Patient Management and Clinical Decision Making

Details

Title

Patient Management and Clinical Decision Making

Type

Stage One

Module code

HPE403

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge in taking a relevant, focused history, performing a limited but focused clinical examination. They will utilise their clinical decision-making skills as they work in partnership with patients and carers with increasingly complex issues and in increasingly challenging circumstances, exercising these higher-level clinical skills as part of the wider MDT. The Clinical Scientist in HSST will be able to synthesise this information and make appropriate decisions within the scope of practice of a Consultant Clinical Scientist in Reconstructive Science. They should also consistently demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their expert knowledge, often working with patients and their carers with complex conditions and needs, with respect to:

Patient Management

• the need for a relevant and focused examination as appropriate to the role of Consultant Clinical Scientist and the patient population referred to Reconstructive Science services, including:
  • previous surgical and medical history and its implications, e.g. implant placement or radiotherapy treatment;
  • systematic examination following recognised best practice and good scientific guidelines for the relevant patient group, e.g. test extra-oral implants for stability or check/record the primary oncology site for abnormal changes;
  • observation and monitoring for the potential development of pathology at the defect site, e.g. symptoms of recurrent cancer, wound breakdown;
  • appropriate recording of the site, including referral/intervention pathways for patients in the event of pathological change;
• the range and methods of communicating with patients, carers and all members of the health and social care team, including active listening;
• how to overcome barriers to communication, e.g. oral cancer cases where removal of the palatal obturator would inhibit the patient’s ability to speak;
• the physical, psychological and behavioural factors associated with altered body image at different ages;
• the importance of different elements of history, including the role of smoking, occupational, environmental and domestic exposures and combined effects;
• how the patient’s agenda and the history should inform examination, investigation and management;
• how drug treatments can affect the patient physically and emotionally, e.g. dry mouth syndrome;
• the importance of social and cultural issues and practices that may have an impact on health;
• the constraints (including those that are cultural or social) to performing examinations and strategies that may be used to overcome them;
• the needs of patients with respect to their personal and social circumstances, e.g. translator requirements;
• strategies for dealing with patients with specific allergic (e.g. latex) or infection management issues (e.g. MRSA) and their subsequent clinical treatment;
• the limitations of examination, in particular in relation to the role of the Consultant Clinical Scientist and the need for adjunctive forms of assessment;
• when the offer/use of a chaperone is appropriate;
• the importance of continuity of care and a holistic approach to clinical practice;
• the use of behavioural management techniques, endeavouring to control anxiety/fear within the patient;
• the importance of exploring and offering all appropriate treatment options allowing the patient to make an informed decision, respecting the patient’s dignity and choices;
• how to develop multimodal pathways that integrate with the wider MDT;
• how to manage the provision of appropriate facilities to treat the patient, understanding local need, facilities and risk assessment tools to protect patients;
• how to improve the knowledge and effectiveness of clinical services by utilising quality of life tools to engage with the end user, the patient.

Clinical Decision Making

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their expert knowledge, often working with patients and their carers with complex conditions and needs, with respect to:

• the evidence base underpinning clinical decision making and judgements;
• aids to clinical decision making, including technology-based systems and other tools;
• the patient’s and carer’s perception of shared decision making, barriers and enablers, e.g. giving patient choices of treatment, sharing the rationale with them and the MDT;
• models of clinical decision making;
• the application of multiple strands of complex information synthesised into a pathway or treatment plan;
• ethical frameworks that support clinical decision making;
• models for measuring the financial impact of clinical decisions, including the development of new healthcare pathways and assessing outcome vs cost, including: cost-benefit, cost-utility and cost-effectiveness;
• the role of UK professional organisations in supporting the adoption of healthcare treatment and interventions, e.g. Cochrane, National Institute for Health and Clinical Excellence (NICE);
• surgical, dental and medical management to consider when making treatment plans that may involve conflicting situations.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills, often working with patients with complex conditions and their carers, and treating them with compassion and kindness, and will:

Investigative Skills

• consent patients appropriately to any proposed treatment;
• perform relevant examinations, identifying and focusing on relevant aspects of patient history;
• develop experience through clinical practice to recognise when patients need further support or intervention and/or specialist care, including dental, medical, social services, and making the relevant referral;
• identify and overcome possible barriers to effective communication;
• communicate effectively with patients from diverse backgrounds and those with special communication needs, including the use of interpreters where appropriate;
• manage expectations of patients with respect to the findings of clinical investigations, e.g. prostheses in palliative care situations;
• assimilate history using the available information from the patient and other sources, including members of the multiprofessional team;
• recognise and interpret appropriately the use of non-verbal communication from patients and carers;
• facilitate balanced and mutually respectful decision making where values and perceptions of health and health promotion conflict;
• recognise the possibility of deliberate harm (both self-harm and harm by others) in vulnerable patients and the need to report to appropriate specialist staff and/or agencies;
• risk assess vulnerable patients and medically compromised patients prior to treatment;
• actively elicit important clinical scientific findings;
• communicate with empathy, recognising the impact of disease and an altered body image at different ages on all aspects of the patient’s wellbeing and psyche.

Ethical Responsible Care

• protect patients of paediatric age and vulnerable adults from maltreatment, abuse, neglect, or exploitation (safeguarding);
• actively listen to the patient, carers and other members of the health and social care team to improve services;
• advise and communicate effectively with patients, carers, relevant clinicians, other healthcare professionals and the public;
• recognise when effective history taking in non-urgent cases may require several discussions with the patient and other parties over time;
• recognise when to supplement history with standardised instruments or questionnaires, e.g. development of pro-formas for focused assessment/review;
• manage alternative and conflicting views from family, carers, friends and members of the multiprofessional team;
• manage the reconstructive science team to ensure that patient safety, comfort and dignity are maintained at all times;
• maintain focus despite multiple and often conflicting agendas;
• consider the social, cultural and religious boundaries, and appropriately communicate findings and make alternative arrangements where necessary;
• take responsibility for the legal and practical requirement for accurate and contemporaneous record keeping, ensuring compliance with national standards in relation to multifaceted records, e.g. clinical notes, digital data storage, physical models;
• ensure compliance with Resuscitation Council requirements that medical equipment and drugs are available wherever patients are treated;
• synthesise very complex information and relay it in a way that can outline the decision-making process to trainees, other staff and the MDT for reflection and training;
• work within professional boundaries and understand the limitations and need to refer to other members of the MDT.