PHRX 3008 Comm Quiz 1.pdf

Caitlyn Farraday Quiz- 10/3/24 PHRX 3008 Comm Quiz 1 Key Points Verbal & Nonverbal Communication / Empathy: Describe the key features of high-quality verbal communication o Effective verbal communication includes: ▪ Co...

Caitlyn Farraday Quiz- 10/3/24 PHRX 3008 Comm Quiz 1 Key Points Verbal & Nonverbal Communication / Empathy: Describe the key features of high-quality verbal communication o Effective verbal communication includes: ▪ Conversational tone ▪ Easy to understand language ▪ Pauses to check for others understanding o Must remember these points when relaying information to a patient while using a combination of verbal and nonverbal communication o Should avoid passive listening styles with patients and aim to use active or interactive listening depending on the specific situation Distinguish between passive, active and interactive listening styles passive active interactive - Hearing but NOT fully - Hearing and paying - more involvement paying attention attention than active listening - Little to no - Showing - Involves the listener participation comprehension about incorporating what what was said was said into further - Asking questions questions, suggestions - Avoiding interruptions and actions and distractions ★ this style leads to better patient feedback and clinical outcomes Relate the iceberg effect with different listening styles o Top of iceberg = active and passive listening ▪ Patient's questions are not fully addressed and only are seen on the surface o Bottom of iceberg = interactive listening ▪ Leads to deeper meaning and connections with patients ▪ Below the surface Identify elements of nonverbal communications ★ 7 elements of non-verbal communication 1. Kinesics 2. Chronemics 3. Proxemics\ 4. Oculesics 5. Hapatics 6. Objectics 7. Vocalics Compare and contrast different forms of nonverbal communication o Proxemics ★ structure and use of space ▪ Comfortable distances for casual conversations should be 18-48 inches ▪ In pharmacy, typically 4-12 feet from each other ▪ When talking about a sensitive topic, you may need to reduce distance ▪ Distance greater than 12 ft is for speaking to a group o Chronemics ★ use of time and how it affects nonverbal communication ▪ Creating value in the wait reduces the negative feelings about waiting BUT we don't want to keep patients waiting too long o Oculesis ★ use of eye contact ▪ Direct eye contact shows interest in conversation but NOT staring because that can be creepy ▪ Amount of eye contact depends on patient’s response o Hapatics ★ use of touch ▪ Can communicate care to a patient ▪ Needs to be used sparingly and depends on: Emotional context Relationship Comfort ▪ Touch should be used very carefully as it can quickly become problematic o Objectics ★ use and choice of objects in communication ▪ Clothes, name badges, chairs, reading materials o Vocalics ★ use of human voice ▪ Tone and pitch  Monotone can show a lack of interest ▪ Emphasis on certain words Important for phone conversations as visual communication is lacking Identify environmental and distracting factors related to nonverbal communication o Environmental ▪ Decor, appearance ▪ Private consultation area and prescription counters in pharmacy ▪ Professional dressed workers ▪ Signage on walls o Distracting factors ▪ Lack of eye contact ▪ Loss of focus ▪ Leaflets ▪ Gum/eating Apply concepts of nonverbal communication to pharmacy practice o Identify if a patient is upset or bothered o Smile and be friendly o Open and warm physical gestures o Professional appearance (white coat) o Appropriate distance during conversations Distinguish between empathetic and non-empathetic responses o Empathetic: ▪ Must first listen to patients concerns in an active listening way ▪ Should be able to sense the patients emotions and imagine what they are feeling ▪ Do not judge the patient and come across as understanding ▪ Pharmacist should be reassuring, calming and explaining to patient and should NOT rush the conversation o Non-empathetic ▪ Not really listening and forcing an interpretation ▪ Discounting the patients feelings ▪ Surface level responses and ignoring deeper issues Describe the components of empathy o Empathy should be... ▪ Nonjudgemental ▪ Encourages patient to express feelings and concerns  ▪ RPh conveys concern, acceptance and respect for patient Patient counseling: Identify the components of effective patient counseling o Establish a trusting relationship with pt o Use verbal and nonverbal communications o Utilize active listening ▪ Open ended questions ▪ Reflective responses o Tailor discussion to meet the patients needs o Provide support for patients Describe the RPhs responsibility to provide patient counseling o Assess pts understanding, proper use and adverse effects of medication o Improve adherence o Motivate the pt in terms of health management o Develop a working relationship with pt o Gather necessary facts o Determine patients needs o Assure that pt carries our treatment plan successfully Differentiate between the biomedical model and socio-behavioral model ★ aim to work in the socio-behavioral model Biomedical model Socio-behavioral model - Practitioner centered - Patient centers - Information provision - Information exchange - Behavior dictation - Behavior negotiation - Compliance - Adherence - Motivate the pt - Assess pt motivation - Persuade or argue - Understand and comfort - Patient resistance is bad - Patient resistance is information - Expects respect from pt - Assume mutual respect with pt Identify and explain the components of the PPCP o Collect ▪ Pharmacist collects the needed information and medical history to understand full clinical status of pt o Assess ▪ Using the information collected, pharmacist analyzes the patients therapy and goals to achieve the best care possible for the pt  o Plan ▪ Develop a patient centered plan with other health care providers for patient to receive the optimal outcome o Implement ▪ Pharmacist implements the plan with patient, caregivers and other medical professionals involved o Follow up: monitor and evaluate ▪ Pharmacist monitors the patients new care plan and makes changes as seen necessary in order to achieve optimal care Utilize PPCP during all patient encounters o Patient centered process of care is the emphasis of PPCP o Works to improve interprofessional collaboration and to enhance communication between pts and healthcare team o Wants to optimize medication use for improved patient outcomes Utilize the prime questions and modified prime questions for medication counseling o The prime questions (used for initial fill) ▪ What did your doctor tell you the medication is for? ▪ How did your doctor tell you to take the medication ▪ What did your doctor tell you to expect? o Modified prime questions (for refills) ▪ What are you taking this medication for? ▪ How are you taking this medication? ▪ What have you noticed that is different? Explain and practice the teach back process o After counselling a patient have them provide an explanation of your conversation in their own words ▪ DO NOT QUIZ THE PATIENT o Clarify any points and repeat if necessary o Requires open ended questions and use of simple terms to achieve the goal of optimal patient understanding and adherence Medication Adherence: Differentiate terms describing medication use o Compliance ▪ A process where a patient passively follows a treatment plan as instructed o Adherence  ▪ A process where a patient actively decides to follow a treatment plan as instructed o Persistence ▪ Duration of how long a patient remains on a medication o Consistency ▪ How regular a patient takes their medication Describe different forms of medication adherence o Non-adherence ▪ Not adherent at all o Initial non-adherence ▪ Initially does not adhere to medication regimen (like not picking up the medication initially) but then eventually becomes adherent o Partial non-adherence ▪ Sporadic non-adherence ★ missing SOME doses 1-19% more or less than prescribed number of doses ▪ Repeat non adherence ★ missing a lot of doses (2-3x a week) 20% or more; more or less than prescribed number of doses o Persistence ▪ Can be non-adherent but persistent ▪ If you are not persistent you cannot be adherent o Adherence ▪ Taking as instructed actively Identify different risk factors and consequences of medication non-adherence o Risk factors: ▪ Complex drug regimens with multiple doses ▪ Asymptomatic and chronic conditions ▪ Cognitive or physical impairments ▪ Dissatisfaction with care / poor relationship with provider ▪ Low health literacy ▪ Difficult route of administration ▪ Caregiver needed for administration ▪ Adverse drug reactions and side effects ▪ Alternative health beliefs ▪ Fear of addiction / long term complications o Consequences  ▪ Physicians may misjudge the efficacy of the medication ▪ Patient loses confidence in the efficacy of treatment ▪ Poor clinical outcomes ▪ Economic loss Recognize the nature and extent of medication non-adherence o Ask patient about missed doses ▪ In the past week / use of medication profile if available o Ask patient about knowledge of regimen ▪ Use prime questions o Evidence of non-adherence should be shared in a way that does NOT accuse patient o Use “I” statements when talking to patients to help aid them in the direction of adherence without creating a defensive environment Distinguish between different theories of patient behavior Health Belief Model Theory of Reasoned Action (TRA) Self-regulation Locus of (HBM) Theory Control Theory 1. Threat ★ predicts behavior based on Patients use Internal locus Model starts with a behavior intention (pts inclination their own of control: perceives illness to perform a behavior) and internal - YOU threat subjective norms (pts perception of information make other beliefs of whether a behavior such as things 2. Factors responding to happe is appropriate or not) Factors related to the ★ affected by 4 factors: their own n illness threat that can 1.Expectation that a behavior will symptoms and External locus affect the likelihood lead to certain outcomes experiences as a of control: of action being taken 2. positive/negative evaluations in way to guide - Things regards to these outcomes themselves to happe 3. Cues 3. beliefs of what others think if their treatment n to Serve as a catalyst to goals. YOU behavior should/should not be propel a patient and preformed factors into action 4. motivation to comply with what 4. Action others think should/ should not be The likelihood of preformed behavior itself Compare and contrast methods for detecting medication non-adherence Method: Advantages: Disadvantages:  Patient interview -Easy to use -Influenced by question - inexpensive construction and skill of interviewer Diary -contains regimen data over -can be overestimated long periods - pt must return diary Drug levels in biologic fluids -recent med use is verified -not good for long term -patient may have kinetic variations Direct patient observation -verified use -impractical at outpatient sites Adherence surveys -easy to administer -accuracy dependent on -often validated instrument - lack of continuous data Physician estimate -easy to obtain from dr -usually based on pt self - based largely on clinical report (bias could happen) outcomes Family member -can be reliable if family is -unclear details very involved Pill count -easy to use -patient may forget or throw -inexpensive away unused pills Pharmacy profile -does not involve -does not always reflect approaching pt for data and is actual use easy accessible - may not be complete Insurance system records -noninvasive -access is more difficult - more complete pharmacy use info MEM caps -precise data on regimen use -expensive - printouts and graphs - inconvenient Apply the RIM approach to assess and select appropriate patient tailored approaches given various sources of non-adherence ★ RIM approach developed by Pfizer o Recognize non-adherence o Identify reason for non-adherence o Monitor non-adherence Behavior Change / Motivational Interviewing: Understand Behavioral change o Involves transition from a past to new behavior o Changing pt knowledge, beliefs and attitudes about the past and new behaviors o Examples:  ▪ Quit smoking ▪ Medication nonadherence ▪ Dietary change Identify the emotional reactions to change o Fear and anxiety o Anger or blaming o Excitement, relief o Frustration, feeling out of control o Depression o Shame or guilt; feeling alone Describe reasons why change is difficult o Lack of confidence in making the transition o Lack of understanding of what needs to be done o Lack of involvement o Inability to see the benefits the change will provide o Think you have done smtg wrong o Believe that change is no longer possible at this stage Describe the transtheoretical model of change (TTMC) ★ helps predict how ready someone is for change and how to intervene to assist them in making a change (EVOLVING CYCLICAL PROCESS; NOT LINIEAR) o Precontemplation ▪ Not thinking about changing anytime soon ▪ Not in next 6 months o Contemplation ▪ Considering changing but not yet ▪ In next 6 months but not in next 30 days o Preparation ▪ Getting ready to change soon ▪ Within the next 30 days o Action ▪ In the process of changing o Maintenance ▪ Changed a while ago Apply the TTMC to pharmacy practice o Counseling during precontemplation: ▪ DO  Strongly advise changing behavior in a non-invasive manner and raise awareness in an empathetic way. Leave the decision to patient ▪ DO NOT Try to persuade patient and act in a judgmental way o Counseling during contemplation: ▪ DO Advise change and provide information and reasons to patients to help motivate and encourage them. ▪ DO NOT Apply action-oriented interventions o Counseling during preparation: ▪ DO Praise patients readiness to encourage them Assess history of behaviors and efforts to change behavior Discuss key issues in order to develop a patient centered change process with specific strategies for the pt Arrange a follow up to assist patient o Counseling during action: ▪ Praise progress and evaluate how the attempt to change is going. Evaluate support system, temptations and encourage alternative behaviors to help prevent relapse ▪ Encourage and praise the new behavior plan and congratulate success o Counseling during maintenance: ▪ Congratulate patient and continue to provide tipis in case of relapse and offer alternative behaviors ▪ POSITIVE REINFORCEMENT Identify principles and strategies of motivational interviewing (MI) ★ negotiates behavior with patient and helps them make a commitment to change o Collaboration ▪ Patient is own expert, and work is done in partnership o Evocation ▪ Patient has resources and motivation to change, and providers task is to call this motivation out and encourage them o Acceptance/autonomy ▪ Pt has right and capacity for self-direction  ▪ Provider respects and affirms this by allowing pt the freedom to choose ★ key principle of MI is expressing empathy o Empathy is expressed by communicating acceptance with the patient and offering an understanding to the patients specific situation in an understanding manner o MI core skills: ▪ Open ended questions ▪ Affirming ▪ Reflective listening ▪ Summaries Integrate MI concepts into changing patient medication adherence behavior o Can follow the guidelines when discussing medication adherence with a patient and can motivate them to pursue their medication and health goals in a way that is non-judgmental and supportive. We can act as a support system for these patients and provide with all resources we possibly can to help them overcome their setbacks and achieve their health goals through adherence. Professional Communication: Define professionalism as it applies to healthcare and pharmacy o Professionalism = a set of values, behaviors and relationships that underpin the trust that the public has in their pharmacists o Includes key traits that should be demonstrated: ▪ Knowledge of skills ▪ Pride in the profession ▪ Accountability ▪ Ethical decision making Identify different perspectives and frameworks on professionalism ★ professional socialization = the development of professional ethos, embodying caring, morality, and ethical behavior o Agents of professional socialization: ▪ Groups that teach core knowledge, model behavior, provide social support and communicate the goals of the profession o Situation-adaptive perspective: ▪ Students are viewed as actively interacting with the agents of socialization and results in a variety of outcomes based if socialization fails or excels o Structural functional perspective:  ▪ Assumes students are molded into ideal practitioners ▪ Assumes student receive consistent messages from agents of socialization Distinguish different attitudes and communication behaviors as professional or not Professional: Unprofessional: Email: Email: - Kind welcome and address recipient in - Opening in a casual manner a professional way - Addressing recipient by first name if a - Should be structured relationship like that has not been - Correct spelling and grammar established Verbal communication: - Abbreviations and reliance on - Use proper titles with last name autocorrect - Kind and respectful of person AND Verbal communication: time - Address by first name - Be open minded and prepared - Interrupt or be rude - Show appreciation and gratitude - Argue Professional dress: Unprofessional dress: - Neatly groomed - Oversized bags and sunglasses - Closed toe shoes - Shorts and jeans - Simplistic outfits that are clean and - Tank tops and graphic tops show professionalism - Sneakers or sandals - Appropriate length dresses/skirts