0000090363 00000 n Consultation models are not rules; they are learning aids to help you develop your own consultation skills. I believe that better clinicians seek information prior to and during the consultation. I do much the same for rounds. Game theorya theory based on assumptions of rational choice and focusing on interactive decision makinghas the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. Neighbour (1989) check point of consultation emphasises the need to be on the same wavelength as the patient and Me first (2017)communication tool does this effectively as it is specifically designed as a child orientated tool. and DRAPER, J., 1996. 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. The. The clinical consultation is a serious piece of work; the clinician should be calm, unhurried and mentally prepared for serious work. Would you like to have an original essay? Yet the processes of clinical consultations on ward rounds and outpatients have attracted little attention in terms of ergonomics or research. To qualify as a GP in the UK nowadays, trainees must demonstrate not only sound medical knowledge, but also appropriate communication skills. 0000003927 00000 n A qualitative study of decision-making in primary care. Essay, My Experience in Excite and Execute Dynamic Groups Essay. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. However, another important person is often discouraged from participating in consultations on ward rounds. On the wards, vacuum cleaners are running, phones are ringing, pagers are bleeping, monitoring equipment is alarming, trolleys trundle and rattle by, staff and relatives are talking at the top of their voices to be heard over the background noise, bed managers, infection control nurses etc all charge into the wards and interrupt. The Inner Consultation suggests summarising throughout the consultation to clarify that your understanding of the problem is the same as the patient's. (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. Summarising is a useful tool to clarify your understanding of the problem. government site. Keep in mind that discussion is a critical part of the classroom experience in graduate school, but discussion that is demeaning of others and . Questions to try include: 'Was there anything else you were hoping to discuss today? FOIA I check my patient census on arriving at work and prepare an MS Word document with similar information. xref 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. 2000). official website and that any information you provide is encrypted (Elwyn et al. 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. KURTZ, S.M., SILVERMAN, J.D. 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. 0000024314 00000 n NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. Even when drug therapy is considered essential (such as insulin and thyroxin) many patients will experiment with dosages and drug-free periods. 0000006866 00000 n 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. Disclaimer: This essay has been written by a student and not our expert nursing writers. Methods This retrospective before-after study included patients admitted to the medical ICU. Critical Analysis Of A Consultation Model Essay. Time to assume that health research is fraudulent, We jumped from planes without parachutes (and lived, Comparative twin study: Access to healthcare, Suchita Shah: HIV and health in the Navajo Nation: why historical trauma matters, Richard Lehman's weekly review of medical journals. 2001). official website and that any information you provide is encrypted If we examine this argument further, any healthcare professional will appreciate that a great deal of modern medical treatment involves prescribing in one form or another. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. Asking the following easy to answer questions gets the patient talking. 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. How nurse prescribers influence the role of nursing. )R%K ;)4~K7c+`W Ht 1[ 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 qualitative study. and 'What were you hoping to get out of today?'. 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. This model introduced the concept of eliciting the patient's ideas, concerns and expectations. For review-of-progress consultations, I believe there is far more that we should do to help patients prepare for consultations. 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. 2002; Kinnersley et al. Show more. The success of this venture would strongly argue that it will progress further still in the future. This essay has been submitted by a student. Sophie Cook is clinical reviews editor, BMJ. BMJ Opinion provides comment and opinion written by The BMJ's international community of readers, authors, and editors. We're here to answer any questions you have about our services. Nurse Educ. consultation, highlight best practices in report writing, discuss visual representation of data within reports, and we identify the critical elements of reporting through an analysis of a sample behavioral consultation report. The section on explanation and planning is particularly helpful for looking at shared understanding and shared decision making. (Welschen et al 2004), These various aspects are explored further in a particularly well written and informative book by Platt and Gordon (1999) it reflects on the fact that doctors and nurses are not generally particularly well trained in the art of communication skills. 0000003991 00000 n The doctor tries to elucidate the reasons for the patient having attended the surgery 3. endstream endobj 56 0 obj<>stream 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. 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. HHS Vulnerability Disclosure, Help The clinical consultation is when the diagnosis is made correctly or incorrectly. 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. Subgroup analysis reported a larger effect size in patients with somatoform disorder (WMD 0.614, . Most people cannot even do attentive listening to someone else, let alone high-level thinking at the same time! 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). No plagiarism, guaranteed! However, if one part of the phase is not completed or fails then the consultation in unlikely to be complete and could lead to the wrong diagnosis or treatment (Courtenay and Griffiths 2010). A framework guiding critical thinking through reflective journal documentation: a Middle Eastern experience. Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. Even having to write notes takes up more of the brain's attention. %%EOF 2012 Jul;32(5):611-3. doi: 10.1016/j.nedt.2011.06.009. 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. doi: 10.1016/j.jpainsymman.2019.04.014. (Elder et al 2004). Unauthorized use of these marks is strictly prohibited. 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. In short, all of the failures of communication were associated with a lack of the patients participation in the consultation process. Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting. 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. Kurtz SM and Silverman JD. 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 can then anticipate the consultation and appear well briefed to the patient. Teaching consultation skills: a survey of general practice trainers. Patient-doctor decision-making about treatment within the consultation--a critical analysis of models Soc Sci Med. There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. 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. An official website of the United States government. 2001; Courtenay and Griffiths 2010). The https:// ensures that you are connecting to the 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. Pendleton et al. 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. The more you practice, the more your model will become automatic so you can concentrate on what the patient is saying. I believe this is crucial to correct diagnosis. Another person is almost essential if the patient is suffering from dementia or delirium. Before 2005 Mar-Apr;53(2):59-65. doi: 10.1016/j.outlook.2004.11.005. If the patient has fallen away from the expected trajectory then the diagnosis must be reviewed as well as determining whether the treatment plan has been executed. 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). ) e'xix|>| Sprague (2005) identifies that consultation models should be straightforward, practical and. Risk communication in the clinical consultation. Consultation models have historically been researched from a GP's perspective (Baird, 2004). 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? 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? A Critical Review Joe Cautilli, St. Joseph's University & Children's Crisis Treatment Center, . Careful research shows that where this occurs it is primarily due to a conflict between the prescribers views and those of the patient. (1984), patient-centred care and joint decision making is incorporated into consultation. Most clinicians will be laughing by now. 2003 Feb;56(3):589-602. doi: 10.1016/s0277-9536(02)00056-4. 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. Register FREE Many doctors will be familiar with Eric Beme's model of the human psyche as consisting of three 'ego-states' - Parent, Adult and Child. 0000010190 00000 n Accessibility Anthropometric data, admission reason, Acute Physiology . (Cox et al 2000). 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. NUTTAL, D. and RUTT-HOWARD, J., ed., 2015. The way that prescribers will often duck issues where they feel uncomfortable or feel that their knowledge is not particularly sound, or perhaps fail to respond to the distress signals sent out (either verbally or non-verbally) by the patient. 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. There is a lot of debate in healthcare about whether we should measure process or outcome. The 10 quality indicators for clinical consultation. Nurse Educ Today. 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? To a conflict between the prescribers views and those of the patient where this occurs it is due. Deconstruction of patient self-determination in the future high-level clinical reasoning ( Elwyn al! 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