Consultation Process in Context of General Practice Same Day Consultation with Advanced Nurse - Case Study Example

Case Study of Patient presenting with flu-like illness Case Study of Patient presenting with flu-like illness An evaluation of the consultation process within context of general practice same day consultation with advanced nurse Background Patients presenting with flu-like illness participating in the UK primary care of late access same day consultation care services from general practitioners as well as advanced nurses. Even though arbitrary trials have shown higher satisfaction after advanced nurse consultations the connection between the expectations of patients before the process and the satisfaction is not always obvious. Introduction Hinchliff, S. M, 2007 state that advanced nurses offer as much high quality care as the general practitioners. Patient satisfaction evaluated using typical patient questionnaires is said to be higher after advanced nurse consultations for flu-like illnesses and minor illnesses. It is from such data that it is discovered that advanced nurses give longer consultations and necessary information as compared to general practitioners. However, some patients who have ever visited a nurse practitioner for insignificant illness care have recorded a preference to seeing practitioners next time, regardless of the fact that they were satisfied with the consultants with the advanced nurse. Patients may not anticipate their general practitioner to create time and listen to hem but they may have much confidence that an advanced nurse would do so (Moulton, 2007). The aim of this evaluation is to determine how the consultation process is carried out by an advanced nurse, inclusive of the methods used in the context of general practice. The method used Subjects were interviewed before and up to one week following their consultation with an advanced nurse. Constant comparative methods and semi-structured interviews were utilized to explore the matter from the patients’ point of view. Subjects A convenience sample of patients with flu-like illness was used, where 15 advanced nurses were used as well as 20 general practitioners. The study was carried out in one of the major towns in the U.K (Rabin, 2007). At the beginning of the study, the role of the advanced nurse in the care of patients with flu-like illnesses was new for the town residents. Therefore, a specified 1-year practice-based training program was initiated. It was comprised of the Higher Professional Education Masters Degree in Advanced Nursing Practice (MANP), inclusive of training on managing common complaints. As the program went on, the advanced nurses were employed, educated, and facilitated with general practices. Common complaints associated with the flu-like illness was compiled for which the participants seek he nurses’ medical attention. According to Keenan, J, 1999, such common problems will always result in minor health issues. The role of the advanced nurse in this study was to assess symptoms like physical examinations, and diagnose or make decisions where appropriate. However, the advanced nurses were not permitted to prescribe any medications, meaning that the general practitioners were frequently available for consultations and validations on referrals and prescriptions. The process required that patients who had appointments for the study be assessed for inclusion. Patients aged over 18 years and had come for the first consultation were welcomed to take part in the study if they requested for an appointment on a day when the advanced nurse was around and had time availed to him or her in the schedule. There was random choice of patients to be allocated in either the reference group or the intervention group. Assignments were given at random by an independent individual and he codes generated. In each project, a research assistant gave an explanation of the research to the patients as they came in and informed consent was achieved. Collection of data and the analysis Before the consultation in the general practice same day consultancy room, the first interview was performed, and the subsequent post-consultation interview performed in the patients’ homes. The performance of these interviews was conducted with the help of prompt guidelines, which were utilized with flexibility. The prior interview was aimed at obtaining information on the reasons why the patients decided to attend and their expectations from the advanced nurse they were consulting with. The aim of the subsequent interview was to explore the views of the patients about the consultation processes. All interviews were carried out, audio-taped, and recorded. Open codes illustrating each unit of meaning in the transcripts were produced and grouped in organizing themes to develop a coding frame. For this study, patients’ prospects of their consultation with an advanced nurse were analyzed between the two interviews. Next, a framework was made to match the patients’ prior expectations regarding the history, evaluation, and the outcome, alongside their accounts to establish if their expectations were met on the same day from the post-consultation interviews. During this stage, the Helman’s Folk model of consultation was utilized, where the patients with flu-like illness were interviewed basing on the questions such as: what happened so that they found themselves at the consultation canter, why has it occurred, the patient may wonder why the illness “targeted” him, what would happen if he does not get the help he came to seek for, and what should he do about it or whom should he consult next. Even though not all these questions would be asked by the interviewer, they might be going through the patient’s mind (Beaumont, 2012). The consultation process AT first, the patients found it difficult to talk of what they expected from the advanced nurses and seemed to focus on their wishful outcome or results based on previous experiences. The first step was a diagnosis of the problem accompanied with prescriptions, responses to questions asked, test or referral to a different care provider, though it also involved recognizing if each individual patient really had the signs of the flu-like illness. Most subjects based their anticipations of the consultation process on their earlier experiences with other types of nurses. Patients who had no experience of a same-day consultation with an advanced nurse before were simply cautious of the entire process. The second step included the coding of data from the questions and recorded into a database created specifically for the study. The research assistant documented the duration of the consultation by use of a stop-watch, right from the time when the patient entered the consulting room of the advanced nurse and stopping when he or she left the room. The length recorded included the amount of time used for prescriptions and any interruptions that might have occurred. According to Moulton, 2007, this objective timing of every personal consultation is called the golden standard for determining the period of duration for the consultation. Next in the process was obtaining data concerning he consultations and the patients presenting the flu-like illness, issuing of prescriptions, ordering of investigation, and referral of he patients to other healthcare providers. For this reason, every patient who participated in the study was categorized on the practice computer system and matching clinical notes were searched. The final procedure involved recording of patients if there was a follow-up consultation, the number of consultations they had performed for the same issue, the number of days they reported the flu-like illness in their working place or in home environments, and the number of days they failed to perform their daily chores. Results Some patients approached the consultation with the assumption that the advanced nurse will be a general practitioner’s subordinate in terms of authority, skills, and knowledge. However, they found out that the advanced nurses were very practical and conducted the process diligently. Some patients had a follow-up, where those in the intervention group were more than those in the reference group. Pertaining the effects found concerning the flu-like illness, patients from both groups reported that they had been missed job attendance at an average of 3 days due to the illness. On the other hand, there was no big difference between the two groups regarding the mean duration where the patients were unable to carry out their daily chores due to the effects of the illness. Conclusively, patients valued the consulting services and care given by the advanced nurses in terms of attitudes, communication, and information provision. In connection to this finding, the authors of the book, “Competencies of Advanced Nursing Practice”, Hinchliff, S and Rogers, R argue that most patients are more contented with consultations with advanced nurses. Discriminating between clinical decision making strategies in order to defend and qualify the resulting patient health outcomes There are numerous clinical decision-making strategies that are required for high-quality clinical practices. This must however include clinical judgment and reasoning in relation to defending the health outcomes and to avoid patient harm. The medical practitioner at this point should put in practice the five check points provided by the neighbour model (Neighbour, 1987). He will first of all connect to the patient’s resultant health outcomes by establishing rapport with him; summarizing the ideas of the patient on the outcome; handing over that involves influencing and negotiating with him on the results; consider the safety net or realize what is to be done; then finally do the housekeeping, that is, the clinician weighs himself whether he is in good sufficient shape to handle the nest patient. The ability of a clinician to offer high-quality, safe, and professional care depends upon their capability to reason and make sound decisions, which can be hindered by lack of experience. The following strategies can be used by nurses to qualify the resultant outcomes in the patients in this context. Perception and intuition Intuition refers to the immediate understanding of knowledge without proof of sensible thinking. According to McCutcheon, H. H., & Pincombe, J, 2001, intuition when applied in clinical practice refers to a procedure where the clinician recognizes something about his or her patient that is not easy o verbalize. It is characterized by instant possession of knowledge, factual knowledge, and information independent of the linear reasoning procedure. When this strategy is used, an individual is able to filter information formerly triggered by imagination, resulting to the integration of all information and knowledge o solve a problem. In this context, the clinicians should relate with their patients, drawing on experiential knowledge or tacit to apply the appropriate knowledge to decide soundly in addressing the needs and outcomes of the patients. Clinicians can have seek insight into a situation through intuition to sport out similarities and patterns, obtain commonsense understanding, ‘as well as sensing the most important information merged with deliberate rationality. The first diagnostic clue is intuitive recognition of commonalities between patients, which must be followed up critically. Lloyd, M., & Bor, R, 2009 differentiates intuition from direct perception, arguing that direct perception depends on the ability to sense complex relationships and patterns that an individual ahs learned through experience. Perception therefore necessitates attentiveness and the knowledge of what is significant before making a decision. Clinicians should remember that in medicine and nursing, means and ends are inseparable. Techne and Phronesis This is a distinction first developed by Aristotle to mean the differentiation between the simple scientific making of things and the associated practice. On the other hand, Keenan, J, 1999, defines the term techne as that act of producing results and it is controlled by a means-ends reasonableness where producer controls the thing or results produced by gaining secrecy over the mode of getting the results to the point of the ability to disconnect the means from the ends. Whilst some elements of nursing and medical practice are categorized under techne, much of medical and nursing falls outside the rationality of means-ends and must be controlled by concern for doing what is best or making the best decisions for the patients in given situations, where being in a relationship and distinguishing certain human aspects at stake direct the actions. In contrast to techne, Phronesis involves decision making concerning the given situation, across time, via transitions or changes in the patient’s and clinician understanding. It is a practical reasoning that takes the form of solving a puzzle or evaluating immediate past record of the patient’s circumstance. Clinicians need this strategy even though many similarities and commonalities with related syndromes can be spotted out through symptoms, signs, and laboratory tests. One can therefore conclude that even though phronetic knowledge should remain open to improvement ant correction, it cannot consistently exceed the institutional setting’s supports and capacities for good practice. However, clinicians require the two methods since they can routinize and standardize issues by diagnoses or even discussing about the patients outcome and treatment (Claxton, Sculpher & Drummond, 2002), Just to justify the above strategies, there are rational calculations offered in techne, including population trends that are developed as decision support configurations and can enhance accuracy when utilized as a position of examination in making clinical judgments on the patient outcomes. Aggregated proof from clinical studies and continuing knowledge of biochemistry, genomics, and pathophysiology are important. Further, the decision making skills of phronessis, that is clinical judgment that critically reasons across time, considering the specified patient and the transitions in the understanding of the clinician is essential for medical and nursing professions. Lloyd, M., & Bor, R, 2009 state that cllinicians must develop the rational skills and character that enable them to understand and perceive their patients’ concerns and needs. This calls for accurate interpretation of the data of patients that is relevant to the given ways required by the practice and to focus as well as intelligently distinguish changes in the patient’s condition. It therefore requires sound action on the side of the nurse or any other health care practitioner to prevent prospective compromises to quality care. Possible ethical dilemmas within therapeutic relationships and consultations The exclusive features of the holistic therapeutic relationships come along with ethical dilemmas (Herth, & Cutcliffe, 2002). One ethical dilemma in this case would have been the risk of violating the confidentiality of the flu-like patients if the information was not accurately camouflaged. The consultation process involved advanced nursing whom the patients were not well conversant with, which could have been made of assurance on the accuracy, soundness, efficacy, and validity of the information provided. At some point, it is quite possible that the nurses could have avoided seeking some related issues due to perceived insufficiency of knowledge required to handle the concerns of the illness. Psychotherapist self disclosure is an ethical dilemma which may be termed as an individual rather than certified information by the therapist to the patients. Some dilemmas with consultant self disclosure in this study could have been: lost focus, where there might have been disclosures that diverted the interview from the patients’ experiences to the advanced nurse’ experience; improper timing may have included disclosures that delayed the building up or terminate the therapeutic relationship; and the dilemma on the duration of the consultation process, which entails the disclosure of too much length that make up a form of introspective disengagement on the consultant’s part (Rawlins & Culyer, 2004). Since the consultation was a same day-based, immediacy could have been an ethical dilemma whereby the consultants may have lacked emotional con troll and objectivity to communicate to the patients. There could have been lack of current experiences for the consultants to associate with the flu-like illness. This might have caused unsuitable levels of intimacy that could reduce a patient’s feelings of psychological and physical safety in the consultation process or lessen the confidence of the patient in the consultant’s abilities. Some information gathered during the interview would have violated cultural etiquette for both the advanced nurse and most importantly, the patient (Jonsen et al, 2006). Balancing between risks and harm is another possible dilemma, where the nurse has to focus on both the risks and the benefits of any prescriptions or referrals made to the patients. In ethical terms, this concerns reconciling the roles of non-maleficence and beneficence, or avoiding harming the patients. Often, there is allowed to cause a certain level of harm to the patient in the medical context if the process will finally prevent greater harm. Clinicians are therefore under a professional and ethical obligation to minimize the probability of harm (Watson, R., & Thompson, D. R, 2006). Such a role can be manifested in various ways depending on the type of therapy. The beneficence duty provides that the practitioners themselves, in this context the nurses, be in good health. Their obligation not to cause any harm to patients means that they should be scrupulous in keeping away from performing invasive processes if they have any infection which could be transmitted to the patient. The dilemma here is that, even though the nurses would have been in good psychological and physical health, there is also a possibility of the patients they attend to, passing on the infection to the nurse, considering that illnesses like flu are airborne. References Bryant‐Lukosius, D., DiCenso, A., Browne, G., & Pinelli, J, 2004, Advanced practice nursing roles: development, implementation and evaluation. Journal of Advanced Nursing, 48(5), 519-529. Beaumont, R. (2012). Health/Medical Consultation Models. 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