please can i have a draft so i know you are on the right track
Critical analysis of a prescribing intervention (2500 words)
This summative assignment requires you to identify an appropriate patient that you have recently encountered during your practice experience and for whom prescribing would have been one option in your care management strategies. The chosen prescribing intervention will need to be amenable to critical examination and should include an introduction to the prescribing context and the independent /supplementary prescribing role adopted. The assignment must demonstrate the application of a theoretical and evidence based approach to the practice of prescribing with specific reference to assessment and diagnosis, justification of an appropriate management strategy and consideration of the prescribing decision and the professional responsibilities involved.
The assignment should include: –
�A clear introduction which establishes the prescribing context and exploration of the independent/supplementary prescribing role adopted
�An exploration of the assessment and diagnostic process undertaken.
A rationale for the assessment approach
Justification of any investigative strategies used
A review of the clinical reasoning process undertaken
�A critical justification of the chosen therapeutic intervention.
An outline of the chosen pharmacological treatment and its effect
Relevant non-pharmacological interventions
Referral strategies (where appropriate)
The provision of patient information and consideration of non-pharmacological strategies in patient care40%
�A critical examination of the legal, ethical and professional issues associated with the prescribing process including the strategies for achieving concordance.20%
Here is the patient i choose
I was asked to assess a patient with regards to re-start his antipsychotic medication Olanzapine The name of the patient has been changed to Miss Brooker, to maintain confidentiality, as the NMC (2008) states:� You must respect people’s right to confidentiality.”
Miss Brooker is a 24 years old lady, known to the mental health service with an established diagnosis of paranoid schizophrenia and had stopped taking her prescribed medication Olanzapine 10mgs for three weeks, who was brought to the Acute Assessment Centre by his parents during the night due to displaying sign of relapsed (paranoid towards her mother, mother having affairs with her friends
HERE IS AN EXAMPLE OF ANOTHER PAPER DONE BY A COLLEAGUE BUT HAS MORE WORDS IT MAY HELP YOU
I WOULD NEED MOST OF THE INFO TAKEN FROM UK GOOKS AND JOURNALS
During one of my shifts as a Senior Nurse Assessor (SNA) (Hospital at night) – Out of hours, I was asked to assess a patient with regards to re-start his antipsychotic medication (Aripiprazole). The name of the patient has been changed to Mr Green, to maintain confidentiality, as the NMC (2008) states:� You must respect people’s right to confidentiality.”
Mr Green is a 34 years old gentleman, known to the mental health service with an established diagnosis of paranoid schizophrenia and had stopped taking his prescribed medication Aripiprazole 15mg for three weeks, who was brought to the Acute Assessment Centre by his parents during the night due to displaying sign of relapsed (paranoid towards his mother, mother having affairs with his friends & delusional beliefs regarding his father is not biologically related to him). The consultation took place in an interview room together with the Duty Doctor & in the presence of his parents. I had to call the Doctor from home, as there is no doctor on site during the night. In order to comply with the NMC (2006): Standards of proficiency for nurse and midwife prescribers-Practice standard 3 � ` to prescribe for a patient/client you must satisfy yourself that you have undertaken a full assessment of the patient/client, including taking a thorough history and, where possible, accessing a full clinical record`, I had to conduct my own assessment (Appendix 1) and read the information available on the electronic records (RIO) prior consulting Mr Green & his parents. Gibbs reflection cycle model (1998) refers this as stage 1 (Description) of the 6 stages and this reflective cycle encourages to think systematically about the phases of an experience.
As a SNA- out of hours- my role is mainly involved working as or covering for a` junior doctor` and I routinely conduct full psychiatric assessment. Therefore it can be suggested that most of the time I work within the traditional medical model. However, one can argue that medical model gives little consideration for the social, psychological and behavioural dimensions of illness as not everyone with the same illness experiences it in the same way. Models of history-taking are becoming increasingly patient-centred and seek to assess the main components of ill health, the biomedical and the psychosocial component. For this reason, Full history taking using aide memoire template adapted from problem oriented medical record, mental state examination & risk assessment are the essential components for a full psychiatric assessment and they are the most important diagnostic tools a psychiatrist has to obtain information to make an accurate diagnosis (Jones 2009). Mental state examination is another important part of the clinical assessment process in psychiatric practice and it is a structured way of observing and describing a patient’s current state of mind, under specific domains. This information enables me to make judgements regarding the presence and severity of any mental illness.
As a SNA, I find the aide memoir template as one of many useful options in taking a full history and assessing the mental state, both are crucial to establish and maintain rapport and to be systematic in obtaining the necessary information. A good history is one which reveals the patient’s ideas, concerns and expectations and listening is at the heart of good history taking, without the patient’s perspective the history is likely to be much less revealing. This reflects the holistic needs of the seven principles of good prescribing identified by National Prescribing Centre (NPC) (1999). From a prescribing perspective, this must be done in a systematically way to ensure safety, however, at times patients do not present with a logical and coherent set of symptoms. Therefore, as a nurse prescriber, it will be important to adopt different consultation styles in different situations to maintain safety, as prescribing inherently brings with it a greater requirement to make a diagnosis (Lymn et al 2010).
Numerous consultation models have been developed over the years since the work of Balint (1987) in promoting patient centred approach during the encounter with patients, such as Balint (1986), The Three Function Approach to the Medical Interview (1989), Pendleton, Schofield, Tate and Havelock (1984), Helman�s �Folk Model� (1981), Calgary�Cambridge approach and many more (Sodha and Dhillon 2009). Most of the consultation models contain similar characteristics to explore interactions between patient & health care professionals (Brookes and Smith 2007). Harper and Ajao (2010) claim that the notion of nurses undertaking consultations is a relatively new dimension & consultation models have historically been researched from a medical perspective. Consultation models must have a degree of structure and should be straightforward, practical and provide guidance that enables advanced nurses to adapt to their new medicalised role (Beaumont, 2012).
In this discussion, I have chosen to use the Calgary-Cambridge consultation model (2000) together with the Roger Neighbour�s (1987) 5 Checkpoints because the consultation was primarily based around concordance issues. Despite the effectiveness of atypical antipsychotics, non-concordance with prescribed antipsychotics is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity (Gray et al 2002). Neighbour�s inner model (1987) describes the consultation as a journey rather than destinations, due to ongoing unfolding of symptoms, problems and feelings, some of which may never conclude as there is always another problem or time to discuss it. According to Munson and Willcox (2007) the Calgary-Cambridge consultation model is a helpful model for achieving concordance through patient-centred discussion and the focus of this model is on building a relationship with a patient as the consultation progresses. Although written specifically for doctors, it is applicable to many nursing consultations and it allows health professionals to examine their communication skills as well as encouraging patients to become involved in the decision-making process. Therefore, it can be strongly argued that communication and consultation skills are inextricably interlinked. The Calgary Cambridge method derives from Pendleton’s approach and is an evidence-based approach to integration of the ‘tasks’ of the consultation and improving skills for effective communication (Epstein 2008). It is divided in five main stages within a framework that provides structure and emphasises the importance of building rapport with patients.
Stage 1- Initiating the session
In any caring settings it is vital to establish rapport with the patient & the carers and to put them at ease. Neighbour�s inner model (1987) refers this as the first Checkpoints (connecting). As a prescriber, connecting is vital to develop a therapeutic alliance, so that patients can recognise the importance of medications. In this scenario, Mr Green & his parents were greeted, introduced ourselves by names & clarifying our roles and provided an outline of what our intentions are and a brief idea of how long the consultation might take. It was our first contact with Mr Green, therefore, it was important to confirm the patient�s name and to check how he prefers to be called as some people like to be addressed by their first name, whilst others may prefer the use of their surname. First impressions are very important, as this will influence the subsequent relation with the patient and it is a chance to demonstrate from the outset of respect, interest and concern (Lymn et al 2010).
Mr Green agreed to be seen in the presence of his parents and they were taken to a quiet consulting room free from interruptions and to maintain confidentiality. The environment was made welcoming and relaxing because patients often find the mental health clinical setting stokes up anxiety. Seating arrangement was made for Mr Green & his parents to sit close to us, rather than confronting them across a desk, as this have the potential to hinder the exchange of information.
The consultation began by asking my Green to outline his concerns `what brought you here tonight�. Open-ended questions are designed to introduce an area of enquiry and allow patients opportunity to answer in their own way and shape the content of their response (Institute 2007). During a psychiatric assessment it is common to use a combination of open-ended and closed questions. Normally, open questions are more commonly asked at the start of the interview with closed questions asked later, as information gathering becomes more focused in an attempt to elicit more detail (Jones 2009). It was important in this opening phase not to interrupt Mr Green as this might inhibit the disclosure of important information. Research has shown that doctors often fail to allow patients to complete their opening statements uninterrupted and yet, when allowed to proceed without interruption, most people do so in less than 60 seconds (Epstein 2008).
Stage 2- Gathering information