Consultation Skills In Relation To Nurse Prescribing

Consultation Skills In Relation To defend PrescribingNurse prescribing was translated into reality in the latter part of the 1990s when a age group of nigh 1,200 tamp ins received specialist training in order to hold them to feel confident and competent in the ethical drug of certain drugs and medications.In the best traditions of scientific endeavour, they were checkmate to a barrage of audits and studies to see how they actually performed. As in all new project there were ineluctable protagonists and detractors and the initial sequels of the first eight studies were extremely positive. (Legge 1997) the accumulative results of the initial studies showed that curb prescribing had been proved in terms of safety, efficacy and improve working practices.The reports did non make any comment upon the cost- solutioniveness of the prescribing as the cohort studied was withal small for statistical analysis. 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?By 2000, the first comparative studies were emerging with sufficient cohort size to go forth a meaningful evaluation of the scope and efficiency of nurse prescribing. Venning (et al 2000) comp atomic number 18d efficiency and cost of a cohort of nurse prescribers with doctors in the equivalent geographical field of battle. The study cohort was over 1,300 affected roles.This particular study was leng thened in its analysis and many of the results are not particularly applicable to the subject of this essay, yet the strong final results showed that there was no significant deviation in health outcome, prescribing patterns or prescribing cost. Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. (Little et al 1997)Consultation and communicating skills authorisation and education of forbearings is now well recognised as an substantial finale bu t most healthcare professionals. (Richards 1999) it follows that if patients are to be involved then their particular priorities must be ascertained and addressed, commonly in the appliance of the acknowledgment. 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 capture them to discuss their problems in an unhurried fashion. (Editor BMJ 2000)This essay is particularly directed to the grapple of consultation skills in relation to nurse prescribing. Although we have briefly examined the boilersuit issues of nurse prescribing, the consultation is obviously the core skill required to piece the diagnosis and therefore the appropriate interference and prescription. Many studies have looked at the influence of confabulation skills on prescribing and other factors related to the consultation. (Richards 1999)Many regimen (Butler et al 1998) advise that the prime skills associated wit h the prescribing process areAdequate exploration of the patients worriesAdequate provision of information to the patient regarding the natural processes of the disease universe treatedThe advisability of self-medication in trivial illnessThe various alarm symptoms that should be notified to indicate that there whitethorn be problems with the treatment. (Welschen et al 2004)These various aspects are explored further in a particularly well written and informatory leger by Platt and Gordon (1999) it reflects on the fact that doctors and nurses are not for the most part particularly well trained in the art of communication skills. In the words of the author we re not very serious at transmitting information, and were no die at picking up the signals that patients shew to send. Critically, they make the point that individual prescribers are not particularly good at varying their coming to the different type of patient.Clearly, the better the direct of perceived empathy between p rescriber and patient, the greater the level of compliance is belike to be. This is likely to be reflected in greater patient satisfaction, greater compliance with book of instructions planetaryly and improved outcomes and again, in the words of the authors fewer lawsuitsThis particular book highlights and gives practical advice on all of the common pitfalls of prescriber patient communication. The way that prescribers volition often duck issues where they feel uncomfortable or feel that their acquaintance is not particularly break, or perhaps fail to respond to the hurt signals sent out (either verbally or non-verbally) by the patient. They also highlight the dangers of closing the conversation early overdue to pressure of time and not adequately exploring ambiguous answers.The hostile and the heart-sink patient can be a particular headache to the prescriber and inappropriate ending can be make unless great care is interpreted to specifically tackle these issues. (RPSGB 19 97)Some commentators in the field of operations 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. The issue of communication in relation to prescribing has received much less prominence. (Elwyn et al.2000)The paper by Cox (et al.2000) found that it was common practice for prescribers to initiate the discussions about meet what medication there were going to prescribe, rarely refer to the medicine by name and equally rarely refer to how a newly prescribe medication is perceived to differ in either action or purpose, to those previously positive(p). Patient understanding is rarely checked as it is usually assumed after the prescriber has given the prescription. Even when invited to do so, patients seldom military issue the opportunity to ask questions. (Cox et al 2000)The same author found that prescribers would strain the positive benefits of the me dication far more frequently than they would discuss the risks and precautions, in spite of the fact that the patients perception was that much(prenominal) a discussion is seen as essential.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. (Drew et al. 2001). 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 situation towards compliance.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 resplendent paper by Britten (et al 2000). The various consultation skills were critically analysed and depleted down into 14 different categories of misunderstanding. In short, all of the failures of communication were associ ated with a lack of the patients participation in the consultation process. Significantly, all of these 14 categories were associated with capableness or even actual less than optimalOutcomes as they resulted in either inappropriate prescribing or inadequate treatment adherence. 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. (Elder et al 2004)There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. (Britten et al 2000). Many take the view that simply arriving at and stating a diagnosis is sufficient credibility for the provision of a prescription.Even when drug therapy is considered essential ( much(prenominal) as insulin and thyroxin) man y patients provide experiment with dosages and drug-free periods. (Barry et al. 2000). It follows that such experimentation is likely to be all the greater when medication is use when the benefits are less immediate (eg. In prophylaxis).If the prescriber is aware of these factors, it will doubtless help to achieve compliance if they are overtly addressed during the consultation process.Concordance vs. complianceElwyn (et al 2003) took a slightly different approach with regard to the consultation process and prescribing. They advocate the process of concordance which is expound 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.This spoken communication reflects not only a change in emphasis but also a change in attitude of the prescriber. This area utilise to be termed compliance which was a re flection of the now outmoded archetype of implicit power and authority invested in the prescriber. The term was seen as macrocosm authority laden (Marinker 1997) where it was expected that patients complied implicitly and without question when a prescription was given. There was little acceptance that patients would actively participate in the decision making process that surrounded the generation of the prescription. (Cox et al. 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. (Elwyn et al. 1999)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. We also know that a substantial proportion of the medication that is current ly prescribed is not taken or, worse still, inappropriately utilised. (Haynes et al 2003).Careful research shows that where this occurs it is primarily due to a conflict between the prescribers views and those of the patient. (Britten et al 2003). Further studies have shown that where rubber eraser (or preventative) prescribing has occurred the situation is statistically worse. 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. Again, this reflects a failure of communication between patient and prescriber. (Coulter 2002)As a result of this, the prescriber, in general terms, has to be aware of the possibility of what is know, in academic circles, as knowing dissent. The patient may occupy 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. (Barry et al. 2000)ConclusionsThe last decade has seen important strides forward in the field of nurse prescribing. The achievement of this venture would strongly argue that it will arm further still in the future.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. The progressive acceptance of the paradigm of concordance (by all prescribers not only nurse prescribers) offers all healthcare professionals a mechanism to move towards incessantly safer and more successful prescribing.Accurate identification of the patients perspectives, needs and beliefs and then the addressing of any significant differences between these and the prescribers r equirements, are seen to be progressively more important in the successful delivery of nurse prescribed health care.The climax of nurse prescribing brings added responsibility to the more traditional role of the nurse. It is important not to neglect the importance of the role of reflective practice in this area (Gibbs 1998). 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).