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. Asking the following easy to answer questions gets the patient talking. These ongoing stresses for busy GPs present potential obstacles to the doctor patient relationship. Byrne and Long (1976) model is an example of a descriptive model. Clock is ticking and inspiration doesn't come? It can be an effective strategy if you feel that the consultation is stalling. 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. I have also seen clinics where patients were put into gowns and placed on examination couches before the clinician even said Hello. Many of the ideas and phrases you have picked up in your GP training - 'the golden minute'; 'ideas, concerns and expectations'; 'shared decision-making . Attentive listening and clinical reasoning require simultaneously doing two high-level mental activities. Patients priorities must be our priority. The clinician should be aware of the whole workload for the session. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. Epub 2010 Jul 23. Nurse Educ. Most clinicians will be laughing by now. 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. In my experience, the patient then divulges a fuller, richer history of presenting complaint because the patient is confident the clinician is interested and trustworthy. Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. . Bethesda, MD 20894, Web Policies Concordance with medication and consultations with pharmacists . A case of antisynthetase syndrome presenting solely with life-threatening interstitial lung disease, Pulmonary CT imaging findings in fat embolism syndrome: case series and literature review, Acute quadriplegia and epileptic seizures in a 47-year-old man, Ten quality indicators for clinical consultations. Some of the literature that compares nurse and GP consultations is also looked at, as is the concept of diagnosis by nurses. Accessibility 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. On searching the literature, many models of consultation were found. Unable to load your collection due to an error, Unable to load your delegates due to an error. . If another patient is slipped into the clinic, I would then spend several minutes reading the notes (charts) before calling the patient in. 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. Would you like to have an original essay? Therefore, this model does not appears as patient-centred as the aim and more doctor-centred. 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. Study for free with our range of nursing lectures! 2005 Mar-Apr;53(2):59-65. doi: 10.1016/j.outlook.2004.11.005. The Inner Consultation suggests summarising throughout the consultation to clarify that your understanding of the problem is the same as the patient's. 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. A framework guiding critical thinking through reflective journal documentation: a Middle Eastern experience. This meant that there was not a ready supply of information into the consultation. How nurse prescribers influence the role of nursing. 0000001531 00000 n Author links open overlay panel Veronika Wirtz a, Alan Cribb b, Nick Barber a. Consultation models are also a great way to help prepare for the clinical skills assessment (CSA). The clinician will have an expected trajectory of progress in their mind. 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. Copyright 2003 - 2023 - NursingAnswers.net is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. Many doctors will be familiar with Eric Beme's model of the human psyche as consisting of three 'ego-states' - Parent, Adult and Child. 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. This is a combination of external and internal factors. Roger Neighbour delivered a thought provoking keynote speech at the RCGP annual conference yesterday, which kicked off with a pre-conference session for associates in training (AITs) and GPs in their first five years post qualification (First 5s). We also know that a substantial proportion of the medication that is currently prescribed is not taken or, worse still, inappropriately utilised. 0000090363 00000 n Cooper, Forrest and Cramp (2006) show that a patient decides in the first 90 seconds if he/she likes or trust you, therefore it is vital to establish a connection within this time period. The various consultation skills were critically analysed and broken down into 14 different categories of misunderstanding. Sophie Cook is clinical reviews editor, BMJ. . 0000003509 00000 n Most students having concrete experience in cooking were able to accommodate the new learning, and developing their metacognition as explained by Haley (2020). *You can also browse our support articles here >. 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. I believe the patient should have a copy of the referral letter and should be actively encouraged to provide information useful for the consultation. Kurtz SM and Silverman JD. 2008 Feb 27;8:77. doi: 10.1186/1471-2458-8-77. endstream endobj 57 0 obj<>stream Its a tall order. 8600 Rockville Pike 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. As the clinician listens to and examines the patient, their brain is full of clinical reasoning, which is high-level thinking around possible diagnoses. Background The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. No plagiarism guarantee. Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. Pendletons consultation model: assessing a patient. 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. 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. Careful research shows that where this occurs it is primarily due to a conflict between the prescribers views and those of the patient. Venning (et al 2000) compared efficiency and cost of a cohort of nurse prescribers with doctors in the same geographical area. 2000). 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. Consultation models have historically been researched from a GP's perspective (Baird, 2004). 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. Disclaimer. This seven task patient-centred model consists of defining the patient's true agenda, considering other problems, choosing an appropriate action for each problem, achieving a shared understanding, using time and resources appropriately and establishing and maintaining a relationship with the patient. 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. It was very significant that the authors concluded that many of the errors were associated with assumptions or guesses on the part of the healthcare professional, and in particular a lack of awareness of the relevance of patients ideas and beliefs which influenced their compliance with the prescribed treatment. The reports did not make any comment upon the cost-effectiveness of the prescribing as the cohort studied was too small for statistical analysis. It can be condensed into a six-stage process: 1. CONSULTATION MODELS Consultation models are established lists of questions or areas to be explored, and provide a framework for a consultation. J Pain Symptom Manage. Take the best out of the existing models and incorporate into your own model. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. 8600 Rockville Pike The clinician is doing two high-level mental activities simultaneously: attentive listening and clinical reasoning. The NHS is meant to be National but in Scotland, I cannot access any clinical information about a patient from England, Wales or Northern Ireland and the danger in patient care is palpable. (Britten et al 2003). ,Hlf]#! 2002; Kinnersley et al. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. As there is no universally accepted denition of person-centred care,[5,15,59,65-72] a pragmatic approach to identifying If the clinician feels hurried, they are distracted at a time when attentive listening and clinical reasoning are essential.

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