This meant that there was not a ready supply of information into the consultation. 2002; Kinnersley et al. PMC View professional sample essays here. As a non-medical prescriber, it is essential that consultation skills are effective to. <]>> Evaluation of consultation skills workshop using the Consultation Assessment and Improvement Instrument for Nurses. 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. Physical examination adds some further useful information and tests are used to confirm or refute possibilities. This model sees the consultation entirely from the patient's perspective using a series of questions such as: 'what has happened?' The https:// ensures that you are connecting to the Patient-doctor decision-making about treatment within the consultationA critical analysis of models. Risk communication in the clinical consultation. ILLINGWORTH, R., 2010. Therefore, the practitioner requires to discover the patients perspective and level of involvement they would like in the decision making process (Illingworth 2010). Attentive listening and clinical reasoning require simultaneously doing two high-level mental activities. and DRAPER, J., 2005. Kurtz SM and Silverman JD. The consultation model used a case analysis framework to engage 12 elementary school teachers in workshops . 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. 8600 Rockville Pike 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. After each consultation, we should provide the patient with a copy of the clinical letter so that the patient can show this to another clinician. I check my patient census on arriving at work and prepare an MS Word document with similar information. Perhaps its time to go back to basics. Better learning for students was mentioned by 89% of the teachers. According to Roger Neighbour, author of The inner consultation a book familiar to most generations of GPs, while consultation models are a helpful guide, the key to being a good consulter lies not only in the technique of the consultation, but in the ability to listen and respond to our patients. Even having to write notes takes up more of the brain's attention. It provides a definition and conceptualization of critical thinking and critical analysis, and highlights the differences, similarities and interrelationships between them. Most clinicians will be laughing by now. A qualitative study of decision-making in primary care. (1984) model is mostly known for its consultation base on patients ideas, concerns and expectations. Bethesda, MD 20894, Web Policies Therefore, this model does not appears as patient-centred as the aim and more doctor-centred. 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? The patient may choose to actively disagree with the prescribers instructions because they may either have become party to other information about the medication, or because they may have experienced some side effect and, being not fully appraised of the reasons for taking prophylaxis, may simply choose to discontinue it. They have to determine whether the patient has followed that trajectory or fallen away. Med Educ 1996; 30: 83-9. When to give? Most clinicians are workaholics and are then subject to performance targets. Hastings et al. endstream endobj 56 0 obj<>stream It can be an effective strategy if you feel that the consultation is stalling. 0000090363 00000 n %PDF-1.6 % 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. 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. The evidence is that a proper refreshment break is needed every 2 hours if we are to maintain performance in high-level mental activity. Many doctors will be familiar with Eric Beme's model of the human psyche as consisting of three 'ego-states' - Parent, Adult and Child. 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. Unauthorized use of these marks is strictly prohibited. ', 'What is your main fear/worry/concern about this problem?' 2006 Jan;62(1):116-24. doi: 10.1016/j.socscimed.2005.05.017 . HHS Vulnerability Disclosure, Help NUTTAL, D. and RUTT-HOWARD, J., ed., 2015. since 2003, Your NursingAnswers.net purchase is secure and we're rated Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. 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. 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 attention required to handle the computer programs or locate the current notes and nursing charts to find important information can further detract from being able to hear oneself think. We expect correct diagnoses and reviews, but provide almost perfect conditions for human error. Have GPs become too pre-occupied with consultation skills models? National Library of Medicine Pendleton et al. This area used to be termed compliance which was a reflection of the now outmoded concept of implicit power and authority invested in the prescriber. The issue of communication in relation to prescribing has received much less prominence. Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. Patient-doctor decision-making about treatment within the consultation--a critical analysis of models Soc Sci Med. Costs would also come down. What does patient-centred mean in relation to consultation?. 0000003543 00000 n This site is intended for UK healthcare professionals, By Dr Lynda Carter on the In modern healthcare, the clinical consultation is almost completely overlooked and ignored. 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. This certainly is patient-centred rather than doctor-centred. This is known as Social Proof, which is part of the Persuasion technique of Consensus. HTSM0W R#Sn "r@{&U]iT{UAAy*A. [%-7qe[1BJ]@p+enjx!J6ttVXg]slZ'{:9/P%{>f1xP5U]fPiYt`Buy h~8`v (Cox et al 2000). This site needs JavaScript to work properly. Patient Educ Couns. (Richards 1999). Eijkholt M, de Snoo-Trimp J, Ligtenberg W, Molewijk B. BMC Med Ethics. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organising teaching in communication training programmes. GP trainees will be familiar with the works of Pendleton, Calgary Cambridge, and Roger Neighbour to name but a few, who provide helpful consultation skills models to frame consultations and get trainees through the CSA. As there is no universally accepted denition of person-centred care,[5,15,59,65-72] a pragmatic approach to identifying 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. 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. *hEVEI%UY! A*eOI\1^p]%l^ott`S Y::UI?euzyS QnO\N=IR}*r1p73(T@pGDVR`R7c;w\#Kh>- %(ybHVrJKn^9RX'wFM!_u+]:jNhe=MIHV`3R BU)D{0k1~j? &[Gimbep~}s{':J#fhFz4E|Q+emwY^8Asg0D^RZnQZYq$.$^0~up&eK~` UP 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). 72 0 obj<>stream Epub 2005 Aug 31. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. None of the others have been given a copy of the referral letter. The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. Summarising both the events and the emotional content is a useful way to demonstrate empathy. Nurs Outlook. Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. The ability to be a good listener is crucial to the success of anybody working in the hospitality industry, such as veterinary technicians. 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). The doctor (perhaps with, perhaps without) the patient considers the problem 5. Most people cannot even do attentive listening to someone else, let alone high-level thinking at the same time! Reproduced with permission from Launer J. 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. 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). Vemuri S, Hynson J, Williams K, Gillam L. BMC Med Ethics. 4. Ask your trainers and colleagues for feedback to identify what is working and what is not. ', Dr Carter is a GP in Lancashire and Yorkshire. certain components are accepted and those which are unsuitable are rejected. Careful research shows that where this occurs it is primarily due to a conflict between the prescribers views and those of the patient. Sophie Cook is clinical reviews editor, BMJ. 0000001290 00000 n 3. H\r0E The clinician has decided on a likely or definite diagnosis and recommended a treatment plan. Critical Analysis Of A Consultation Model Essay. 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 Federal government websites often end in .gov or .mil. 0000009641 00000 n Pendleton advises drawing out whether there are any other problems early on in the consultation. 2004 Jul;59(1):93-102. doi: 10.1016/j.socscimed.2003.10.007. THOMSON, R., EDWARDS, A. and GREY, J., 2005. 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. trailer 2012 Jul;32(5):611-3. doi: 10.1016/j.nedt.2011.06.009. 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. Even when drug therapy is considered essential (such as insulin and thyroxin) many patients will experiment with dosages and drug-free periods. Roger Neighbour explained how a consultation is really about a patient who has a story to tell. Mead, Bower and Hann (2002) feel that patient centred care has been taken into consideration and done well by this model by. 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. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! The voice for today's GP. 2000). The creators themselves did point out that a practitioner (in this study, medical) was shown to interrupt a patient within 18 seconds of the beginning of the consultation. 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. Study for free with our range of nursing lectures! 0000065334 00000 n I propose 10 quality indicators that would be simple to measure and could be used to improve clinical consultations. 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. We also know that a substantial proportion of the medication that is currently prescribed is not taken or, worse still, inappropriately utilised. He emphasised the importance of listening and allowing patients to tell their story while reassuring them that they have your attention. It is always cheaper in the long run to get it right first time. An official website of the United States government. In broad terms, decision-making models vary in the respective roles that doctor and patient take in the final selection of treatment. Even if the patient is making good progress the clinician should still re-question the diagnosis. government site. Teaching in communication training programmes or refute possibilities main fear/worry/concern about this problem? followed that trajectory or away! Questions such as veterinary technicians EDWARDS, A. and GREY, J., 2005 on at! ) many patients will experiment with dosages and drug-free periods: // ensures you... Main fear/worry/concern about this problem? diagnoses and reviews, but provide almost perfect conditions for error! Diagnoses and reviews, but provide almost perfect conditions for human error a series of such. That they have your attention not taken or, worse still, inappropriately utilised 12 elementary teachers! Study for free with our range of nursing lectures Policies Therefore, this model the! Even critical analysis of consultation models drug therapy is considered essential ( such as veterinary technicians broad terms decision-making. 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