Lecture Notes - Pharmaceutical Care and Communication Skills PDF

Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Basics for Development DAVID DUNNING AND JUSTIN KRUGER RESEARCH WAS INTERPRETED TO DK EFFECT ( 6 STAGES)...

Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Basics for Development DAVID DUNNING AND JUSTIN KRUGER RESEARCH WAS INTERPRETED TO DK EFFECT ( 6 STAGES)....................... 1 PROFESSIONAL DEVELOPMENT = (CXC)R............................................................................................................... 2 JOHARI WINDOW................................................................................................................................................. 3 FEEDBACK.................................................................................................................................................................... 4 LEADERSHIP THEORY OF 5 STAGES....................................................................................................................... 7 LISTENING SKILLS AND EMPATHY.................................................................................................................................... 10 BASIC COMMUNICATION (2) MEHRABIAN THEORY.............................................................................................12 A) 55% VISUAL & THE NONVERBAL COMMUNICATION....................................................................................................... 12 B) VOCAL COMMUNICATION 38%.................................................................................................................................. 15 C) VERBAL COMMUNICATION 7%................................................................................................................................... 16 MOTIVATIONAL INTERVIEWING..........................................................................................................................16 PERSONAL TAILORED COMMUNICATION.............................................................................................................19 David Dunning and Justin Kruger research was interpreted to DK effect ( 6 stages) a cognitive bias in which people of low ability have illusory superiority and mistakenly assess their cognitive ability (Skills , Knowledge) as greater than it is. However, a topic for advance course to explain What David Dunning and Justin Kruger research was. 1  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Ref: Kruger, Justin; Dunning, David (1999). "Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments". Journal of Personality and Social Psychology. 77(6): 1121-1134. doi:10.1037/0022-3514.77.6.1121 What do Tantalization mean in professional context ? Professional Development = (CXC)R (Competence X Commitment)(Behaviour + Attitude) Competence = Knowledge + Skills Knowledge = Knowing + Understanding, formal education. Skills = Doing it + Practicing it, experience. Commitment = Motivation + Confidence Motivation = Enthusiasm (Internal + external) + Moral Satisfaction. Confidence = Self-awareness + Believes + self-assurance. Basic Communication Skills 2  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Johari Window Your Self Yes (known) No (Unknown) Yes (known) Others No (Unknown) 3  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Feedback The Feedback is the process that ensures the receiver has received the message and interpreted it correctly as it was intended by the sender. It increases the effectiveness of the communication as it permits the sender to know the efficacy of his message. On the other hand, It can be a kind of helpful information or criticism that is given to someone to say what can be done to improve a performance, product, etc. Barriers of delivering feedback It’s difficult to seek or give feedback because We: 1. Un-awareness of its value and impact. 2. Lack of knowledge and skills of both seeking and delivering feedback. 3. Believe that the other person cannot handle the feedback. 4. Have had previous experiences in which the receiver didn't change or was defensive to feedback. 5. Worry that the other person will not like you. 6. Believe that feedback is only negative! 7. Feel the feedback isn't worth the risk! Types of feedback 1. Positive Feedback 2. Developmental feedback (Negative!) 3. Description Feedback. 4. Corrective feedback (warning letters) 4  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Types of feedback receivers A) Feedback: Negative receiver 1. Becoming defensive. 2. Self-Justification. 3. Cannot separate the person giving the feedback from the feedback itself. 4. Volley ball approach (Argue) 5. Excuse, Resist, fight …etc. B) Feedback: Passive receiver 1. Dismissing the information by denying accuracy. 2. Detached 3. Underestimate its value and benefit. 4. Ignore or Forget. C) Feedback: Assertive receiver (positive) 1. Accepting and praising when it is given. 2. Being open and engaged. 3. Accepting feedback without denial. 4. Being sincere. 5. Respecting the speaker. 6. Active listening to the message. 7. Probing for better understand, if needed. 8. Double check your understanding. Tips to Deliver a feedback 1) Clear about what you say. 2) Specific, cases & examples. 3) Behaviour not the person. 4) Observation not intention. 5) Description not Judgment 6) ‘I’ statements for opinion 7) Self-discovery better than pointing. 8) Guidance better than advice. 9) Future-focused Not simply pinpoint critic; Suggests future action Don’t dwell on the past. 10) Encouraging Before you speak THINK True, Helpful, Inspiring, Necessary, Kind. 5  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills De elopmental feed ac ega e Levels of Self Expression X Person is bad. X Person behaved in bad way. X Person at y situation behaved in bad way. In my opinion X Person at y situation behaved in bad way. X person behaviour is Not Good …………… In my opinion, I see the behaviours of the x person are good in the following xyz, to be even better, I hope to receive so and so from x person behaviour … (where so and so is the positive side you would like to receive from x person). 6  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Leadership theory of 5 stages STOP!!!! By: John Maxwell American author, speaker, and pastor. a Doctor of Ministry degree at Fuller Theological Seminary Books … Development The 5 Levels of Leadership, Centre Street- 2011 Developing the Leader Within You, Thomas Nelson, 1993 (Repackaged 2001) Developing the Leaders Around You, Thomas Nelson, 1995 (Repackaged 2003) The 21 Irrefutable Laws of Leadership, Thomas Nelson, 1998 The 360° Leader, Thomas Nelson, January 2006 - 1 of Executive Book Summaries 30 Best Business Books in 2003 Leadership Gold: Lessons I've Learned from a Lifetime of Leading, Thomas Nelson–March 2008 Success related books Your Road Map for Success, Thomas Nelson, March 2002 (Orig. titled: The Success Journey, Thomas Nelson, 1997) How Successful People Think (originally published as Thinking for a Change), Centre street. June 2009 Communication related books Everyone Communicates, Few Connect: What the Most Effective People Do Differently, Thomas Nelson- 2010 Winning with People, Thomas Nelson, December 2004 - 1 of Executive Book Summaries 30 Best Business Books in 2005 The 15 Invaluable Laws of Growth, Centre Street- 2012 The 17 Indisputable Laws of Teamwork, Thomas Nelson, August 2001 7 Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills 8  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Level 1 — Position The lowest level of leadership—the entry level. After all, anyone can be appointed to a position! While nothing is wrong with having a leadership position, everything is wrong with relying only on that position to get people to follow. Hint: People who remain on the position level may find it difficult to work with volunteers. Why? Because position does not automatically result in influence, and volunteers are aware that they don’t ha e to follow anyone. They truly only follow if they want to. Furthermore, difficult to impact on non-job-related issues. But the news is not all bad about this level. It is a prime place for you to begin investing in your growth and potential as a leader. Level 2 — Permission Level 2 is based on relationship. At this level, people choose to follow because they want to. In other words, they give the leader Permission to lead them. Level 2 is where solid, lasting relationships are built that create the foundation for the next level. Level 3 — Production The best leaders know how to motivate their people to GTD – get things done! And getting things done is what Level 3 is all about. On this level, leaders who produce results build their influence and credibility. People still follow because they want to, but they do it because of more than the relationship. People follow Level 3 leaders because of the record of accomplishment. Level 3 leadership still need to do the things that make Level 2 happen. They just add Level 3 strategies to the mix. And as they become effective at Level 3, they are ready to layer on the goals of the next levels. Level 4 — People Development Level 4 can be summed up in one word: Reproduction. Your goal at this level is to identify and develop as many leaders as you can by investing in them and helping them grow. The more you raise up new leaders, the more you will change the lives of all members of the organisation. As a result, people will follow you ecause of what you’ e done for them personally. And as an added bonus, some of those mentoring relationships are likely to last a lifetime. 9  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Level 5 — Pinnacle The highest level of leadership is also the most challenging to attain. It requires longevity as well as intentionality. You simply can’t reach Le el 5 unless you are willing to in est your life into the lives of others. But if you stick with it, if you continually focus on both growing yourself at every level, and developing leaders who are willing and able to develop other leaders, you may find yourself at the Pinnacle. Level 5 leaders often transcend their position, their organization, and sometimes their industry. Listening Skills and Empathy Hearing = Ear function to receive sounds. Listening = pay attention (Ear and Mind) in order to hear. (Perceiving, paying attention, remembering) Active Listening = Hence its name, it is to activate your listening. Responsible Listening = Take responsibility. Active Listening = Hence its name, it is to activate your listening: Repeating: use exactly the same words. Rephrasing: repeat with synonyms Paraphrasing: Rendering by expressing the meaning with different descriptions or summarising. Reflecting: Rendering by using your own word with emphasis the emotional dimension. Empathy vs Sympathy! what are the differences ? Responsible Listening: take responsibility - React (+ve & favourable) to your active listening, By implementing good actions. LISTEN Look interested – Relax, smile, eye contact, remove all kind of distraction. Involve yourself by 2 pathway communications. Stop talking, opposing, assuming, jumping, interruption. Stay on target. Test your understanding Empathy ; put yourself in spea er’s shoes Neutralise your feelings 10  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Example of asking for patient’s feedback: “I want to e sure I ha e explained things clearly. Please summarize the most important things to remem er a out this medicine.” “How do you intend to take the medication?” “Please show me how you are going to use this nasal inhaler.” “It is important that I understand that you now how to ta e this medication. Now when you get home, how are you going to take this medication?” “Describe in your own words how you are going to ta e this medication.” Tips, Steps for Receiving Feedback 1. Agree on a time and place for the session that will help you feel at ease and enable you to concentrate on the feedback. Be specific; ask for feedback on specific issues, as: I may receive your feedback on my English vocabulary Or Grammar, Or Results, Method …etc. 2. Plan how you will be open to the feedback. If you think you might get upset, consider strategies for staying calm. Focus on what you want to learn from the feedback and write those objectives down. Separate the person giving the feedback from the feedback itself. 3. Stay open to the feedback given. Resist the urge to justify your behavior. Take notes if this helps you focus on what is being said. Work hard at understanding the other person's point of view. Use active listening techniques, such as rephrasing what you've heard or asking questions for clarification. 4. Clarify the context from your perspective. If necessary, provide a differing description of the event, or offer details that the giver doesn't have. Keep in mind that the purpose of the feedback is to improve your performance. 5. Decide what you can learn from the feedback. Don't overreact; consider the feedback and requests. Assess the giver's intention and the validity of the feedback. a) Does the giver want to work with you to help you improve? b) Does the giver have any direct control over your work? c) Have you heard this feedback before, from someone else? d) Does this person have knowledge about you and your situation? e) What facts can you agree on? f) What can you improve for next time? g) 11  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills 6. Consider your options for responding, then decide on an action. You can: Accept the feedback and also you can Decline it! 7. Describe your commitment and time frame. Include the reasoning behind what you believe you cannot accomplish. 8. Thank the other person for the feedback, and ask for his or her support in helping you achieve the goal. Basic Communication (2) Mehrabian theory Mehrabian theory ‘Three V’s of communication Ver al, Visual and Ver al’ Figure below shows the Mehrabian formula, Total acceptance (liking) = 55% Visual + 38% Vocal + 7% Verbal. To build Rapport with the patient. Mehrabian Formula for liking in human communication A) 55% Visual & the Nonverbal communication Proxemics (the use of space) kinesics (body movement) Oculesics (eye contact) Olfactics (smell) Chromatics (colours) Haptics (touch) and silent. A. 1) PROXEMICS It is the study into how people physically place themselves in relation to other people and objectives. The structure and use of space, is a powerful nonverbal tool. Applying these ideas in real life situations can really help produce the desired functions of a space e.g. creating spaces for social conversation, negotiation, or collaboration 12  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills A-1.1 Using the office space Communication channels Communication channels = N (N-1) / 2 Where N is the number of persons. A-1.2 Using distance zones 13  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills A.2) KINESICS The manner in which you use your arms, legs, hands, head, face, and torso. As a health care professional, you need to generate a feeling of empathy and commitment to the helping of others. It is apparent, therefore, that your body movement or kinesics should complement this role. 14  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills B) Vocal communication 38% Volume / Clarity and Variety: Tone = a particular quality, way of sounding, modulation, or intonation of the voice (Rhythm) Pace = speed which somebody speaks (Rate of delivery) Pitch = rate of vibration of the vocal folds Emphasis, Stress or Articulation (Power): "I didn't tell the patient you were wrong." (Somebody else told the patient.) "I didn't tell the patient you were wrong." (I emphatically did not.) "I didn't tell the patient you were wrong." (I implied it.) "I didn't tell the patient you were wrong." (I told someone else.) "I didn't tell the patient you were wrong." (I told the patient someone else was wrong.) "I didn't tell the patient you were wrong." (I told the patient you're still wrong!) "I didn't tell the patient you were wrong." (I told the patient something else about you.) I did not tell the patient take this medication three times a day. I didn’t say the hospital service was bad. 15  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills C) Verbal communication 7% Patient will not remember what you say... the patient may remember how did you say it. However, Professional pharmacist should use professional and scientific vocabulary. To build Rapport with the patient. Emotional Fulfilment: Gi ing your customer ‘the experience of eing understood.’ Rational Fulfilment: Sharing knowledge & facts / product specifications and information. Rapport Relationship Established quickly. Long-term effort. Based on the immediate interaction Based on common experiences or other connections and how you behave. between people. Rapport + consistency = Trust. Match and Mirror to build rapport If the customer (patient, provider, friend, manager You might… …etc) Makes a large gesture with his arm. Make a similar, smaller gesture. Talks quickly and with great passion. (or vice versa) Subtly match his pace and level of enthusiasm. Shifts from leaning left to right. Lean the same direction, either matching or mirroring. Nods a lot. Nod occasionally. Makes eye contact frequently. Mirror the level of eye contact the customer uses. Motivational Interviewing 1) Definition/ 2) Principles/ 3) Strategies/ 4) Techniques and approaches/ 5) Change formula 6) example of resistance 7) levels of training. 1) Definition & Background: Motivational interviewing is an intervention designed for situations in which a patient needs to make a behaviour change but is unsure about it, sometimes to the extent of being quite hostile to the idea. The first paper on MI, written by a psychologist in New Mexico called Bill Miller in 1983, tackled this issue, and was rooted in his own clinical practice. In summary Bill Miller suggested that rather than seeing patient’s Alcoholic denial as poor willpower or lack of motivation to solve the problem, it might be more helpful to see this outcome as a product of the situation in the counselling session. When we confront anyone with something, we are likely to increase their resistance and hear them argue the opposite side. 16  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills These ideas started to circulate, and came to the attention of Stephen Rollnick, a clinical psychologist originally from South Africa but then working in (Addictions) in the UK. A commonly used definition of MI is: ‘A goal directed, patient-centred counselling style for eliciting eha iour change y helping patients to explore and resol e am i alence.’ Rollnic and Miller, 1995 (Note **Goal directed is better than the originally written definition directive). 2) Principles of Motivational Interviewing: 1 Principle 1: don’t tell people what to do. People do what they want to do in most cases, they rarely do what they have been told to do 2) Principle 2: listen is more important than talking 3) Principle 3: let the patient tell you they need to change ‘People elie e what they hear themsel es say’. Blaise Pascal noted that: people are much better persuaded by reasons they think up themselves than those thought up by others 4) Principal 4: cognitive dissonance People are struggling with a choice about changing, which is making them feel uncomfortable 5) Principle 5: Most people need to feel confident before trying to change Someone will feel confident and are much more likely to succeed. Mi is explicit about the need to keep morale high 6)Principle 6: Ambivalence is normal 3) Strategies in Motivational interviewing The strategies of motivational interviewing are more persuasive than coercive, more supportive than argumentative The four principle strategies of MI are: 1. Get a conversation going - express empathy through reflective listening. 2. Develop discrepancy between a patients' goals or values and their current behaviour. Develop discrepancy between patients' goals or values and current behaviour, helping patients recognize the discrepancies between where they are and where they hope to be. 3. Avoid argument and direct confrontation and adjust to resistance rather than opposing it directly. 4. Support self-efficacy and optimism; that is, focus on patients' strengths to support the hope and optimism needed to make change. 4) Techniques and approaches OARS Technique/ Approach Open Questions (Not simple the WH questions VS the Module questions. Affirmations (to make statements of recognition of patient strengths) 17  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Reflective Listening Summaries FRAMES Technique/ Approach Feedback regarding personal risk, which is given and usually includes normative (descriptive) of implications Responsibility for change is placed squarely and explicitly with the individual. Patients have the choice to either continue their behaviour or change it. Advice about changing is clearly given in a non-judgmental manner. It is better to suggest than to tell. Asking patients' permission to offer advice can make patients more receptive to that advice. Menu of patient self-directed change options is offered. Empathic counselling, showing warmth, respect, and understanding, is emphasized. Self-efficacy or optimistic empowerment is engendered in the person to encourage change. 5) Change Formula: Equation of Change D*V*F Change = R+C+1 D = Dissatisfaction with how things are now, i.e. the Need for change V = Vision of the new status F= First, concrete steps that can be taken towards the vision R= Resistance of change C= Cost of change or change requirements Note the original theory Gleicher, Dannemiller , Beckhard-­­Harris D x V x F > R 18  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills 6) Examples which indicate a resistance mood: There are many examples of resistance talk, many of which you will be familiar with: Disagreeing. “Yes, ut...” Discontinuing “I’ e already tried that.” Interrupting “ ut...” Side-tracking “I now you want me to do my airway clearance, ut did you notice I gained 5 pounds? You ha e to admit I’ e een doing a great jo with my weight ” Unwillingness “I don’t want to ha e to do that as well” Blaming “It’s not my fault. If only my parents...Or if the go ernment Or if the Dr …etc” Arguing “How do you now?” Challenging “Well the medication doesn’t ma e a difference to MY lung functioning” Minimizing. “I’m not that sic ” Pessimism. “I eep trying to do etter ut nothing seems to help.” Excusing: “I now I should eat more calories, ut with my jo I’m always on the go and it’s hard to prepare and then sit down for a ig meal” Ignoring. 7) Six levels of training 1. Introduction to MI – Experience the bases of MI and decide level of interest in learning more 2. Application of MI: To learn one or more specific applications of MI 3. Clinical Training: To learn the basic clinical style of MI and how to continue learning it in practice 4. Advanced Clinical Training: To move from basic competence to more advanced clinical skillfulness in MI 5. Supervisor Training: To be prepared to guide on ongoing group in learning MI 6. Training for the Trainers: To learn a flexible range of skills and methods for helping others learn MI Personal tailored communication Section will be moved to final year students, i.e. graduated students. For successful rapport building through matching and mirroring it is fruitful to understand how patients descri e their medication indi idual patient’s trait, preference and perception For example; patient memorised the actual names of medication, or described the physical appearance (as colour or shape) or referred to the name of health care providers, or name of places or the purpose of medication … etc. 19  Dr Mohanad Odeh: lecture notes – Pharmaceutical care and Communication skills Moreover, for advanced skilled practice: special concern should be there also to understand the insight of patient’s and the cogniti e orientation intro erted1 or extroverted2 approach) as well as patient attitude toward receiving information (intuition3 or sensing4). 1 - Inward, the personal energy moves from outside to inside, Need Privacy, tend to receive actions and avoid starting communication, preference for inner self and ideas to understand and protect or nurture it, find people draining, less people interaction. 2 Outward, the personal energy moves from inside to outside, need people and communication more than privacy, tend to start and initiate actions with others, preference for the outer world and one's own action and effect on it, find people energising, more people interaction. 3 See the big picture with imagination and framework. Interpreting patterns, possibilities and meaning from information received. 4 - See the details, with realistic down to earth facts. focusing on facts within information. 20