During the consultation we need access to information because we cannot hold it all in our brains: what was the pro-brain natriuretic peptide level, the creatinine and potassium level, what did electrocardiography and echocardiography show, should the dose of apixaban be reduced in renal impairment? Nurse Educ Today. Anthropometric data, admission reason, Acute Physiology . Med Educ 1996; 30: 83-9. 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. KINNERSLEY, P. et al., 2000. This site is intended for UK healthcare professionals, By Dr Lynda Carter on the Thomson et al. (Little et al 1997), Empowerment and education of patients is now well recognised as an important goal but most healthcare professionals. 0000003927 00000 n A study by Little et al. Again, there is so much emphasis on evidence-based treatment, but so little emphasis on the process to correct diagnosis. When I ask patients to tell medical students What makes for a good doctor? by far and away the commonest answer is A doctor who listens. A seemingly hurried clinician cannot appear to be listening. Duberstein PR, Kravitz RL, Fenton JJ, Xing G, Tancredi DJ, Hoerger M, Mohile SG, Norton SA, Prigerson HG, Epstein RM. A framework guiding critical thinking through reflective journal documentation: a Middle Eastern experience. Free resources to assist you with your nursing studies! Listening and talking are essential activities of our everyday life. 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 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. There was little acceptance that patients would actively participate in the decision making process that surrounded the generation of the prescription. 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. 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. COOPER, N., FORREST, K. and CRAMP, P., 2006. Yet the processes of clinical consultations on ward rounds and outpatients have attracted little attention in terms of ergonomics or research. 2021 Oct 6;9(28):8312-8326. doi: 10.12998/wjcc.v9.i28.8312. Department Health (2003) advocate empowering patients to take more ownership of their health condition. MUNSON, E. and Wilcox, A., 2007. Diseases versus illness in general practice. At my current hospital, we do not have any computers that work at the bedside; this means all the important information is yards away from the bedside consultation. 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. Discussion focuses on critical theoretical elements associated with. These battles can use up all of our brain's cognitive capacity, so that there is no brain power left for clinical reasoning. On searching the literature, many models of consultation were found. government site. 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). 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. 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). (1984) model would be appropriate for use in OOH as it is a useful way of building a relationship with the patient, involving them in care and decisions during the short time the practitioner will meet them. 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. Epub 2005 Aug 31. For use in OOH this would not be appropriate, having a very short period with the patient and most likely to have been the first time to consult with the patient, there needs to be a well established relationship during this short time and allowing the patient to speak and trust the practitioners diagnosis and plan. and DRAPER, J., 1996. PMC I am sure that I can discharge more patients from clinic after one attendance because I try to make the consultation unhurried. I prepare for clinic a week in advance by typing an MS Word document that contains known diagnoses, medications and recent results. Promotion of critical thinking by using case studies as teaching method. (Barry et al. 0000001686 00000 n I argue that the process of clinical consultation defines the possible outcomes. Bethesda, MD 20894, Web Policies This site needs JavaScript to work properly. The ongoing development of Advanced Practice (AP) not only in nursing but also in the role of paramedics, pharmacists and other allied health professionals has allowed for consultations to move away from a skill predominately carried out by and regarded as a medical practitioners role (Stenner 2010; Franklin 2017). Kurtz, Silverman and Draper (2005) highlights communication to show skill and certainty, as without these it is likely to put doubt into the patients confidence in the practitioner. Consultation models are clearly useful tools for practitioners to use during the patients journey. Is there a crisis in clinical consultations? 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. Revising a diagnosis is a major psychological effort and again the clinician's mind must be free for high-level clinical reasoning. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. that are consistent with key elements of positive psychology. HTSM0W R#Sn "r@{&U]iT{UAAy*A. [%-7qe[1BJ]@p+enjx!J6ttVXg]slZ'{:9/P%{>f1xP5U]fPiYt`Buy h~8`v 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. 2006 Aug;62(2):205-11. doi: 10.1016/j.pec.2005.07.003. Counseling Strategies and Consultation Models CEP 863 Spring 2009 . 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. We're here to answer any questions you have about our services. The 10 quality indicators for clinical consultation. (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. HHS Vulnerability Disclosure, Help 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. This terminology reflects not only a change in emphasis but also a change in attitude of the prescriber. EVANS, A. Eet al., 2001. 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. 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. As in any new project there were inevitable protagonists and detractors and the initial results of the first eight studies were extremely positive. Nurse Educ Today. References and further information 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. Published: 11th Feb 2020. Decision-making approaches for children with life-limiting conditions: results from a qualitative phenomenological study. Notes FAQ Contact Us. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organising teaching in communication training programmes. sharing sensitive information, make sure youre on a federal 2002; Kinnersley et al. This provides the first step for developing further research on the content of the model, i.e. Even having to write notes takes up more of the brain's attention. Clock is ticking and inspiration doesn't come? The doctor tries to elucidate the reasons for the patient having attended the surgery 3. The following summary includes the models that I believe are the most useful with a brief explanation, highlights and questions to use in consultations. 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. Even when invited to do so, patients seldom take the opportunity to ask questions. Careful research shows that where this occurs it is primarily due to a conflict between the prescribers views and those of the patient. If a consultation does become difficult you will have different strategies ready to get things back on track. All work is written to order. Subgroup analysis reported a larger effect size in patients with somatoform disorder (WMD 0.614, . An official website of the United States government. Kurtz SM and Silverman JD. Patient-doctor decision-making about treatment within the consultationA critical analysis of models. Another way to improve your consultation skills is to video your consultations and watch them. PMC 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. In short, all of the failures of communication were associated with a lack of the patients participation in the consultation process. Preferences of patients for patient centred approach to consultation in primary care: observational study. and transmitted securely. If we cannot ensure that clinicians brains are free for high-level clinical reasoning, we should not be surprised if patient outcomes and experiences are poor, bad or even fatal. As the clinician listens to and examines the patient, their brain is full of clinical reasoning, which is high-level thinking around possible diagnoses. Even if the patient is making good progress the clinician should still re-question the diagnosis. Disclaimer. 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. 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. No plagiarism, guaranteed! Bookshelf 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. This is a critical . LITTLE, P., et al., 2001. HR;0Siq0\TRRp|"m(e5n(T Lph>&9FghA4Fg;37#gll8Fx6{xR^1|'#Ns;uXZOuQ. The curtains are usually pulled around, but everyone in the bay can hear the consultation. Better consultations would reduce the possibility of misdiagnosis and also improve patient outcomes, patient experience, patient safety and staff satisfaction. They are well argued with new insights. 2000). 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. (Richards 1999) it follows that if patients are to be involved then their particular priorities must be ascertained and addressed, usually in the mechanism of the consultation. 0000010190 00000 n since 2003, Your NursingAnswers.net purchase is secure and we're rated Most people cannot even do attentive listening to someone else, let alone high-level thinking at the same time! Use a specific time frame, for example 'come back in two weeks if it doesn't get better'. 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. Must be free for high-level clinical reasoning actively participate in the bay hear. Because I try to make the consultation a Middle Eastern experience guiding critical thinking through reflective journal documentation: Middle! 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