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Effective Communication Skills for Pharmacists….. Part 2

Sometime ago, we published the part 1 on “effective communication skills for pharmacists”. In case you missed it, click here 

Now here is the part 2

Verbal Communication

—Essential verbal communication skills include the ability to listen, understand, and respond to what people say (active listening) and the ability to interpret nonverbal communication and respond in a way that encourages continued interaction (evaluation).

ACTIVE LISTENING

—Focusing on the patient, family member, or health care professional.

—Making that person feel like the center of attention.

—Conveying an open, relaxed, and unhurried attitude.

—Setting aside all professional and personal distractions and really focusing on the person.

—Preventing or minimizing interruptions (e.g., telephone calls, consultations).

OBSERVATION AND ASSESSMENT

—Effective two-way communication requires continual observation and assessment of how the other person is communicating.

—Body language and gestures provide important clues for the pharmacist, as well as the patient and health care provider.

—Sitting or standing at eye level, maintaining eye contact, and using a focused body posture to convey interest and attentiveness.

—Being physically close enough to the patient, family member, or health care professional for clear and comprehensible communication but not intruding on the other person’s personal space.

Factors Influencing Communication

Communication is affected by the integration of factors affecting both the patient and the pharmacist;

—Internal Factors: previous experiences, attitudes and values

—Sensory and Emotional Factors: fear, stress, pain and anxiety

—Environmental Factors: lighting, noise and privacy

—Verbal Expression: language barrier and Jargon

—Nonverbal Expression: body movement and facial expression

—Vocals refer to how something is said.

Communication Impediments

1- Psychological

—How the Pharmacist sees him/herself. Is s/he a dispensing Pharmacist or care provider?

—Confidence or diffidence. Lack of adequate skill to counsel patients

—Lack of desire to counsel patient

—Not paying enough attention to message

—Not clarifying message

—Partial listening

—Partial understanding

—Personal interpretation of message

  1. Environmental

—The loud noises/ distractions

—Too many people

—The counter

—Pharmacist in a place not seen

—Pharmacist is higher than the patient

—Glass window

—Low level of privacy

—High work load

—Inadequate staff

3- Functional barriers

—Physiological barriers – may result from individual’s personal discomfort, caused, for example, by ill health, visual and hearing impairments,

—Language differences,

—Low literacy level

—Comprehension difficulties.

—Culture, beliefs

—Emotional situationsà anger, hostility, sadness, depression, fear, anxiety, embarrassment, know-it-all attitude

—Message – Too long

—Mood of sender/receiver

—Tone of language/speech

—Senders/ receivers mannerism

—Differences in pronunciations and accents

—Physical Barrier- staff are located in different buildings or on different sites.

—System design- unclear, inefficient or inappropriate information systems

—Age

—Incomplete/distorted information

—Noise

—Attitudinal barriers -as a result of problems with staff in an organization

—Ambiguity of words/phrases- Words sounding the same but having different meaning

Communication Noises

—In any communication model, noise is interference with the decoding of messages sent over a channel by an encoder.

—Environmental noise- standing next to loud speakers at a party or a rowdy time at the pharmacy.

—Physiological-impairment noise- deafness or blindness

—Semantic noise – different connotations, e.g. weed

—Syntactical noise-mistake in grammar

—Organizational noise- unclear and badly stated direction

—Cultural noise e.g. wishing a non-Christian ‘Merry Christmas’

—Psychological noise- great anger or sadness may cause someone to lose focus on the present moment.

Telephone Communication

—An important tool used to communicate with patients, patient family members, physicians, nurses, other pharmacists, and other health care professionals.

—Speak clearly, listen carefully, be organized, and state facts clearly and calmly.

—Telephone calls from angry and upset patients, patient relations, nurses, physicians, and other health care professionals should be handled as calmly and coolly as possible.

Essential Skills for Effective Communication

1)Questioning skills

2)Listening skills

3)Participatory skills

4)Explaining skills

5)Writing skills

6)Presentation skills

7)Negotiation skills

The Purpose of Questioning

—Obtaining specific information

—Diagnosing specific difficulties

—Facilitating interactions (e.g. ‘Hello, how may I help you?’)

—Assessing knowledge and understanding

—Help create enlightenment

—Maintaining control of interactions

—Encouraging full participation

—Showing interest and concern (e.g. ‘How are you today, sir?’)

—Ascertaining attitudes, opinions and feelings

Types of Questions

1)Open questions

2)Closed questions

3)Direct Questions

4)Indirect Questions

5)Loaded Questions

6)Leading Questions

7)Probing questions

8)Prompting

9)Multiple questions

Open Questions.

—Open questions begin with the words, “What, How, When, Where, Who, Which or Why.”

—They are used to gain more information, and cannot usually be answered with just “Yes“ or “No.“

—Open questions that yield the most information usually start with “What” or “How.“

—“How are you supposed to be taking this…?

—“Tell me more about this…”

Closed Questions

—”Closed” questions, on the other hand  are those that are used to direct or guide discussions – and are normally answered with a “Yes“ “or “No“

—For example, “Do you. . ?”, “Have you. .. ?”, Are you…? “Should you..?“ are closed questions.

—Some questions in this category are perceived as requests for more

—information; but technically they are “closed” questions.

—For instance questions like:  “Can you be more specific? Or “Could you give me an example?” are not ‘normally’ answered with a “Yes” or “No,” even though they are in fact closed questions. Thus they are good questions’ to ‘use in obtaining feedback from the other person.

Guided Questions

—Guided questions direct the discussion to either the positive or negative side of an issue.

—For example, if your co-worker responded to you by saying, “I really like my job, but  my family hates it,” you can guide the discussion to either side of this statement by asking:

—What do you like about your job?” Positive

—”How does your job affect your family?” Negative

Loaded Questions

—Suppose you made a comment about your boss, Carol. Your co-worker responds by saying, “Don’t you think that Carol is a pain in the neck?” Your co-worker did not really ask a “question“ He. or she actually stated an opinion in the form of a question.

—Questions like, “Don’t you think . . . ?”, “Don’t you feel. . . ?”, or “Wouldn’t you agree that. . . ?” are really just expressions of the speaker’s strong opinion. People often mask opinions as questions because they feel it is “safer“ than saying openly “I believe that…”

—If you want to find out what someone else believes or feels, you should ask them directly

Leading Questions, Probing and Prompting

Leading Question lead the person towards an expected response. Response to questions of this type may be distorted.

Probing question: a follow up question used to build upon an initial response. Probes can be open closed or leading.

Prompting: used to encourage a person to give an adequate answer following a situation where the person either does not answer or gives an inadequate answer.

Expression

—This is concerned with the manner in which questions are posed.

—It consists of flow and attitude

—Flow refers to the pacing and sequencing of questions

—Attitude refers to the person’s thoughts, feelings and beliefs towards a particular person, and also to the overall disposition of the speaker.

—Attitudes are manifested primarily through body language and paralanguage.

Listening

—It is a fundamental part of communication process.

—It is not just physiological process of hearing but listening is a mental process.

—It is important to listen carefully to respond appropriately.

Obstacles/Barriers to Listening

—Speech and Thought Rates

—Speaker Fluency and Clarity

—Message Emotion

—Individual Bias

—Inattentiveness

—Mental Set

—Dichotomous Listening

—Other Distractions

Useful Tactics to Block Conversation

—On deliberate choice to close interaction or decision to divert focus of conversation, useful tactics to achieve these include:

—Rejecting involvement

—Denial of feelings

—Selective responding

—Admitting insufficient knowledge

—Topic shift

—Referring, Deferring

—Pre-empting any communication

Communication With Colleagues

—Begins with respect for other coworkers and a willingness to be team player.

—Regular meetings should be scheduled to bring up problems or issues in the workplace in a non-confrontational or non-blaming way.

Communicating Information to Physicians 

—Keep patient focused

—Provide the physician with any meaningful background information

—Clearly and concisely outline the problem the patient is experiencing with the drug therapy

—Propose a solution (pharmacist’s intervention)

—If face to face, request physician feedback for the solution

Assertive, Unassertive and Aggressive Behaviours

Counseling

—An interaction between two or more persons whereby information is received from the other on an issue and the information is provided with all possible solutions highlighted and the person is allowed to make an informed decision.

—Counseling can also be said to be interpersonal communication in which a counselor (service provider) helps the client to:

– identify

– clarify

– resolve problems

Principles of Counseling

—What does the individual already know? One should never assume that people do not know anything

—Consideration for the age of counselee

—Being patient and understanding clearly what the person wants or is saying

—Using the language the person understands

—Giving client the freedom in making decisions

—Being honest and nonjudgmental

—Supporting expressed fears and feelings

—Maintaining a culturally accepted distance

—Ensuring confidentiality

Difficult Moments in Counseling

—Client stops talking (usually due to a concern of confidentiality or judgment)

—Client breaks down

—Counselor cannot provide answer.

—The counselor has little time to attend to client

—Client talks continuously and inappropriately.

—A well known client may be referred to another counselor.

—If the counselor is embarrassed by the subject matter, s/he should refer.

Qualities of a Good Counselor

—Approachable

—Friendly and warm

—A good listener

—Tolerant and patient

—Welcoming and humorous

—Well focused

—Self-confident

—Confidential and willing to go extra mile

Patient Counseling

—An interactive session between the patient and the pharmacist

—The pharmacist seeks to educate the patient about the role and administration of his medication

—He provides relevant and comprehensible information

—He answers patient’s question about his medication

—He assesses patient’s understanding of the information conveyed

—Counseling patients regarding their medications is an important responsibility for pharmacists

—Pharmacists are often the only health care providers focusing patient education on medication: how to take it, what to expect, and side effects and drug interactions.

—It is a patient-focused intervention. It can be non-drug counseling where the patient receives education for positive behavioral changes – health promotion and disease prevention measures.

Drug Focused Counseling

The patient should be provided a minimum of;

—The name and purpose of medication

—How much of the medication that should be taken, when to take it and how long to take it.

—How to administer medicines.

—Prescription refill information.

—What to do when a dose is missed.

—Important side effects e.g. causes dizziness, stomach irritation, etc.

—Precautions e.g. causes sleep do not drive; avoid exposure to sunlight when on this medication.

—Interaction with foods, beverages and other medicines.

—How to store medicines at home.

Strategies for Establishing the Pharmacist-Patient Relationship

—Introduce self to patients during an encounter.

—Outline for the patient what will occur during the encounter.

—Demonstrate empathy or caring attitude so that the patient feels at ease.

—Discuss with the patients the duration of the encounter.

—Discuss the expected outcome of the encounter.

—Use feedback strategies throughout the encounter to ensure patient understanding.

—Ensure sufficient time for patients to ask questions towards the end of the encounter.

—Resolve a drug therapy problem in a timely manner.

—Follow up with patients

Ideal Counseling Process

The Processes are best explained with the acronyms:

“GATHER” “CLEAR” “ROLES”

Conclusion

—Good communication skill and correct patient counseling are very important skills that every pharmacist, irrespective of area of practice, must develop and grow to achieve measurable pharmacological and non-pharmacological therapeutic output in patients and other clients.

Source: DIS

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