0000010190 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. The NHS Diabetes Prevention Programme has been linked to a 20% reduction in the risk Health and social care secretary Steve Barclay is under pressure to save a GP surgery Spiralling pressure on general practice is driving a rise in disputes within GP partnerships GP leaders have hailed a 'grim milestone' for general practice after the workforce More advice and information for GP trainees, Find more advice and information for GP trainees, Consultation skills - Control the length of the consultation, Consultation skills: Consulting with the bereaved patient, GP training: The BATHE model of communication, GP training: Writing a PDP in your e-portfolio, The audio clinical observation tool (COT) in GP training, GP consultation skills: The 10-minute consultation, NICE recommends eight digital therapies to treat anxiety and depression, NHS 'in full-blown crisis' as recovery plan falls short, MPs warn, NHS prevention programme linked to 20% reduction in risk of developing diabetes, Steve Barclay under pressure as constituents demand halt to GP practice closure, GP crisis driving rise in partnership and PCN disputes, 'Grim milestone' passed in steady decline of GP workforce. Please enable it to take advantage of the complete set of features! . ) High-level thinking usually requires a quiet controlled environment like a library or conference room; interruptions must be kept to a minimum, the brain must be refreshed by regular refreshment breaks and important information must be to hand. 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. The site is secure. Summarising both the events and the emotional content is a useful way to demonstrate empathy. NUTTAL, D. and RUTT-HOWARD, J., ed., 2015. The reports did not make any comment upon the cost-effectiveness of the prescribing as the cohort studied was too small for statistical analysis. However, an incorrect diagnosis usually results in delayed and prolonged care, iatrogenic harm or even an avoidable death. 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. 0000003100 00000 n The study cohort was over 1,300 patients. A thorough assessment and examination of the respiratory system will follow, together with a rationale for examination skills used and a critical analysis of the clinical findings. Home / Essay Samples / Life / Communication Skills. Counseling Strategies and Consultation Models CEP 863 Spring 2009 . 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. Collection. 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). The best pieces make a single topical point. Nurse Educ Today. As I get older and more experienced, I find myself writing less and less during the consultation, so my brain is free to listen, observe and think more. 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? 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. The medicine partnership ensures safety ansbetter health outcomes and helps reduce cost and wastage for the NHS. National Library of Medicine From the point of the patient this means the models differ according to the degree to which the patient is able to take part in, and shape, the choice of their treatment (see Fig. To see what works for you try adding in a different question each week. 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. Having your own model ensures you have an internal guide to draw on during the consultation to achieve the best outcome for your patient. When Roger Neighbour asked the young audience to raise their hands if they found general practice leisurely and contemplative, there was a notable absence of activity. The voice for today's GP. FOIA We cannot know the possible outcomes until we know the diagnosis. Please go to the home page and simply click on the edition that you wish to read. The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. Soc Sci Med. (Britten et al 2000). 0 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). 2000). In the best traditions of scientific endeavour, they were subject to a barrage of audits and studies to see how they actually performed. Costs would also come down. Accessibility The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Promotion of critical thinking by using case studies as teaching method. 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. by Dr Lynda Carter Sign in to continue Sign In Email address Password Stay signed in Trouble signing in? Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. It also means you have a range of different techniques to use in difficult consultations. Bookshelf On NHS wards, there is close to no confidentiality and dignity during consultations on ward rounds. In summary, this leaves a situation which is open to misinterpretation, uncertainty as a result of unadressed worries and for patients to be ambivalent towards the medication that they have been prescribed. Randomised control trial of nurse practitioner versus general practitioner care for patients requesting same day consultations in primary care. We've received widespread press coverage 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). The progressive acceptance of the paradigm of concordance (by all prescribers not just nurse prescribers) offers all healthcare professionals a mechanism to move towards ever safer and more successful prescribing. The issue of communication in relation to prescribing has received much less prominence. 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. Ward rounds are also subject to constant noise, interruptions and distractions. HR;0Siq0\TRRp|"m(e5n(T Lph>&9FghA4Fg;37#gll8Fx6{xR^1|'#Ns;uXZOuQ. Clinical consultations rarely feel like well-prepared business-like meetings. Choose your writer among 300 professionals! 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. The Pendleton model introduced the concept of eliciting the patient's ideas, concerns and expectations. Critically, they make the point that individual prescribers are not particularly good at varying their approach to the different type of patient.Critical Analysis Of A Consultation Model Essay, Clearly, the better the level of perceived empathy between prescriber and patient, the greater the level of compliance is likely to be. Preferences of patients for patient centred approach to consultation in primary care: observational study. Department Health (2003) advocate empowering patients to take more ownership of their health condition. <]>> Attentive listening and clinical reasoning require simultaneously doing two high-level mental activities. Another person is almost essential if the patient is suffering from dementia or delirium. 8600 Rockville Pike 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. EVANS, A. Eet al., 2001. Patient participation in Dutch ethics support: practice, ideals, challenges and recommendations-a national survey. 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. In short, all of the failures of communication were associated with a lack of the patients participation in the consultation process. 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. We need a lot of information readily available to make the correct diagnosis in the patient's context. Bethesda, MD 20894, Web Policies 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. ) e'xix|>| PMC I can then anticipate the consultation and appear well briefed to the patient. FOIA Consultation models are used in healthcare as a framework and guide for the practitioner when in contact with a patient, this can be at any point of contact through the patients journey (Harper and Ajao 2010; Nutall and Rutt-Howard 2015). The success of this venture would strongly argue that it will progress further still in the future. At the same time, we have to battle either with illegible paper notes (charts) or hugely inefficient software purporting to be electronic patient records. There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. This article will discuss some of the more common consultation models in use today and their relative advantages and disadvantages. The evidence is that a proper refreshment break is needed every 2 hours if we are to maintain performance in high-level mental activity. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. 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. (Cox et al 2000). (2005) concluded that effective consultations give positive outcomes. GPs now have their own agenda as well as the patients to fulfil, and all this must be achieved in 10 minutes. Venning (et al 2000) compared efficiency and cost of a cohort of nurse prescribers with doctors in the same geographical area. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! 0000008715 00000 n They have to determine whether the patient has followed that trajectory or fallen away. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. Consultation models are also a great way to help prepare for the clinical skills assessment (CSA). The https:// ensures that you are connecting to the Again, this reflects a failure of communication between patient and prescriber. . Do you have a 2:1 degree or higher in nursing or healthcare? The site is secure. 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. and DRAPER, J., 1996. This model uses six steps for structure, which unlike most, includes closing the consultation. 2. SHUM, C. et al., 2000. At any given moment each of us is in a state of mind when we think, feel, behave, react and have attitudes as if we were either a critical or caring Parent, a logical Adult, or a spontaneous or dependent Child. Sprague (2005) identifies that consultation models should be straightforward, practical and. Summarising the problem is also important and allowing the patient to hear your thoughts is helpful. 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. 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. 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. Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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! (Barry et al. . ) No plagiarism guarantee. PERRY, G., 2011. Meaning what does happen and what should happen during a consultation. 2001; Courtenay and Griffiths 2010). In this paper, a PC based computer mine ventilation consultation software model developed by the authors is introduced. Disclaimer. A Critical Review Joe Cautilli, St. Joseph's University & Children's Crisis Treatment Center, . Nurse Educ Today. the published studies. 2000 and Shum et al. 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. Listening and talking are essential activities of our everyday life. J R Coll Gen Pract 1981; 31: 548-52. Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting. This essay has been submitted by a student. 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. Although there will inevitably be a gap between models and practice--this much is in the nature of the models--we suggest that these two issues are substantially neglected by the models and yet are fundamental to understanding patient-doctor decision-making. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. The Clinical Skills Assessment (CSA) demands good communication skills. I know many clinicians who never take lunch and, at the extremes, may work 14 hours without even going to the toilet. National Library of Medicine 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. 2004 Jul;59(1):93-102. doi: 10.1016/j.socscimed.2003.10.007. 19 April 2018. It is even easy to overlook checking the chest X-ray. Patient-doctor decision-making about treatment within the consultationA critical analysis of models. Following a consultation model is a key element of consultations in clinical practice, Coffrey and Bowskill ( 2010)recognised that a diagnosis could be made on good quality history taking alone. 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. Yet the processes of clinical consultations on ward rounds and outpatients have attracted little attention in terms of ergonomics or research. since 2003, Your NursingAnswers.net purchase is secure and we're rated 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 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. 2021 Oct 6;9(28):8312-8326. doi: 10.12998/wjcc.v9.i28.8312. Consultation models in practice | GPonline GP Training Trending Red Flags A-Z COVID-19 GP Wellbeing GP Locums Consultation models in practice How to incorporate consultation models into your 10-minute consultation. Many of the ideas and phrases you have picked up in your GP training - 'the golden minute'; 'ideas, concerns and expectations'; 'shared decision-making . Physical examination adds some further useful information and tests are used to confirm or refute possibilities. If the diagnosis is incorrect, the treatment will be incorrect and recovery delayed or derailed completely. government site. Outpatient consultations are usually far better for confidentiality and dignity. The Consultation, Assessment and Improvement Structure for Nurses (CAIIN) is considered a useful tool which can be used for ongoing assessment and development of consultation skills in nursing practice (Hastings and Redsell, 2006). A competing behaviors model identifies the current performance level, as well as a desired . 0000006162 00000 n 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. Dignity is often fairly minimal with patients expected to accept physical examination in front of several strangers. 8600 Rockville Pike endstream endobj 56 0 obj<>stream 0000012859 00000 n Federal government websites often end in .gov or .mil. 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. 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). 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 my previous hospital, I had to have 10 software applications open for an outpatient (office) consultation and the paper notes too! KURTZ, S.M., SILVERMAN, J.D. 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 clinician is doing two high-level mental activities simultaneously: attentive listening and clinical reasoning. In addition, watching others consult allows you to pick up questions they use to elicit information. (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. Therefore, this model does not appears as patient-centred as the aim and more doctor-centred. (Little et al 1997), Empowerment and education of patients is now well recognised as an important goal but most healthcare professionals. 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). Decision-making approaches for children with life-limiting conditions: results from a qualitative phenomenological study. Clipboard, Search History, and several other advanced features are temporarily unavailable. The .gov means its official. Similarly, if their mind is not free for clinical reasoning again, they may well arrive at the incorrect diagnosis. Critical Analysis Of A Consultation Model Essay. MEAD, N., BOWER, P. and HANN, M., 2002. I have described how I prepare for the consultation; this fits with the often-given advice of Read the notes. J Pain Symptom Manage. model for the functional analysis of resistance in clients. 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. The patient must have confidence that their assessment has been thorough. One can presume that this is mainly because, in these conditions the patient tends to be asymptomatic and therefore the perceived need to take medication may well be less. Statements to demonstrate empathy include: 'I can see how sad/frustrated/angry/frightened/upset you are.'. endstream endobj 43 0 obj<> endobj 44 0 obj<> endobj 45 0 obj<>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>> endobj 46 0 obj<> endobj 47 0 obj<> endobj 48 0 obj<> endobj 49 0 obj<> endobj 50 0 obj[/ICCBased 65 0 R] endobj 51 0 obj<> endobj 52 0 obj<> endobj 53 0 obj<> endobj 54 0 obj<> endobj 55 0 obj<>stream (Haynes et al 2003). 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. It can be condensed into a six-stage process: 1. In 2017, I proposed 10 quality indicators for clinical consultation (Box 1).1 Some of these are not easy to measure, but we must learn to measure what we value not just value what is easy to measure. One of the six blueprint areas tested in the CSA is a person-centred approach using recognised communication techniques that enhance understanding of a patient's illness and promote a shared approach to managing problems. 0000003543 00000 n 2018 Jul 30;6(1):50-58. doi: 10.1002/nop2.180. Pendleton advises drawing out whether there are any other problems early on in the consultation. (Elwyn et al. Externally, everything should be done to provide an environment conducive to high-level thinking. Their clinical reasoning directs the closed questions and focused physical examination. It follows that if the clinician elicits a poor history or physical examination, they may well arrive at the incorrect diagnosis. 0000002086 00000 n He emphasised the importance of listening and allowing patients to tell their story while reassuring them that they have your attention. eCollection 2019 Jan. What are the ingredients for a successful evidence-based patient choice consultation? Patient-doctor decision-making about treatment within the consultation--a critical analysis of models Soc Sci Med. 0000004860 00000 n 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. Vemuri S, Hynson J, Williams K, Gillam L. BMC Med Ethics. When to give? During a new patient consultation the clinician is firstly trying to work out whether the patient is ill. Then the clinician is trying to answer What is the diagnosis? so that the appropriate investigations, treatment and review can be planned. The Consultation, Assessment and Improvement Structure for Nurses (CAIIN) is considered a useful tool which can be used for ongoing assessment and development of consultation skills in nursing practice (Hastings and Redsell, 2006). To give their account, the patient must speak. official website and that any information you provide is encrypted HHS Vulnerability Disclosure, Help The hostile and the heart-sink patient can be a particular headache to the prescriber and inappropriate decision can be made unless great care is taken to specifically tackle these issues. government site. 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. Disclaimer: This essay has been written by a student and not our expert nursing writers. 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. 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. All work is written to order. He was an absolute wonderful writer and had a great amount of patience with me as well as following all directions very accordingly. This means the patient does not know in advance what the consultation is about and cannot even prepare an account of their symptoms or concerns.