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Nurse Practitioner Consultation

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Nurse Practitioner Consultation
For the purpose of this essay, I will discuss the case of a five years old patient presenting to my place of work with the symptom of shortness of breath (SOB). To maintain confidentiality the pseudonym “Ryan” will be used to refer to the child and Ryan’s mother will be frequently referred to as “mum”.
As this assignment is a critical evaluation of my own practice, elements of it will be written in the first person. Webb (1992) considers writing in the first person acceptable when personal experiences and opinions have played a significant role in shaping the ideas presented.

My current role is that of unscheduled care practitioner (paediatric specialist) within a health centre, which aims to compliment the services of local GP surgeries. I am employed to carry out same day consultation, assessing and managing patients presenting with a vast variety of illnesses and injuries.

The first part of this work will be pertinent with the history taking process within a consultation; the second part will focus on assessment and physical examination. This essay aims to demonstrate comprehensive history taking and a structured approach to the consultation. A thorough assessment and examination of the respiratory system will follow, together with a rationale for examination skills used and a critical analysis of the clinical findings.

On searching the literature, many models of consultation were found. However, one that follows a logical approach, which is applicable to most clinical settings is the Calgary-Cambridge guide developed by Silverman, Kurtz and Draper (2004). As observed by Munson (2007) this model provides an easy-to-use structure that complements the traditional nursing holistic assessment. I choose this guide as it encourages a patient-centred, active partnership between the nurse practitioners and the patient, based on therapeutic communication, whilst it advocates the value of reflective practice to aid personal and professional development (Gibbs,



Bibliography: Advanced Paediatric Life Support Group (2005) Advanced Paediatric Life Support: the practical approach 4th edn. London: Wiley-Blackwell. Aylott, M. (2006a) ‘Observing the sick child: part 2a respiratory assessment’, Paediatric Nursing, 18(9), pp. 38-44. Aylott, M. (2006b) ‘Observing the sick child: part 2c respiratory auscultation’, Paediatric Nursing, 19(3), pp. 38-45. Barnes, K. (2003) Paediatrics: a clinical guide for nurse practitioners. Edinburgh: Butterworth-Heinemann. Bickley, L.S. (2009) Bates’ guide to physical examination and history taking 10th edn. Philadelphia: Lippincott Williams & Wilkins. Burns, C., Gray, M. and Henry, R. (2008) ‘The development, dissemination and evaluation of written information as a component of asthma management for parents of children with asthma’, Neonatal Paediatric and Child Health Nursing, 11(3), pp. 9-12. Bush, A. (2007) ‘Diagnosis of asthma in children under five’, Primary Care Respiratory Journal, 16(1), pp.7-15. Cahill, P. and Papageorgiou, A. (2007) ‘Triadic communication in the primary care paediatric consultation: a review of the literature’, British Journal of General Practice, 57, pp. 904-911. Candy, D., Davies, G. and Ross, E. (2001) Clinical paediatrics and child health. Edinburgh: WB Saunders. Chafer, A. (2003) Communication skills manual. February-July 2003. [Online] Available at: http: www.skillscascade.com/teaching/csManual.doc (Accessed 28th December 2010). Egan, G. (2002) The skilled helper: a problem-management and opportunity-development approach to helping 7th edn. California: Brooks/Cole. Epstein, O., Perkin, G.D., Cookson, J. (2008) Clinical examination 4th edn. Edinburgh: Mosby. Gask, L. and Usherwood, T. (2002) ‘ABC of psychological medicine. The consultation’, British Medical Journal, 324(7353), pp. 1567-1569. Gibbs, G. (1988) Learning by doing. A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford. Gill, D. and O’Brien, N. (2002) Paediatric clinical examination made easy 4th edn. London: Churchill Livingston. Howells, R. and Lopez, T. (2008) ‘Better communication with children and parents’, Paediatrics and Child Health, 18(8), pp.381-385. Kaufman, G. (2008) ‘Patient assessment: effective communication and history taking’, Nursing Standard, 23(4), pp.50-56. Knowles, H. (2004) The biology of child health: a reader in development and assessment. Basingstoke: Palgrave Macmillan. Langewitz, W., Denz, M., Keller, A., Kiss, A., Ruttimann, S. and Wossmer, B. (2002) ‘Spontaneous talking time at start of consultation in outpatient clinic: cohort study’, British Medical Journal, 325, pp. 682-683. Lewis, C.C., Pantell, R.H., Sharp, L. (1991) ‘Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention’, Pediatrics, 88, pp. 351-358. Malty, H.J., Kristjanson, L. and Coleman, M.E. (2003) ‘The parenting competency framework: learning to be a parent of a child with asthma’, International Journal of Nursing Practice, 9, pp.368-373. McChance, K.L. and Huether, S.E. (2006) Pathophysiology: the biologic basis for disease in adults and children 5th edn. St. Louis: Elsevier Mosby. McKiernan, C.A. and Lieberman, S.A. (2005) ‘Circulatory shock in children: an overview’, Paediatrics in Review, 26(12), pp.451-460. Monaghan, A. (2005) ‘Detecting and managing deterioration in children’, Paediatric Nursing, 17(1), pp. 32-35. Munson, E. (2007) ‘Applying the Calgary-Cambridge model’, Practice Nursing, 18(9),

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