Following further discussion, Ronnie and the practice nurse agree a way forward. The nurse writes this up in her notes, which include:
- Ronnie agrees to take amlodipine as it is prescribed once per day in the morning, making it easiest to remember.
- Ronnie will have a return appointment in two weeks to have his BP re-checked. In the meantime, Ronnie will keep a diary of when he’s is taking his tablets.
After the consultation with Ronnie, the nurse reflects on how the discussion went. Reflecting on practice can help nurses make sense of their work and, ultimately, improve care. The nurse decides not to address any lifestyle interventions at this stage. Instead, her focus is on building a therapeutic relationship with Ronnie.
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Pulse point
You will find further useful information on reflection on the NMC website.
The nurse reviews her practice by filling in a Reflective Accounts Form
Nursing Midwife Council
Reflective Accounts Form
Reflective Account
What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?
A patient with possible non-concordance attended, for which I had to be very aware I handle the situation carefully, There were many reasons he might be non-concordant with previously prescribed medicines, and I had to bear in mind he was within his rights not to take his medicines – assuming there were no concerns about his capacity.
There were many reasons in his life where there was some difficulty – financial difficulties, low mood, and some work-related stress – leading to possible low motivation for him to look after his health. So I was aware I would need to explore these with him in order to provide good care.
I was worried about this person’s risk of developing real and long-term cardiovascular problems if I couldn’t help him, if he was willing to accept this, understand the degree of risk versus the relatively smaller problem of helping him treat his hypertension.
What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?
There are many and varied reasons why people don’t take their medicines – and it isn’t always intentional.
Exploring health beliefs and attitudes involves helping people to identify these themselves.
This is a very worthwhile – but sometimes challenging – clinical activity.
I think that this patient went away from this encounter with more insight that he came into it! And I felt like I’d really learned something valuable!
How did you change or improve your practice as a result?
I did a literature search on concordance and read through the most recent NICE guidance, and from that I wrote down the most important and relevant practical steps to take when dealing with possible concordance issues.
I have started the Motivational Interviewing Learn Pro modules and will then start the Alcohol Brief Interventions module.
Most importantly, I have made this an important part of my attitude – to not assume concordance and make time to explore it in a way that avoids communicating blame, in a non-judgemental way.
How is this relevant to the code?
Select one or more themes: prioritise people – practise effectively – preserve safety – promote professionalism and trust
prioritise people
practise effectively
preserve safety
promote professionalism and trust
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Page last reviewed: 17 Sep 2020
