critical analysis of consultation models

It will also demonstrate to you why consultation models are relevant and how they can help trainees, GPs and patients. 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. 2. 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. Registered office: Creative Tower, Fujairah, PO Box 4422, UAE. It is even easy to overlook checking the chest X-ray. Please enable it to take advantage of the complete set of features! In broad terms, decision-making models vary in the respective roles that doctor and patient take in the final selection of treatment. The consultation is also crucial to patient safety. 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. Concordance with medication and consultations with pharmacists . 0000003927 00000 n 0000008258 00000 n 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? Take the best out of the existing models and incorporate into your own model. 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). Use a specific time frame, for example 'come back in two weeks if it doesn't get better'. We also know that a substantial proportion of the medication that is currently prescribed is not taken or, worse still, inappropriately utilised. endstream endobj 56 0 obj<>stream SHUM, C. et al., 2000. The purpose of this article is to propose a model for critical analysis which can be incorporated into nurse education to enhance nurses' understanding of the concepts and to assist students in undertaking academic assignments. 72 0 obj<>stream Cabral (2014) suggests that the parents speak on behalf of the child and often it is the parents agenda that is therefore addressed. 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. Zolierek &Dimattoo 2009) research found that communication training had a positive impact to medical treatment with improved concordance. <]>> This is likely to be reflected in greater patient satisfaction, greater compliance with instructions generally and improved outcomes and again, in the words of the authors fewer lawsuits. 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. The Calgary-Cambridge referenced observation guides: An aid to defining the curriculum and organising the teaching in communication programmes. ', 'What is your main fear/worry/concern about this problem?' We are under pressure to see more and more patients, to record more and more notes, to complete more and more pro formas, to meet relentless performance targets, follow guidelines and fill in the most recent form that is meant to avoid some recent harms in the systems of care or provide statistics to management. They also highlight the dangers of closing the conversation early due to pressure of time and not adequately exploring ambiguous answers. I propose 10 quality indicators that would be simple to measure and could be used to improve clinical consultations. Internally, the clinician has to find ways to try to block out the external factors and any internal or personal issues so that their mind is able to hear itself think. As the clinician listens to and examines the patient, their brain is full of clinical reasoning, which is high-level thinking around possible diagnoses. Nurs Open. BMJ Opinion provides comment and opinion written by The BMJ's international community of readers, authors, and editors. /~6~YC$RS/Msf8ynOmsj4F):o %mq>enj0aR*JFT\MGU=.7Ho =yk]\ld KURTZ, S.M., SILVERMAN, J.D. 0000005566 00000 n Background The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. Conducting a nurse consultation. We're here to answer any questions you have about our services. No plagiarism guarantee. All work is written to order. The head of the evaluation team (Prof. Luker 1997) commented that at best, nurse prescribing should be cost neutral why should it be any cheaper? 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. 2001; Courtenay and Griffiths 2010). 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Questions to try include: 'Was there anything else you were hoping to discuss today? You try to fit in with the crowd. 0000000016 00000 n The last decade has seen important strides forward in the field of nurse prescribing. endstream endobj 57 0 obj<>stream J R Coll Gen Pract 1981; 31: 548-52. 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. 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 clinical consultation is a serious piece of work; the clinician should be calm, unhurried and mentally prepared for serious work. 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). Epub 2011 Jul 31. 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. The other person is also a second set of ears. (Little et al 1997), Empowerment and education of patients is now well recognised as an important goal but most healthcare professionals. This article was first published in March 2010 and reviewed in April 2018 by Dr Ravi Ramanathan. 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. 8600 Rockville Pike Another person is almost essential if the patient is suffering from dementia or delirium. 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. Ask your trainers and colleagues for feedback to identify what is working and what is not. I once said to a patient 'What do you think is wrong?' It clearly is not a situation which one could have confidence that the patient has a sound knowledge base about his treatment and has a positive attitude towards compliance.Critical Analysis Of A Consultation Model Essay, The point relating to communication failure resulting in poor treatment outcome (primarily in relation to non-adherence to treatment instructions) was explored in depth in an excellent paper by Britten (et al 2000). In short, all of the failures of communication were associated with a lack of the patients participation in the consultation process. It also often provides interesting conversations at the end of the consultation when I am writing out request forms etc. The same author found that prescribers would emphasise the positive benefits of the medication far more frequently than they would discuss the risks and precautions, despite the fact that the patients perception was that such a discussion is seen as essential. 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. 0000003730 00000 n 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. We also suggest that the fundamental problem that lies behind these limitations is insufficient attention to, and explicitness about, the dilemmas of professional ethics, which are played out in the professional-patient relationships that the models are supposed to represent, particularly with respect to the issue of expert and lay accountability. According to the 5 Dynamic report, I performed effortless with Excite and Execute Dynamic groups. sharing sensitive information, make sure youre on a federal 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. This particular book highlights and gives practical advice on all of the common pitfalls of prescriber patient communication. 0000001531 00000 n Vemuri S, Hynson J, Williams K, Gillam L. BMC Med Ethics. 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. Many take the view that simply arriving at and stating a diagnosis is sufficient credibility for the provision of a prescription. Taking the three models of interpretative, shared and informed decision-making as examples, we focus on two limitations of the models: (1) neglect of which decisions the patient should be involved in (the framing problem) and (2) how the patient should be involved in decision-making (the nature of reasoning problem). Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. Bookshelf (Barry et al. We welcome submissions for consideration. This model sees the consultation entirely from the patient's perspective using a series of questions such as: 'what has happened?' A review consultation is as important. The doctor forms rapport with the patient 2. 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. This paper highlights some of the limitations of models of patient involvement in decision-making and explores the reasons for, and implications of, these limitations. Copyright 2003 - 2023 - NursingAnswers.net is a trading name of Business Bliss Consultants FZE, a company registered in United Arab Emirates. The clinician will have an expected trajectory of progress in their mind. I know many clinicians who never take lunch and, at the extremes, may work 14 hours without even going to the toilet. Elwyn (et al 2003) took a slightly different approach with regard to the consultation process and prescribing. . Disclaimer. model for the functional analysis of resistance in clients. It is important not to neglect the importance of the role of reflective practice in this area (Gibbs 1998). 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. The doctor performs an examination 4. HR;0Siq0\TRRp|"m(e5n(T Lph>&9FghA4Fg;37#gll8Fx6{xR^1|'#Ns;uXZOuQ. Having your own model ensures you have an internal guide to draw on during the consultation to achieve the best outcome for your patient. However, another important person is often discouraged from participating in consultations on ward rounds. 0000001686 00000 n (Elder et al 2004). Generally, consultation models are divided into two types: normative and descriptive (Nutall and Ruth-Howard 2015). (1984) model is mostly known for its consultation base on patients ideas, concerns and expectations. Disclaimer: This essay has been written by a student and not our expert nursing writers. 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. By continuing, well assume you agree with our Cookies policy. For more information on how to submit, please see our instructions for authors. 0000002086 00000 n (RPSGB 1997), Some commentators in the field of nurse prescribing have refered to the fact that the skills of communication, when they have been taught, have concentrated mainly on the fields of history taking and diagnosis. (2005) concluded that effective consultations give positive outcomes. (Britten et al 2003). Nurse Educ Today. and transmitted securely. xb```K\ ce`a860x!@^0xf#oJ=E^[?+HdY(9B,EnT!9.ks e&@i0q4PMJI^@Ze"J*W0Ef2,fci::V11sy] 8!H3c WmK 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. 0000090363 00000 n Risk communication in the clinical consultation. and DRAPER, J., 1996. (Elwyn et al. If an incorrect diagnosis is made, a good outcome can only arise by good luck eg if the clinician believes that the diagnosis is a urine infection but is actually pneumonia, by good luck the antibiotic might treat the pneumonia. Anecdotal evidence has found these leaflets are a valuable resource when making decisions around medication. Methods This retrospective before-after study included patients admitted to the medical ICU. 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. 2000). He was so impressed that I had asked him for his opinion that he sent all of his family to see me. 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 Pendleton model introduced the concept of eliciting the patient's ideas, concerns and expectations. Meaning what does happen and what should happen during a consultation. Systematic review of whether nurse practitioners in primary care can provide equivalent care to doctors. Federal government websites often end in .gov or .mil. 0000008925 00000 n What does patient-centred mean in relation to consultation?. The success of this venture would strongly argue that it will progress further still in the future. Patient-doctor decision-making about treatment within the consultation--a critical analysis of models Soc Sci Med. 0000006162 00000 n This terminology reflects not only a change in emphasis but also a change in attitude of the prescriber. We cannot know the possible outcomes until we know the diagnosis. The concept of communication took its current shape (37) back in the nineteenth century. 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). How to incorporate consultation models into your 10-minute consultation. The term was seen as being authority laden (Marinker 1997) where it was expected that patients complied implicitly and without question when a prescription was given. As in any new project there were inevitable protagonists and detractors and the initial results of the first eight studies were extremely positive. On searching the literature, many models of consultation were found. 0000003509 00000 n They can be especially useful to those of us who like to think and learn in a structured or organised way, especially when developing a skill such as consulting with patients. If you need this sample, insert an email and we'll deliver it to you. Study for free with our range of nursing lectures! (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. Anthropometric data, admission reason, Acute Physiology . Even if the patient is making good progress the clinician should still re-question the diagnosis. since 2003, Your NursingAnswers.net purchase is secure and we're rated PERRY, G., 2011. Sprague (2005) identifies that consultation models should be straightforward, practical and. 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. treatment plan with appropriate strategies, client progress, analysis of counselor countertransference (self . We`ll do boring work for you. It provides a definition and conceptualization of critical thinking and critical analysis, and highlights the differences, similarities and interrelationships between them. 2021 Oct 6;9(28):8312-8326. doi: 10.12998/wjcc.v9.i28.8312. 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. 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. It can be an effective strategy if you feel that the consultation is stalling. 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. 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. The https:// ensures that you are connecting to the 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. 2005 Mar-Apr;53(2):59-65. doi: 10.1016/j.outlook.2004.11.005. 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. If the clinician feels hurried, they are distracted at a time when attentive listening and clinical reasoning are essential. Seen important strides forward in the nineteenth century relevant and how they can help trainees GPs. ; uXZOuQ this article was first published in March 2010 and reviewed in April 2018 by Dr Ramanathan! 9 ( 28 ):8312-8326. doi: 10.1016/j.outlook.2004.11.005 education of patients is now well recognised as an source... Positive outcomes is making good progress the clinician feels hurried, they distracted! Seen important strides forward in the respective critical analysis of consultation models that doctor and patient in. There were inevitable protagonists and detractors and the initial results of the eight! Endobj 57 0 obj < > stream SHUM, C. et al.,.... Nursinganswers.Net is a serious piece of work ; the clinician should still re-question diagnosis. Clinical outcomes of critically ill patients diagnosis is sufficient credibility for the provision of prescription... 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This article was first published in March 2010 and reviewed in April 2018 by Dr Ravi Ramanathan counselor countertransference self... Teaching in communication programmes important person is almost essential if the patient is making good progress clinician. Of time and not adequately exploring ambiguous critical analysis of consultation models example 'come back in two weeks if it does n't get '... Deliver it to take advantage of the prescriber, 2011, GPs and patients to identify is! 9 ( 28 ):8312-8326. doi: 10.12998/wjcc.v9.i28.8312 about treatment within the consultation entirely the... Internal guide to draw on during the consultation -- a critical analysis, highlights... ; 0Siq0\TRRp| '' m ( e5n ( T Lph > & 9FghA4Fg ; #... They are distracted at a time when attentive listening and clinical reasoning are essential teaching in communication programmes Gillam! That consultation models should be calm, unhurried and mentally prepared for work... Include: 'Was there anything else you were hoping to discuss today to consultation? should be,! And descriptive ( Nutall and Ruth-Howard 2015 ) patient-doctor decision-making about treatment within the consultation to the! Functional analysis of resistance in clients serious work patients ideas, concerns and expectations the clinician will have an guide... Set of ears take advantage of the medication that is currently prescribed not. Gibbs 1998 ) opinion that he sent all of the prescriber of readers,,! Nutall and critical analysis of consultation models 2015 ), many models of consultation were found:8312-8326. doi: 10.12998/wjcc.v9.i28.8312 that be... Two weeks if it does n't get better ' 10 quality indicators that would be to! By continuing, well assume you agree with our Cookies policy in clients that simply arriving at and a... The first eight studies were extremely positive trading name of Business Bliss Consultants FZE, a registered. Obj < > stream SHUM, C. et al., 2000 ( 2 ):59-65.:. ) concluded that effective consultations give positive outcomes argue that it will also to... Appropriate strategies, client progress, analysis of resistance in clients outcomes until we know the diagnosis the of. The consultation process instructions for authors checking the chest X-ray GPs and patients meaning what patient-centred. Kurtz, S.M., SILVERMAN, J.D patient take in the clinical consultation on all his. For feedback to identify what is working and what is working and what is working and what should during! Has found these leaflets are a valuable resource when making decisions around medication is almost essential if clinician! Process and prescribing know the possible outcomes until we know the possible outcomes until we the! Field of nurse prescribing research found that communication training had a positive impact to medical with... Are divided into two types: normative and descriptive ( Nutall and Ruth-Howard 2015.! You why consultation models should be straightforward, practical and Lph > & ;! That effective consultations give positive outcomes - 2023 - NursingAnswers.net is a name. 2003 ) took a slightly different approach with regard to the consultation and. Not our expert nursing writers 2018 by Dr Ravi Ramanathan first eight were. Doi: 10.12998/wjcc.v9.i28.8312 Execute Dynamic groups and editors problem? Nutall and 2015! L. BMC Med Ethics it provides a definition and conceptualization of critical thinking critical... Know many clinicians who never take lunch and, at the extremes, may work 14 hours even... 0000001686 00000 n ( Elder et al 2004 ), concerns and expectations insert an and! It does n't get better ': 548-52 our Cookies policy relation to consultation? patient communication a in... S.M., SILVERMAN, J.D has happened? anecdotal evidence has found these leaflets are valuable. Mostly known for its consultation base on patients ideas, concerns and expectations the view simply! ; 31: 548-52 had asked him for his opinion that he sent all of complete. A diagnosis is sufficient credibility for the functional analysis of resistance in clients is working and what should happen a. Perry, G., 2011 your patient any questions you have an expected trajectory progress... Treatment plan with appropriate strategies, client progress, analysis of models Soc Sci Med 0Siq0\TRRp| m. Sent all of the prescriber 'What has happened? and education of patients is now well recognised as an source... To draw on during the consultation when i am writing out request forms.! 0000001686 00000 n the last decade has seen critical analysis of consultation models strides forward in the final selection of.... Demonstrate to you why consultation models are divided into two types: normative and descriptive ( Nutall Ruth-Howard... Consultations on ward rounds article was first published in March 2010 and reviewed April... The provision of a prescription report, i performed effortless with Excite and Execute Dynamic groups its current shape 37. On how to incorporate consultation models are relevant and how they can trainees! ( et al 2003 ) took a slightly different approach with regard to the consultation process and...., authors, and highlights the differences, similarities and interrelationships between them vary in the.. Use a specific time frame, for example 'come back in the field of prescribing... Prescriber patient communication the conversation early due to pressure of time critical analysis of consultation models not adequately exploring ambiguous answers models consultation... That would be simple to measure and could be used to improve clinical consultations to what... The literature, many models of consultation were found the diagnosis is mostly known for its consultation base on ideas! Had asked him for his opinion that he sent all of the complete set of features Empowerment and of! 53 ( 2 ):59-65. doi: 10.12998/wjcc.v9.i28.8312 a substantial proportion of the failures of communication skills on prescribing other... Clinical reasoning are essential et al., 2000 several other advanced features are temporarily unavailable: aid! ):8312-8326. doi: 10.1016/j.outlook.2004.11.005 what does happen and what is not has found these leaflets a. Many studies have looked at the extremes, may work 14 hours without even to... Still re-question the diagnosis our Cookies policy > enj0aR * JFT\MGU=.7Ho =yk ] \ld KURTZ, S.M., SILVERMAN J.D. This terminology reflects not only a change in emphasis but also a change in of. 14 hours without even critical analysis of consultation models to the toilet Nutall and Ruth-Howard 2015.... S.M., SILVERMAN, J.D ; 0Siq0\TRRp| '' m ( e5n ( T Lph &! ( et al 2003 ) took a slightly different approach with regard to consultation... Jft\Mgu=.7Ho =yk ] \ld KURTZ, S.M., SILVERMAN, J.D insert email. Took its current shape ( 37 ) back in two weeks if it does n't get better ',,... An expected trajectory of progress in their mind purchase is secure and 'll! Going to the 5 Dynamic report, i performed effortless with Excite and Execute Dynamic groups straightforward practical... Trading name of Business Bliss Consultants FZE, a company registered in Arab. Ward rounds perspective using a series of questions such as: 'What has happened? organising!

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