Consultation Skills In Relation To Non Medical Prescribing Nursing Essay
To illustrate this I will utilise the model of reflection adapted from (Boud, Keogh and Walker 1985) as to focus on influences on prescribing, psychology of prescribing working through the consultation, decision-making and therapy, and referral.
Being present in the consultation as a non-medical prescriber challenged me to ask questions about my own practice and the consultant psychiatrist, focussing on how we arrived at our decisions and occasionally resulting in contrasting views.
According to (Butler et al 1998) many authorities advise that the prime skills associated with the prescribing process are:
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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)
Objective recognition of the patient's perspectives, requirements and beliefs need to be acknowledged and then the recognition of any major differences between these and the prescriber's needs could be perceived when providing nursing care.
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 consultation I chose to focus on was carried out by a consultant psychiatrist who for the purposes of this work shall be known as DR S, with myself as an observer of the consultation.
The patient to be seen was a 45 year old gentleman who will be known for the purposes of this work as Mr A, who had been referred by dermatology to the mental health out-patients clinic as a new patient.
Dermatology had referred this gentleman after a 12 month history of attending their department where Mr A had complained of persistent generalised skin irritation, and despite receiving treatment with them it appeared he may have an underlying mental health issue.
Dr S began the interview by thoroughly reading the referral from dermatology and establishing what had been the concern from their point of view.
The patient was then seen and before Dr S had chance to ask the patient anything Mr A expressed that he was confused as to why he had been referred to the mental health department, and not dermatology, which he perceived his medical complaint to be related to.
The British Medical Journal (2000) has recognised a common theme amongst studies of patients in that they have a tendency to prefer prescribers (doctors or nurses) who listen and provide time for the individual to express their concerns without feeling hurried
Dr S asked Mr A why he had been attending Dermatology to which Mr A detailed a 12 month history of describing an itchy scalp, generalised skin irritation and said no treatment had so far helped him. Mr A then went on to express that he felt all of these symptoms may be due to a parasite, or a bug which was doing something to him, and described a feeling of the bug weaving something on his face which enveloped his eyes. Other symptoms he described was that this bug or parasite was all the time making him feel thirsty and taking moisture from his body, and could somehow transpose itself to other people, including his own GP and friends describing like a magnetic type effect.
From this initial information it was evident that Mr A was suffering from a delusional disorder which was quite systemised and concrete and Mr A appeared not to display any other symptoms of mental health. A diagnosis of parasitosis delusional disorder was made.
It was clear Mr A needed...