Consultation and Communication Skills

In the best traditions of scientific endeavour, they were subject to a barrage of audits and studies to see how they actually performed. As in any new project there were inevitable protagonists and detractors and the initial results of the first eight studies were extremely positive. (Legge 1997) the accumulative results of the initial studies showed that nurse prescribing had been proved in terms of safety, efficacy and improved working practices.

The reports did not make any comment upon the cost-effectiveness of the prescribing as the cohort studied was too small for statistical analysis. The head of the evaluation team (Prof. Luker 1997) commented that at best, nurse prescribing should be cost neutral - why should it be any cheaper?

By 2000, the first comparative studies were emerging with sufficient cohort size to give a meaningful evaluation of the scope and efficiency of nurse prescribing. Venning (et al 2000) compared efficiency and cost of a cohort of nurse prescribers with doctors in the same geographical area. The study cohort was over 1,300 patients.

This particular study was extensive in its analysis and many of the results are not particularly relevant to the subject of this essay, but the significant outcomes showed that there was no significant difference in health outcome, prescribing patterns or prescribing cost. Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. (Little et al 1997)

Consultation and communication skills

Empowerment and education of patients is now well recognised as an important goal but most healthcare professionals. (Richards 1999) it follows that if patients are to be involved then their particular priorities must be ascertained and addressed, usually in the mechanism of the consultation. A frequent finding in many of the studies on the subject is the fact that patients tend to prefer prescribers (nurses or doctors) who listen and also allow them to discuss their problems in an unhurried fashion. (Editor BMJ 2000)

This essay is particularly directed to the issue of consultation skills in relation to nurse prescribing. Although we have briefly examined the overall issues of nurse prescribing, the consultation is obviously the core skill required to establish the diagnosis and therefore the appropriate treatment and prescription. Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. (Richards 1999)

Many authorities (Butler et al 1998) advise that the prime skills associated with the prescribing process are:

Adequate exploration of the patient's worries

Adequate provision of information to the patient regarding the natural processes of the disease being treated

The