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PubMedDate not supplied

A model for patient-centred nurse consulting in primary care.

A model for patient-centred nurse consulting, developed in the context of secondary prevention of cardiovascular disease, is reported in this article. The model was created in the absence of any existing model for nurse consulting. Heart disease clinics are increasingly being used to implement the National Service Framework for Coronary Heart Disease and it is anticipated that this model will be of practical use to nurses running these clinics. The model consists of eight steps, broadly following the chronology of the consultation. Each step contains a question for the nurse to ask him/herself and a task to complete. The model was developed as part of a research project on the influence of customized computer software used on nurse consultations with patients with heart disease.

Computer Communication Networks↗
PubMed2003

The first 2 years of a palliative care consultation team in the Netherlands.

In January 1999 an integrated multidisciplinary palliative care consultation (PCC) team was established in Maastricht in the Netherlands. The team included experts in palliative care who had extensive experience in a variety of settings. One of the major tasks of the PCC team was to give support, information and advice to healthcare professionals caring for terminally ill patients. The PCC team was asked by the government to consecutively register and evaluate all consultations. This article describes these consultations, including information on the requesting caregivers, the patients, the questions asked and the recommendations given in the first 26 months. The results show that the PCC team served the needs of professional caregivers in a variety of settings. Most consultations concerned physical and pharmacological problems and the majority of recommendations were evaluated as positive.

Aged↗
PubMedDate not supplied

Consultation with community care facilities.

An innovative application of consultation to community care facilities, also known as board and care homes, is presented in order to improve services to chronically mentally ill persons. An extended Caplanian model for establishing an effective consultant-consultee relationship with administrators is described with reference to the following tasks: (a) understanding the setting; (b) recognizing an unmet need; (c) resolving problems of entry; and (d) negotiating a contract for case consultation and for program consultation. Interventions that reduce theme interference with work efficiency are described by examining realistic conflict resolutions utilizing problem clarification, expressing understanding, sharing feelings, and exploring solutions. The results include development of a climate of responsibility among the chronically mentally ill residents and more effective use of community resources.

Administrative Personnel↗
PubMed2003

Primary process and peer consultation: an experiential model to work through countertransference.

Various models exist for peer supervision and consultation of group therapy. This article documents the authors' experience using an experiential group consultation of group therapy model that relies on primary process to overcome countertransference dilemmas. A review of group therapy supervision and consultation models is followed by vignettes from the authors' experience. Discussion of the vignettes highlight critical issues in group consultation and expound upon the strengths and challenges of using an experiential model.

Countertransference↗
PubMed2002

Questionnaire survey of women aged 56-59 years: consultations in general practice, use of hormone replacement therapy (HRT) and participation in screening programmes.

OBJECTIVES: To ascertain attitudes to consultations in general practice and the gender of the doctor. To determine whether women participate in the National Health Service (NHS) screening programmes available to them and their use of hormone replacement therapy (HRT). DESIGN: Postal questionnaire survey to women aged 56-59 years. SETTING: The Honiton Group Practice, East Devon, UK. PARTICIPANTS: Two hundred and ninety-four of the 334 eligible women returned the questionnaire (response rate 88%). MAIN OUTCOME MEASURES: Women's embarrassment on consulting general practitioners (GPs) and preference for a female doctor. Up-to-date cervical smears and mammography screening in eligible women and use of HRT. RESULTS: A large majority of women (248/294; 84.4%) were not embarrassed when consulting a GP and did not express a preference to see a woman GP for any problem (240/294; 81.6%). However 123/294 (41.8%) did express a preference to see a woman doctor for 'women's problems'. Sixty-five women had had a hysterectomy, and 218 of the remaining 229 (95.2%) had had a smear in the past 5 years. For breast screening, 267/294 (90.8%) had undergone mammography in the previous 3 years. Ninety-three women (32%) were currently on HRT, and on record searching a total of 146 (49.7%) had at some time been HRT users. CONCLUSIONS: Embarrassment does not appear to be a major problem for consultations related to female health. A well-organised general practice with motivated patients can achieve very high uptakes of both cervical and breast screening programmes. Interest in HRT has also risen, with half the women aged 56-59 years having used systemic HRT.

England↗
PubMed1987

Dentists' consulting behavior and associated knowledge levels.

Telephone interviews with stratified random samples of urban and rural dental general practitioners (GPU, n = 120; GPR, n = 97) and oral surgeons (OS, n = 105) in New York State indicated that requests for expertise, additional data, confirmation of patient's medical status, or medico-legal issues were frequent motives for requesting a consult. Those who consulted more frequently had lower mean knowledge scores than those who consulted less frequently, suggesting that the quality of patient care is potentially improved via the consulting process.

Data Collection↗
PubMed1975

Management of the borderline patient on a medical or surgical ward: the psychiatric consultant's role.

The patient with borderline personality hospitalized on a medical or surgical ward has a disorganizing effect on the house staff, who may regress in response to the patient's impulsivity, dependency, entitlement, and rage. The psychiatric consultant's role in the management of such a patient should consist of a specialized type of consultee-oriented approach in which countertransference hatred and fear, typically generated in the staff by the borderline, are drawn away from the patient and strategically metabolized within the staff-consultant relationship. The consultant should actively promote a behavioral management practicum, placed in the medical chart for reference and as a symbol of the psychiatrist's helping presence, which discusses: a) clear communication with the patient and among staff, b) understanding the patient's need for constant personnel, c) dealing with the patient's entitlement without confronting the patient's needed defenses, and d) setting firm limits on the patient's dependency, manipulativeness, rage, and self-destructive behaviors. The consultant should work to counteract feelings of helplessness in the staff, to neutralize punitive superego in the staff, and to diminish fearfulness toward the patient.

Adult↗
PubMedDate not supplied

Emergency psychiatric consultation: a case report.

Emergency psychiatric consultations present with unique and dramatic difficulties. A case is presented of a young male with multiple fractures, whose poor relationship with nursing staff and physicians led to inordinate difficulties with his case. After four weeks of hospitalization, a crisis emerged following an episode where the patient spit on a nurse and had a physical altercation with his surgeon. The surgeon refused to see the patient any longer; the nurses threatened to resign in preference to caring for the patient; and the patient insisted on leaving the hospital. Yet, his medical condition made that impossible. Emergency psychiatric consultation was requested. The consultant took control of the situation resulting in a sudden dramatic behavioral change on the part of the patient. This change was sustained during the rest of the hospital course, which proceeded smoothyly. Emergency psychiatric consultations occur under certain very difficult circumstances but they can provide great therapeutic opportunities.

Adult↗
PubMed1997

Improving consultations between health-care professionals and older clients: implications for pharmacists.

Consultations between pharmacists and many clients are now federally mandated in the United States, but guidelines have not been developed for communication in this context. This article reviews research on communication between clients and health-care professionals in order to help develop recommendations for consultations between pharmacists and older clients. The review is organized around a collaborative approach to health communication, which identifies strategies by which speakers and listeners work together to achieve mutually defined goals. This approach is used to analyze cognitive processes underlying communication during pharmacist consultations. This review suggests that miscommunication often reflects a break-down in collaboration between health-care professional and clients. Recommendations are developed to improve collaboration, including suggestions for initiating consultations, presenting easy to understand messages, and monitoring to ensure that the messages are mutually understood. Most important, successful collaboration requires tailoring strategies to individual clients rather than basing communication on general assumptions about clients.

Aged↗
PubMedDate not supplied

The application of competency-based education to consultation-liaison psychiatry: III. Implications.

In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.

Clinical Competence↗
PubMed1975

Consultation-liaison psychiatry: a psychosomatic service in the general hospital.

Consultation psychiatry, an outgrowth of the tenets of psychosomatic medicine that followed the departure from mental-hospital psychiatry to the general-hospital-based psychiatric units, is similar to those consultation services in other specialties available on medical-surgical wards. Its primary aim is to interpret the psychosocial phenomena of health and illness and to redirect the physician from disease- to patient-orientation and to a comprehensive approach. Its functions are diagnostic-therapeutic, instructional and research directed. The psychosomatic orientation is a sine qua non in the understanding of the psychosocial meaning of physical illness, its effect on psychic disability, the psychosocial adjustment of the patient and his family and his ability to adapt to illness and the hospital. An essential feature is the evaluation of the doctor-patient relationship, especially when severe illness requires serious interventions, including the consultation and its reciprocal effect upon the doctor-patient relationship. Liaison activity consists of interpretive-therapeutic mediation between the patient and the therapeutic team when strain endangers their satisfactory cooperation. The therapeutic activity must be short-term and so construed as not to interfere with the primary treatment. The instructional aspect is for the sake of the usual recipients of the service, as well as residents and students. Teaching the interview techniques, especially to students, should demonstrate the holistic approach, comprehensive diagnosis and the need of avoiding orthodox one-sidedness. This paper reviews briefly the scope and role of consultation psychiatry, compares its North American model with its status elsewhere and explores the resistances to it.

Adaptation, Psychological↗
PubMedDate not supplied

Parent consultants in the health-care system: a new approach in the care of children with special needs.

A unique and innovative role for parents has emerged from the recent emphasis on family-centered, community-based health care for children with special health-care needs. The role of parent consultant is described in the following article. Identified are the characteristics of the consultant role, benefits as well as challenges, how the role is enacted, and ways to finance the position. Nurses can serve to support and nurture the parent consultant role to ensure positive role development. Parent consultants have a unique and important perspective to offer in the delivery of a family-centered approach.

Child↗
PubMed1987

Illness and disease in female patients. II. A study of consultation techniques designed to improve the exploration of illness in general practice.

Health problems in female patients often confuse the general practitioner. Many of them are classified as "unspecific" or "various". Psychiatric, psychosomatic or musculosceletal diagnoses may imply a diagnostic level inadequate for proper solution of the problems. This study of middle-aged female patients assumes that such conceptual inadequacies are related to the communication and the context of the consultation. A consultation technique designed to improve the exploration of illness based on the women's own "medical" language is described. The results indicate that this may be an effective tool in the consultation. Mobilizing the women's own resources seems to improve the doctor's insight in her illness and the outcome of the consultation.

Adult↗
PubMed1997

The list system can reduce the waiting time and number of consultations in a centralized primary care centre that provides out of hours medical care.

OBJECTIVE: To study the waiting time and number of consultations of the patients who required out of hours medical care from a centralized primary care centre before and after the introduction of a list system. DESIGN: Non-controlled intervention study. A questionnaire, completed by receptionists, concerning all out of hours general practice consultations for one week each month during two separate years (in 1990 with no list system and in 1993 with list system in operation). SETTING: One health centre in central Finland in a region with 39495 inhabitants. SUBJECTS: All patients contacting the health centre to request medical help during out of hours work. OUTCOME MEASURES: Consultation rates by age and sex of the patients and their waiting time before seeing the GP. RESULTS: In 1990, the average out of hours consultation rate per 1000 inhabitants per year was 826 for women and 819 for men. These figures were reduced by 271 for women (95% CI 262-280) and 305 for men (95% CI 297-314) in 1993. The mean waiting time was 55 min in 1990 and 32 min in 1993 (p < 0.001). CONCLUSION: The introduction of a list system leads to more effective primary care services.

Adolescent↗
PubMed1993

[Present status of elderly patients at geriatric outpatient clinics in terms of number of clinics consulted and number of drugs taken].

It has been said that elderly patients generally have many diseases (polypathology) for which they consult multiple doctors and are given a wide variety of drugs by their attending doctors (polypharmacy). There is a tendency for elderly patients to buy various kinds of drugs from drug stores without medical prescriptions. However, little is known about the actual status of the numbers and kinds of drugs they take. To answer these questions, we studied 192 elderly patients who were regularly consulting the outpatient clinic of geriatric medicine at Kyoto University Hospital. Seventy nine patients (41%) were consulting other clinics of the same hospital in parallel with ours. Of these patients 81% were given some drugs at other clinics. Forty of 192 patients took a variety of OTC drugs, concerning which they did not inform their attending doctors. Among these, 24 patients took some kinds of traditional Chinese medicine. Thus, a considerable percentage of elderly patients were consulting more than one clinic and in most of these patients were given some drugs. Some of them also take, without permission, drugs other than those prescribed by attending doctors. These results led us to conclude that elderly patients should be under the strict control of a single attending doctor to avoid unexpected adverse effects.

Aged↗
PubMedDate not supplied

Consulting for quality continuing education.

The consultant's role in continuing education (CE) is presented and discussed from a variety of perspectives. This article proposes that using a consultant will enhance the quality of continuing education and be cost effective at the same time. The steps to be taken to select a consultant include: determining the consultant's role, acquiring a content or process expert, and finalizing the contractual agreement. The American Nurses' Association (ANA) criteria for continuing education offerings are provided as a reference table. Emphasis throughout the article is on how to obtain quality service at a minimal cost.

Consultants↗
PubMed1982

Consultation and liaison implications of awakening paralyzed during surgery: a syndrome of traumatic neurosis.

The traumatic neurotic syndrome that occurs upon awakening paralyzed during surgery is a clinical problem unique to the medical setting. It presents the liaison nurse with potential problems in assessment. Given the patient's hesitancy to discuss the experience, the existence of this syndrome always should be considered when evaluating a highly anxious post-operative patient. Beyond the problems of patient assessment, this syndrome can represent a complex consultation-liaison problem, especially with a staff unfamiliar with its existence. A review of the concepts of consultation-liaison work often identifies problematic areas (such as interdisciplinary cooperation and educational needs) that the consultant should cover. The case presentation and discussion illustrated the process of applying consultation liaison principles to a complex clinical problem unique to the medical setting--the traumatic neurotic syndrome that occurs as a result of awakening paralyzed during surgery.

Adult↗
PubMed1993

Forensic responsibilities of the legal nurse consultant.

1. Legal nurse consultants are registered nurses who use their clinical knowledge and expertise to assist attorneys with their cases in any context where law and medicine overlap. 2. A working knowledge of the four elements that constitute negligence is essential for a legal nurse consultant who works on medical and dental malpractice cases. 3. The ultimate goal of the legal nurse consultant is to provide the attorney with answers to questions relating to medical issues that may arise in a court of law. 4. The greatest challenge and opportunity the legal nurse consultant faces is the task of educating attorneys on the medical issues of their cases so that they are as knowledgeable and comfortable with these issues as they are with the liability issues.

Consultants↗