Patient-doctor decision-making about treatment within the consultation--a critical analysis of models Soc Sci Med. Essay, My Experience in Excite and Execute Dynamic Groups Essay. Info: 1861 words (7 pages) Nursing Essay Even when invited to do so, patients seldom take the opportunity to ask questions. CONSULTATION MODELS Consultation models are established lists of questions or areas to be explored, and provide a framework for a consultation. 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. They also highlight the dangers of closing the conversation early due to pressure of time and not adequately exploring ambiguous answers. 0000007586 00000 n and transmitted securely. (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. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. 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. 19 April 2018. Critical thinking and patient outcomes: a review. 2005 Mar-Apr;53(2):59-65. doi: 10.1016/j.outlook.2004.11.005. Helmann CG. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. 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 NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. The medicine partnership ensures safety ansbetter health outcomes and helps reduce cost and wastage for the NHS. 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. When you feel you have a system of questions that are working, memorise them so that you can use them if a consultation stalls or in your CSA exam. Is there a crisis in clinical consultations? The https:// ensures that you are connecting to the Again, this reflects a failure of communication between patient and prescriber. Critical Analysis Of A Consultation Model Essay. 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. *You can also browse our support articles here >. (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. Randomised control trial of nurse practitioner versus general practitioner care for patients requesting same day consultations in primary care. 2000 and Shum et al. 0000004860 00000 n 0000090363 00000 n 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. I can then anticipate the consultation and appear well briefed to the patient. The various consultation skills were critically analysed and broken down into 14 different categories of misunderstanding. 2000). 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. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! 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. Consultation models are not rules; they are learning aids to help you develop your own consultation skills. Eijkholt M, de Snoo-Trimp J, Ligtenberg W, Molewijk B. BMC Med Ethics. The clinician is doing two high-level mental activities simultaneously: attentive listening and clinical reasoning. They advocate the process of concordance which is described as the process whereby there is a negotiation between the patient and the prescriber which involves a discussion about the perceived benefits and drawbacks of the proposed medication, together with an exchange of beliefs and expectations. The more you practice, the more your model will become automatic so you can concentrate on what the patient is saying. 0000009641 00000 n 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. Jones IR, Berney L, Kelly M, Doyal L, Griffiths C, Feder G, Hillier S, Rowlands G, Curtis S. Soc Sci Med. 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. 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. Promoting critical thinking and academic writing skills in nurse education. 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. I believe this is crucial to correct diagnosis. 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. Refreshments are called refreshments because they refresh the mind, body and spirit. that are consistent with key elements of positive psychology. Conducting a nurse consultation. 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. (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. This meant that there was not a ready supply of information into the consultation. This is a combination of external and internal factors. 0000000016 00000 n Bethesda, MD 20894, Web Policies If another patient is slipped into the clinic, I would then spend several minutes reading the notes (charts) before calling the patient in. 0000001531 00000 n All rights reserved. The https:// ensures that you are connecting to the 2001). 2006 Jan;62(1):116-24. doi: 10.1016/j.socscimed.2005.05.017 . In this paper, I discuss the central importance of the clinical consultation to defining the potential outcomes for an episode of care. 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. Is there a crisis in clinical consultations? Decision-making approaches for children with life-limiting conditions: results from a qualitative phenomenological study. 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 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. Share. 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. If healthcare providers realised that clinical consultations are the crucial productive process of their business and worked to improve the process of clinical consultation, we could see fewer misdiagnoses with substantial improvements in patient outcomes and experiences, along with happier more fulfilled staff within 2 years from now. To see what works for you try adding in a different question each week. It will also demonstrate to you why consultation models are relevant and how they can help trainees, GPs and patients. This article was first published in March 2010 and reviewed in April 2018 by Dr Ravi Ramanathan. In addition, watching others consult allows you to pick up questions they use to elicit information. 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. 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. Counseling Strategies and Consultation Models CEP 863 Spring 2009 . xref National Library of Medicine The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. Careers. 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? Epub 2006 Sep 7. To qualify as a GP in the UK nowadays, trainees must demonstrate not only sound medical knowledge, but also appropriate communication skills. In the best traditions of scientific endeavour, they were subject to a barrage of audits and studies to see how they actually performed. Would you like email updates of new search results? (RPSGB 1997), Some commentators in the field of nurse prescribing have refered to the fact that the skills of communication, when they have been taught, have concentrated mainly on the fields of history taking and diagnosis. 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). 0000003730 00000 n There was little acceptance that patients would actively participate in the decision making process that surrounded the generation of the prescription. The term was seen as being authority laden (Marinker 1997) where it was expected that patients complied implicitly and without question when a prescription was given. A review consultation is as important. 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. Promotion of critical thinking by using case studies as teaching method. 0000008258 00000 n Most people cannot even do attentive listening to someone else, let alone high-level thinking at the same time! Unauthorized use of these marks is strictly prohibited. model to fit the context of general practice. Critical thinking and analysis: a model for written assignments The purpose of this article is to propose a model for critical analysis which can be incorporated into nurse education to enhance nurses' understanding of the concepts and to assist students in undertaking academic assignments. 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