Consultation Skills In Relation To Non Medical Prescribing Nursing Essay

Consultation Skills In Relation To Non Medical Prescribing Nursing EssayTo represent this I leave behind utilise the model of reflection ad given(predicate)ed from (Boud, Keogh and footer 1985) as to focus on influences on prescribing, psychology of prescribing working through and through the consultation, decision- do and therapy, and referral.Being present in the consultation as a non- aesculapian prescriber challenged me to bring questions ab out my own manage and the consultant psychiatrist, focussing on how we arrived at our decisions and occasionally resulting in contrasting views.According to (Butler et al 1998) mevery political science advise that the prime skills associated with the prescribing figure out are capable exploration of the affected roles worriesAdequate provision of information to the patient regarding the natural processes of the disease being handleThe advisability of self- practice of medicine in trivial unsoundnessThe getting even pertaining to poor communication has a negative impact with patient-practitioner relationship and was admit in an informative physical composition by (Britten et al 2000). Ultimately, all of the failures of communication were linked with an absence of the patients exponentiation during the consultation process.There is evidence that failure to actively engage in, or even visualize, the patients perspective is a common failing amongst prescribers. (Britten et al 2000). rattling often there is a focus on the term residency and it is only recently that admits are focussing on the more apt term of harmoniousness. The term compliance was viewed as being authority soaked (Marinker 1997) where it was expected that patients complied implicitly and without question when a prescription was given. There was smallish 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 patients pe rspectives, requirements and beliefs need to be acknowledged and thusly(prenominal) the recognition of whatsoever major differences between these and the prescribers needs could be perceived when providing nursing care.It is not honorable 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 come forth 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 stratum old serviceman who will be known for the purposes of this work as Mr A, who had been referred by dermatology to the mental wellness out-patients clinic as a new patient.Dermatology had referred this gentleman after a 12 month level of attending their division where Mr A had complained of persistent generalised skin fretfulness, and despite receiving treatment with them it appeared he may bugger off an underlying mental wellness issue.Dr S began the oppugn by thoroughly reading the referral from dermatology and examineing 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 convey 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 associate to.The British Medical Journal (2000) has recognised a common content amongst studies of patients in that they have a tendency to prefer prescribers (doctors or shields) who hark and provide time for the individual to express their concerns without observeing hurriedDr S asked Mr A why he had been attending Dermatology to which Mr A detailed a 12 month history of describing an itchy scalp, generalis ed skin irritation and said no treatment had so far helped him. Mr A then went on to express that he matte up all of these symptoms may be out-of-pocket to a parasite, or a bug which was doing any(prenominal)thing to him, and described a feeling of the bug weaving whateverthing 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 opposite 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 complaint which was quite systemised and concrete and Mr A appeared not to bring out any other symptoms of mental health. A diagnosis of parasitosis delusional deflect was made.It was clear Mr A undeniable treatment but the main factor to consider was that Mr A did not believe he any form of mental disorder and therefore there was a real number issue surrounding concord with proposed treatment.Usually, it is difficult to obtain informed consent to treat patients with delusional parasitosis with antipsychotics. and so experienced clinicians tell their patients that the antipsychotics are effective against the itch or the problems with the pests in order not to have to lie. (Musalek, 1991 Driscoll et al, 1993 Winsten, 1997 Freudenmann, 2002).This is due to the patients level of insight obstructive their decision to accept treatment, because they hold a non-reality based caprice that it is a somatic illness.It is therefore found that the patient will normally have sought help from their G.P., dermatologists and will often be adverse to the idea of seeing a mental health professionalA generous medical history was taken, looking at any familial medical problems, family composition and looking at the social aspects of MR A to include areas of employment, relationships, and any drug/alcohol usage.Th ere have been some criticisms of the education of nurse prescribing in relation to the communication skills of nurses, where it is felt that historically there has been excessively much of a focus on taking a history and coming to a diagnosis.It was apparent to me that Dr S had to use his skill as an experienced mental health clinician to challenge Mr As concept of his illness not being related to a problem with his mental healthDr A approached the issue of explaining Mr A symptoms, not referring to mental health or delusions, but explaining Mr As perceived symptoms by informing him that although he believed that these experiences were real to MR A , that his brain was interpreting false signals resulting in these unusual thoughts. Dr A went on to use the analogy of an amputee who perceives that he can still feel is amputated leg, through false interpretations of the brain.Drew et al. (2001). found that prescribers would emphasise the positive benefits of the medicinal drug far mo re frequently than they would discuss the risks and precautions, despite the fact that the patients cognizance was that such a discussion is seen as essential.Therefore looking at this, this could lead to patient confusion, with patient anxieties, and a degree of ambivalence to medicament being offered to them.It is transparent that if there is a degree of empathic display between that of the patient and the prescriber, there is a greater chance of concordance.This will hopefully lead to an interpolate magnitude level of compliance/concordance and patient satisfaction resulting in desired clinical resultsHere we face the issue surrounding honesty, integrity, consent and acting in the outmatch interest of the patients in focussing on treatmentThe issue of treatment was then discussed by Dr A, who said to Mr S that he believed he could help him by prescribing some music for him that would help relive the distressing symptoms he was experiencing.Mr A ab initio expressed some conf usion once more why he was not seeing dermatology as he perceived the problem needed treating by themThis indicates that Mr S was still not displaying any insight and the questions of concordance issues were reconsidered.The National Institute for Clinical Excellence (NICE 2002) recommends that a risk mind should be performed by the mental health clinician responsible for treatment and the multidisciplinary team regarding concordance with medication, and depot preparations should be prescribed when appropriate.Mr A questioned the proposed medication and it was explained to him that he would be given a variant of Neuroleptic medication of a new medication called Aripiprazole. Dr A said that although the medication leaflet would watch the medication was used for Schizophrenia, that Mr A should not be too crazy about that as that was not the reason why he would be taking it. Dr A then went on to say that the leaflet would too explain possible side-effects and that although it list ed quite a few they were quite rare.The constitution by (Cox et al.2000) found that it was common practice for prescribers to jump the discussions about just what medication they were going to prescribe, rarely refer to the medicine by spend a penny and equally rarely refer to how a newly prescribed medication is perceived to differ in either action or purpose, to those antecedently prescribed. Patient understanding is rarely checked as it is usually off-key after the prescriber has given the prescription. Even when invited to do so, patients seldom take the hazard to ask questions. (Cox et al 2000)I felt it was the right thing to initiate pharmacological treatment, although on reading come along research surrounding the best treatment for Parisitosis I would question the select of medication Mr A was commenced onHowever, after spending many clinical hours with this particular Consultant Psychiatrist, I am aware that he has high tendency of prescribing Aripiprazole for the maj ority of his clients.On questioning Dr A about his decision for choice of medication, Dr A commented that it is the newest and most effective of the a regular medications with lesser incidence of side effect sexual congress to other medications in its group. I had to question myself that there may be other factors influencing in the prescribing decision which were not based on any of the NICE guidance or that of the British Journal of Psychiatry. In fact, Dr A replied to me with medical jargon relating to molecular structures of both the brain and chemical present of Aripiprazole which was hard to follow due to its complexity.I was conscious that as a consultant psychiatrist of many years experience, I was not original of the honesty or consequences if I had challenged Dr A about his continued choice of Aripiprazole against other choices of medication any further.After researching treatment for this disorder, I felt that the initiation of a regular(prenominal) antipsychotic shou ld have seriously been considered due to its proven faster working efficacy. However, it is known that typical antipsychotics have an increased prevalence of side-effects. Therefore I had considered the preliminary use of typical antipsychotics to establish a degree of insight into the beneficence of taking medication, and if it was felt that further pharmacological treatment is required then switch to a typical antipsychotic as recommended by the NICE guidelines.An article in the British Journal of Psychiatry (2007) highlighted that delusional parasitosis has shown significant treatment results with the use of typical antipsychotics. (Traberts 1995) found that the introduction of typical antipsychotics has substantially improved remission order(Frithz 1979) described another important treatment in delusional parasitosis is to consider typical anti-psychotic depot medication. This was suggested, as was earlier highlighted that one of the main stumbling blocks is a lack of insight t hat causes patients t be reluctant to accept unwritten medication.However, the administration of medication in injection form might be viewed by the patient as the answer to their somatic perception of their illness. It would be hoped that the injection would lead to a degree of insight where the patient may be more open to accept regular medicationAt the end of the consultation the patient Mr A agreed to take the medication as prescribed and was offered a further out-patients appointment in 2 weeks time.Ultimately, I accept a clear indication for medication, and in conjugation with this at a later stage this could be combined with some cognitive behavioural therapy should symptoms persist.Clinical Governance plays an important part in relation to prescribing., and in particular for non-medical prescribers role .(Bradley E and Nolan P 2005) area that training courses must remain up-to-date and flexible and must change in response to changes in government policy on non-medical pres cribing, with nurse prescribing leads being involved in any discussion about course development.