful to those of us who like to think and learn in a structured or organised way, especially when developing a skill such as consulting with patients. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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? Attentive listening and clinical reasoning require simultaneously doing two high-level mental activities. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2007 Feb;65(2):189-96. doi: 10.1016/j.pec.2006.07.007. . ) In this paper, I discuss the central importance of the clinical consultation to defining the potential outcomes for an episode of care. Perhaps its time to go back to basics. Duberstein PR, Kravitz RL, Fenton JJ, Xing G, Tancredi DJ, Hoerger M, Mohile SG, Norton SA, Prigerson HG, Epstein RM. It clearly is not a situation which one could have confidence that the patient has a sound knowledge base about his treatment and has a positive attitude towards compliance.Critical Analysis Of A Consultation Model Essay, The point relating to communication failure resulting in poor treatment outcome (primarily in relation to non-adherence to treatment instructions) was explored in depth in an excellent paper by Britten (et al 2000). Preferences of patients for patient centred approach to consultation in primary care: observational study. This model outlines safety netting where the doctor and patient plan together to manage uncertainty. Pendleton advises drawing out whether there are any other problems early on in the consultation. endstream endobj 56 0 obj<>stream HHS Vulnerability Disclosure, Help 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. I have also seen clinics where patients were put into gowns and placed on examination couches before the clinician even said Hello. Their clinical reasoning directs the closed questions and focused physical examination. 2002 Jan-Feb;27(1):37-41. doi: 10.1097/00006223-200201000-00018. KINNERSLEY, P. et al., 2000. In the UK, the emphasis on targets in the ED, wards and outpatients (office) means that clinicians feel hurried the majority of the time. On searching the literature, many models of consultation were found. It also often provides interesting conversations at the end of the consultation when I am writing out request forms etc. 0000008258 00000 n 0000005566 00000 n You try to fit in with the crowd. Outpatient consultations are usually far better for confidentiality and dignity. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. Take the best out of the existing models and incorporate into your own model. Externally, everything should be done to provide an environment conducive to high-level thinking. 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. The patient should also know what is likely to happen during the consultation will they be subject to intimate examination or will the consultation be only a conversation? In addition, watching others consult allows you to pick up questions they use to elicit information. 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. 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. 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. My belief is that if healthcare providers placed as much emphasis and resource on my 10 quality indicators for clinical consultation as they have put on venous thromboembolism (VTE) prophylaxis or the 4-hour emergency department (ED) target, we would have substantial improvements in patient outcomes and experience within 2 years. They have to determine whether the patient has followed that trajectory or fallen away. 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. It follows that such experimentation is likely to be all the greater when medication is used when the benefits are less immediate (eg. Were hoping to discuss today how a consultation is really about a patient who has story... 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