communications skills .pdf

1 COMMUNICATION SKILLS Patient centered view of medication use process Medication use process begins when the patient perceives health care or there is health related problems. Now How it begins: -Step1 : perception process: perception of health problem by the patient could be different from patient...

1 COMMUNICATION SKILLS Patient centered view of medication use process Medication use process begins when the patient perceives health care or there is health related problems. Now How it begins: -Step1 : perception process: perception of health problem by the patient could be different from patient to other and the perception could be vary like self-limiting ; transient; painful; disabling. The factors that may effect type of perception include: 1) Psychological factor 2) Social factor; which will effect the interpretation of perception. This interpretation will depend on: A. Previous experience with such problem B. Family influence C. Culture influence D. Personal motive & goal After perception of health problem by the patient the next step will be patient's action - Step2 : Patient Action at this step patient will do either A) Not take any action. Since patient either consider his health problem as minor or the patient lack to initiate action or treatment B) Take an action. The patient's action could include either 1- Start self treatment 2- contact non medical provider like faith healer 3- Contact with health provider like physician or pharmacist or Nurse. and here the communication will start - Step3 : Patient communication will start by patient description of his symptoms to the health care provider to make diagnosis. Diagnosis will be made depending upon : A- Patient report of symptoms B- Physician skill to elucidate diagnosis from symptoms C- Utilizing additional diagnosis tools like examination & lab data After that diagnosis will be made and recommendation to the patient from health provider will include either to start non pharmacological treatment like surgery or pharmacological treatment. - Step4 : patient response to recommendations; which include A- will not carry out recommendation that may be due to 1- Economical constrains of communication) 2- lack understating the goal of treatment ( represent failure 3- Psychological factor like (fear) COMMUNICATION SKILLS B- Will carry out recommendation : patient will do his best to reach goals of treatment but there will be some errors. For pharmacological treatment; errors will represent medication errors that could be due to A- Missing dose B- patient self modification of regimen without knowing the goals C- patient non adherence to therapy and cutting off - Step5 : Fate of the medication use Process A- Interruption which may be due to: 1- Failure to get contact with health provider. but when patient get contact will start again on management Ex: like patient with chronic medication of CVS drug for hypertension or angina, they will change medication or continue medication for along time without re monitoring his blood pressure or hasten to get response and change his physician 2- Some time patient get contact with health provider but he will not convey the information in well framed form. Or physian will fail to build safe , confident relationship with patient. After getting a contact with health provider; the management either will be changed by provider or patient Continue same management. From this medication use process we conclude that: 1- Decision of health provider is small part of the process. 2- Patient activity represent that major component of the process 3- Patient & provider could make parallel decision making with sporadic communication 4- Some time there was incomplete or unfinished communication process leading to failure of treatment. Pharmacist responsibility in patient centered communication process 1- Establish ongoing relationship with patient to exchange information necessary to assess your patient health condition. To make a decision on effective treatment plan and effect of treatment on patient quality of life. Generally pharmacist responsibility was greatly changed from medication centered to patient centered. That ensures safe and effective drug treatment; which not required only dispensing treatment but also participation in activities that enhance patient adherence and wise medication use which requires pharmacist to develop a trustful relationship with patient which in turn helps to reach to optimum therapeutic goal. This requires effective communication activity. Also there is some programs are used to teach the patients how to be more assertive in obtaining information from health provider Ex: Patient should make sure he can read the physician hand writing since if the patient can't read it pharmacist will can't. Also Patients should encourage to share their experience during taking therapy since: 2 COMMUNICATION SKILLS 123456- Patient has a lot un answered questions Patient may misunderstand the goal of therapy Patient may experience problems related to therapy Patient may experience monitoring his own response to the treatment Patient made his own decision related to the therapy Patient may not reveal his own information unless you initiate the dialogue. Principles & Elements Of Interpersonal Communication Communication Size or Types 1- Broad Spectrum Media like Mass Communication via TV, Radio 2- Large group like by lecture or Speech 3- Small group like committee meeting and Discussion group 4- Person to person or Interpersonal communication " most occur in pharmacy practice" Interpersonal communication Is best described as messages generated &transmitted by one person and subsequently received & translated by another one. Element of interpersonal Communication Model 1- Sender : represents who the create & transport to another person 2- Message : is the element transported from one person to another; it could be thoughts, ideas emotions, information or others. Method of transporting of message A- Verbally or by talking like speech B- Non verbally like facial expression , hand gesture , body expression like attitude ,lokking down shyness, pit of voice. Non verbal component represent 55% of message sent 3- Receiver: like health care practitioner including physician , pharmacist, nurse. The receiver will decode the message and assign the particular meaning of it. He will decode verbal & non verbal component of message. 4- Feed Back: is process where by receiver communicate back to the sender their understanding of senders' message. The feed back message also will consist of verbal & non verbal components, and represent how the senders' message was interpreted or translated. the process of ( Send –Receive- Send ) is called feedback loop. The feedback message could be simple like just head nodding or complicated like repeating a set of instruction to ensure you interpret thesenders' message correctly. Point of failure in feed back loop when there is a negative(no) response to senders' message or sender failed to ask response. 5- Barriers of message send & transport: interference or barriers will affect accuracy of communication exchange. Such barriers like noise that will effect message perception and understanding. 3 COMMUNICATION SKILLS Personal Responsibility in communication model A- Sender responsibility: is to ensure the message transmitted in clearest form (i.e.) understood by receiver in an environment conductive to clear transmission. To make ensure about that by asking for feedback and clarify the misunderstanding. B- Receiver responsibility: is to listen to what was transmitted by sender & ensure accurate communication by sending feedback message otherwise misunderstanding will occur. Critical component of interpersonal communication is assigning meaning of message by receiver. How to assigning meaning by: 1- Search word & their context: since words sometime give more than one meaning, or bad spelling due to speeching difficulty (like in stroke patient), or language difficulty cause miss understanding. And here the assigning depends on receiver experience & efforts Ex: Foot ball ( USA) = rakby UK= soccer Lift (USA) = ‫يرفع او يركب‬ (Uk) = ‫مصعد‬ Ex: patient with UTI advised to take a lot of fluids? Problem is what the meaning of a" lot of" is it a glass or more. And also what he meant by fluid is milk, juices, coca cola , water. so it should send another feedback to clarify that to patient even the patient did not ask to. 2- Search Congruence between verbal & non verbal message: Like facial expression when a patient is suffering from a certain pain while talking. since the final message is what you can understand from message. 3- Preventing misunderstanding: key to prevent misunderstanding is anticipate how other people may translate the message. And we can anticipate that by using feedback message through A- Use questioning to ensure that receiver or feedback receiver is under standing like ex: when you ask patient in the pharmacy about a drug hypersensitivity he may answer no I just has a lot of sneezing. B- Use feed back reply to check meaning assigning. like to ask patient to repeat instructions that you are already filled to him to check weather there was or not any mis understanding. 4- Perception of meaning of message: Perception is interpretation of verbal and non verbal components sent through the message of sender leading to understanding of the mean of message. To improve perception you should avoid communication obstacles weak hearing, noise and already patient perception like about pharmacist as they are only busy people who concern about dispensing medication and taking their money. To avoid MisPerception by: A- Learn as much as about patient background B- Be with patience and with good attitude. you will amazing at the opportunity that crop upto help one another C- Talk about your differences and don't patronize. 4 COMMUNICATION SKILLS The summary the best technique used to avoid misunderstanding and assigning meaning is by using feedback message send. Ch3. Nonverbal Communication It involves a complex mix of behaviors, psychological responses, and environmental interaction through which we consciously or unconsciously relate to another person. It differ from verbal communication in that the medium of exchange is neither vocalized language nor written word. It represents 55-95% of communication sources. Awareness & skilled use of your nonverbal abilities can make the difference between fulfilling, successful interpersonal relationships & frustrated non productive interaction. Non verbal communications are unique since: 1- They mirrors innermost feeling &thoughts. 2- Is difficult, if not impossible, to fake during interpersonal communication. 3- It should be consistent with verbal communication otherwise people will be suspicious from you meaning intended in the message.(lack of congruence) Non verbal components may be referred as (cues) within message. And may transmitted like a clusters (combinations) Elements of Nonverbal Communication 1- Kinesics: represents the manner in which you use your arms, legs, hands, head, face and torso. To make an expression that may have a dramatic impact on the messages that you sends. Like hand shaking ( non verbal meaning is acceptance or body bow means you are welcomed by Japanese.) As health care professional : you needs to generate a feeling of empathy and commitment to the helping of others. Body movement like posture may be involved in this role.To make sure you may send good impression through your kinesics. You should ensure the following: 1- Varied eye contact ( consistent, but not stare) 2- Relaxed posture There were two type of body stance (posture) A- Open stance : in which full body frontal is appeared to another person (it good posture for communication) and your hands & leg are not crossed B- Closed stance: like arm folded in front of your chest or leg are closed, face with complex expression it cues that you are interesting with patient talk and this may lead to limit or stop dialogue or communication. 3- Appropriate comfortable gesture 4- Frontal appearance ( shoulder square to another person) 5- Slight lean to ward the other person 6- Erect body position ( head up , shoulders back) 5 COMMUNICATION SKILLS 2- Proximics : It is the distance between two interacting persons, it plays important role in non verbal communication and they found that the quality of interactions can vary depending upon distances between communicators. They found that each body has reserved the most protected space or zone with diameter of 18 inches. Some people may feel with anxiety when the other become closer than that like in crowded elevators ( tend to apologize when touch other). And patient be more comforted if you do not invade his zone , but in some instant he may allow you to be within his zone for listening the private instruction like about vaginal inserts or rectal suppository. 3- Environmental nonverbal factors : Like colors , lighting, space occupying all effect the quality of non verbal communication also dirt ,smell, untidiness, bad appearance ( especially in pharmacy may negatively effect communication). 4- Distracting factors Most distracting non verbal communication are: A- Lack of eye contact: Is frustrating to talk to somebody who is not looking at you. Good eye contact does not mean that you continuously stare at patient because that may make them uncomfortable. The key is that you spend most of time looking at them. B- Facial Expression: is damaging if your expression are inconsistence with verbal expressions C- Body position :it project your sincere desire to talk with patient D- Tone of voice: Avoid threaten tone, load voice, shouting and dull voice , but use empathic tone of voice. Detecting Non-verbal cues in other Here some tips and tactics to help in that: 1- Watch your patient before engaging in aconversation: 2- Discuss sensitive issues with clarity and avoid potential frightening scenarios: 3- Be cognizant of potential of non adherence especially if the drug use for sensitive situation. 4- Filter the meaning of non verbal message and avoid making false assumption or conclusion. 5- Try to overcome any miss understanding, anger, embarrassment by simple smile and soft voice. CH4: Barriers to Communication Obstacles that constrain the message transmission &/or feedback through effecting message meaning assigning; rendering interpersonal communication less effective to gain the required goals. Minimizing Communication barriers typically required a two stage process: 1- You should be aware that barriers are exist 6 COMMUNICATION SKILLS 2- Take an appropriate action to overcome them Environmental Barriers These could be obvious or subtle. A. One of most obvious barrier in community practice; is the height of prescription counter separating patient from pharmacy personnel. They act as barrier of effective communication by the following effects: 1- Prevent seeing the personnel worker by the patient (especially if they are so high). 2- They may intimidate some patients & inhibit communication because pharmacist is standing over them. 3- Type environment will sound like pharmacist does not want to talk with patient. Correction of this barriers: by lower counter height or provide area with lower height so that patient and pharmacist within eye level which facilitate patient – pharmacist interaction. B. Noisy crowded prescription area like due to music, patient talk. These may interfere with ability to listen to the patient or transmit of message. They also effect communication with physician through phone call. Solution: try to treat cause of noise and or provide a calm area for private conversation. Like by use glass partitions, planter, or a division gives the patient privacy. One approach to remove environmental barrier is to detect them from patient point of view. Where the patient will raise some questions by him those questions represent potential environmental barriers.by checking. 1- Is pharmacist visible? 2- It is easy to get pharmacist's attention 3- Does it appear that pharmacist wants to talk to patients 4- Is prescription area conductive to private conversation? 5- Do you have to speak to the pharmacist through a third party 6- Is there a lot background noise or are there distractions. Personal Barriers A12345- Potential pharmacist-related personal barriers low self confidence shyness dysfunctional internal dialogue lack of objectivity cultural differences like: Definition of illness (some patients may not perceive them self to be sick Perception of what to do when ill ( some culture stress self-reliance rather than seeking help Health related habit (eating habits) Health seeking behavior (more reliance on folk medicine) Perception of health care provider (like distrust health care system due to past negative experience) 7 COMMUNICATION SKILLS 6- discomfort in sensitive situation 7- Negative perception about the value of patient interaction. Unfortunately people do not realize that communication skills can be learned & developed and they required practice & positive reinforcement with avoiding or overcome negative reinforcement of negative communication. B- Patient related personal barriers: Negative perception by patient to ward health care provider make communication difficult and may lead to management failure. Such perception like 1- Feeling untrustworthy 2- Perception of health care is impersonal 3- Perception that they treated as a case not as person 4- They failed to understand the severity of their illness or anxious about their condition 5- Frustration when nobody give the full information about their condition or use of medications Administrative Barriers: 1- Most community practitioner considers patient education as expensive service and not as high priority. 2- Pharmacies work policies discourage pharmacist patient interaction and deter counseling. 3- Using of machines to dispense, label, or count prescription may also deter better communication with patient. 4- Subtle barrier is pharmacist's desire to answer every phone calls. 5- Reduced no of staff may inhibit patient counseling. Time Barriers: 1- Like during crowded or many prescriptions on counter to dispense 2- Like when patient not ready to hear or starting a new dialogue ( mother spent 3 hours in physician room discussing case of her children) This could be solved by Using short notes or written notes about use of medication. 8