Pharm Comm Exam 2 Flashcards
Define empathy, contrast with sympathy and pity and understand challenges of the use of empathy by healthcare professionals.
Empathy is the ability to understand the patient’s experiences and feelings accurately as well as to demonstrate that understanding to the patient.
Empathy vs Pity and Sympathy
Pity
A relationship which separates physician and patient. Pity is often condescending and may entail feelings of contempt and rejection.
Sympathy
When the HCP experiences feelings as if he or she were the sufferer. Shared suffering
Empathy
Is the feeling relationship in which the HCP understands the patient’s plight as if the physician were the patient.
The HCP identifies with the patient and at the same time maintains a distance.
Empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship.
As a health care provider you must be empathetic but not sympathetic. Separation of empathy (compassion for the patient, but delivery of effective health care.) Sympathy clouds ones judgement in giving health care to the patient.
o 4 domains of empathy
• Emotive: the ability to imagine patients’ emotions and perspectives
• Moral: the HCPs internal motivation to empathize
• Cognitive: The intellectual ability to identify and understand patients’ emotions and perspectives
• Behavioral: the ability to convey understanding of those emotions and perspectives back to the patient
Identify phrases, techniques and behaviors that facilitate empathy and responses to patients when “window of opportunity” occur.
“Windows of opportunity” - when you hear a patient say the following, you have an opportunity to display empathy: ◦Statement of emotion: “My biggest fear is…” “I’m just scared because…” “I’m worried that…”
◦Statement of progress:
“I’ve been exercising more than last time…”
“I’ve been working hard on….”
“We just got married.”
◦Statement of challenge:
“But sometimes it’s hard just eating three ounces of meat, you know what I mean?”
“I just haven’t had enough energy to do my job as much anymore”
Understand emotional intelligence and five primary domains.
Emotional intelligence is… “The ability to manage feelings so that they are expressed appropriately and effectively, enabling people to work together smoothly toward their common goals.”
Level of competence in personal and interpersonal skills.
◦Personal and interpersonal skills are the most important determinant of our performance success.
Emotional Intelligence will determine how well you
◦Know and manage yourself
◦How well you handle what happens to you
◦How well you interact and handle others
Self-awareness (1)
◦Recognizing one’s internal states and personal abilities.
◦Key competencies are emotional awareness, self assessment, and self confidence.
Self-regulation (2)
◦Managing one’s emotional state.
◦Key competencies are self-control, being trustworthy, conscientious in one’s work, flexible/adaptable, and creative/innovative.
Emotional Intelligence: 5 Domains
Lust E et al. Am J Pharm Edu. 2006;70(1): Article 06.
Motivation (3)
◦Emotional factors that help one reach their goals.
◦Key competencies are achievement drive, commitment, taking initiative, and being optimistic.
Empathy (4)
◦Awareness of the feelings and needs of others.
◦Key competencies are the ability to understand and empathize with others, developing others, having a service orientation, leveraging diversity, and being politically aware.
Emotional Intelligence: 5 Domains
Lust E et al. Am J Pharm Edu. 2006;70(1): Article 06.
Social Skills (5) ◦A diverse skill set used to induce desirable responses in others. ◦Key competencies are influence, verbal and non-verbal communication skills, ability to manage conflict, being a leader, influencing change, building personal or team bonds, collaboration/cooperation with others, and team work capabilities.
Identify techniques to manage conflict including assertiveness, choosing the right response and managing “angry” patients.
Stay calm ◦Do not respond to anger with anger maintain your self respect NOT ◦“Patient is always right.” BUT ◦“Patient deserves respect.” Take the opportunity to demonstrating caring, respect, civility in the face of adversity.
Assertiveness
- Times when you’ll need it!
◦Inappropriate demands of others
- Patient asks you to provide a refill without the physicians authorization
- Nonassertive people don’t respect themselves.
- Aggressive people don’t respect others.
- Assertive people respect themselves and others.
Choosing the right response
Assertive responses = “I” statements
“I” statements:
◦Respond in a way that will de-escalate conflict
◦Avoid using “you” statements that will escalate conflict
◦Identify feelings
◦Identify behaviors that are causing the conflict
◦Help individuals resolve the present conflict and prevent future conflicts
Higher confidence in people that are assertive compared to nonassertive speakers Assertiveness is NOT: ◦Rude ◦Impolite ◦Pushy ◦Uncaring
Types of assertion:
◦Simple assertion
“I will be unable to refund your money on this item.”
“I want you to take this medication three times a day, every day, until it is completely gone.”
◦Empathic assertion
“I know that this came as a complete surprise to you. There was no way to prepare for it.”
“I can tell that having to take three different medications seems to overwhelming to you right now.”
◦Confrontive assertion
“You say you’re going to take your medication as we have discussed, but I’m not sure that you’re taking this seriously.”
◦Negative feeling assertion:
“I feel really frustrated when I have trouble explaining to you how to properly take your medicine. You seem to feel that this is your wife’s responsibility more than your own. When you do this, I feel like I really don’t want you to leave the pharmacy until I can hear some personal commitment from you.”
◦Positive feeling assertion:
“I’m glad to see you.”
“I really like it that you come in on the exact day your are scheduled for your refill.”
Describe cultural competency methods used within patients counseling sessions.
Models of Effective Cross-Cultural Communication and Negotiation
BATHE
◦Background (“What is going on in your life?”)
◦Affect (“How do you feel about what is going on?”)
◦Trouble (“What troubles you most?”)
◦Handling (“How are you handling that?”)
◦Empathy (“This must be very hard for you.”)
BELIEF
◦Beliefs about health (“What caused your illness/problem?”
◦Explanation (“Why did it happen at this time?”)
◦Learn (“Help me to understand your belief/opinion.’)
◦Impact (“How is this illness/problem impacting our life?”)
◦Empathy (“This must be very difficult for you.’)
◦Feelings (“How are you feeling about it?”)
ESFT model ◦Explanatory model ◦Social risk of noncompliance ◦Fears and concerns about the medication ◦Therapeutic contracting and playback
ETHNIC
◦Explanation (“How do you explain your illness?”)
◦Treatment healers (“What treatment have you tried?”
◦Negotiate (“Have you sought any advice from folk healers?”
◦Intervention (mutually acceptable options)
◦Collaboration (with patient, family and healers)
Kleinman’s questions
◦“What do you think has caused your problem?”
◦“Why do you think it started when it did?”
◦“What do you think your sickness does to you?”
◦“How sever is your sickness? Will it have a short or long course?”
◦“What kind of treatment do you think you shoud receive?”
◦“What are the most important results you hope to receive from this treatment?”
◦“What are the chief problems your sickness has caused for you?”
◦“What do you fear most about your sickness?”
LEARN
◦Listen with sympathy and understand to the patient’s perception of the problem
◦Explain your perceptions of the problem
◦Acknowledge and discuss the differences and similarities
◦Recommend treatment
◦Negotiate treatment
Describe each of the types of conflict management styles and key elements of the ART of Active Listening
Conflict Management - Causes of conflict ◦Lack of awareness - Willingness to know ◦Incompatible goals - Achievement of goal is being threatened ◦Scarce resources - Compete for resources (or rewards) ◦Dependence - Occurs when people cannot function independently ◦Values - Every has their own view of “right” and wrong”
Rules for Feedback
- Be descriptive – not judgmental.
- Be specific rather than general.
- Deal with things that you can change.
- Give feedback when it is desired.
- Consider the motives for giving and receiving feedback.
- Give feedback at the time of the behavior takes place.
- Give feedback when its accuracy can be checked with others.
Strategies for Managing Conflict
Non-effective: Win-lose
- Be descriptive – not judgmental.
- Be specific rather than general.
- Deal with things that you can change.
- Give feedback when it is desired.
- Consider the motives for giving and receiving feedback.
- Give feedback at the time of the behavior takes place.
- Give feedback when its accuracy can be checked with others.
Strategies for Managing Conflict
Non-effective: Win-lose
Competing
◦High desire to satisfy own concerns – less with others
Accommodating
◦High desire to satisfy others concerns – less with your own.
Dominating
◦Low level of cooperativeness and high level of aggression
◦Personal attacks on others
◦Need to be in control
Strategies for Managing Conflict:
Non-effective: Lose-lose
Avoidance
◦Low level of cooperativeness and low level of assertiveness
◦Conflict is seen as useful way of punishing
◦Removing oneself
Compromise
◦Moderate desire to satisfy one’s own concerns and a moderate desire to completely satisfied the other person’s concerns
Win-Win, Problem Solving
- Identify the problem
- Identify all possible solutions
- Decide which solution is best
- Determine how to implement the solution
- Assess the outcome of your solution
•Someone is blocking us from achieving
our goals
•Someone is not acknowledging us
•Someone is not understanding our beliefs/values
•We have different expectations about roles, resources, or outcomes
Types of people
- Avoiders- withdraw from heated discussion- silence is preaise worthy
- Accommodators- let others have their way- soft words ensure harmony, turn the other cheek
- Compromisers- seek quick solution on a middle ground-both people should give exactly 50%
- Competitors- escalate quickly…flash tempers- if you stand firm others will weaken
- Collaborators- give and solicit as much as information as possible- no one person has the final answer, each has a piece
Identify responses that can be classified as judging, quizzing, placating, advising, paraphrasing and active listening
o Judging: tells people that their feelings or perceptions are right or wrongs, appropriate or inappropriate praiseworthy or blameworthy
o Advising: may give the impression that the professional knows best
o Quizzing: an indirect way of giving advice
o Placating: pacifying; getting the person to “look on the bright side”
o Distracting: changing the subject
o Paraphasing: conveying back what the person has said
o Empathic Reflective Response: Communicating understanding without implying agreement or an evaluation
Describe the results of the American Heart Association’s study on medication adherence and its impact upon healthcare outcomes.
US patients do not take medication as prescribed Rx prescribed = 100% Rx filled = 88% Rx started = 76% Rx completed = 47%
Patients-reported reason for non adherence
Just forgot = 54.9%
Don’t think it’s always necessary = 13.7%
Don’t like being dependent on drugs = 7.3%
Hate taking drugs = 7.1%
Side effects = 6.4%
Other = 3.6%
Don’t think drugs are working = 3.4%
Too expensive = 1.8%
If I didn’t take them the prescription will last longer = 1.3%
Don’t like being told what to do = 0.6%
Improved adherence is associated with:
wReduced overall health care costs
wDecreased risk of hospitalization
wImproved clinical outcomes
Compare and contrast the biomedical method of patient counseling to the behavioral model.
(Biomedical) (Behavioral)
Practitioner centered = Patient centered
Information giving = Information exchange
“Save” the patient = Patient “saves” self
Dictate behavior = Negotiate behavior
Compliance = Adherence
Authoritarian (Parent-Child) = Servant
Motivate the patient = Assess motivation
Persuade, manipulate = Understand, accept
Resistance is bad = Resistance is information
Argue = Confront
Respect expected = Respect earned
Describe the 5 general principles of Health Behavior change known as “READS”.
- Roll with resistance
- Express empathy
- Avoid argumentation
- Develop discrepancy
- Support self-efficacy
o ROLL with resistance
• Use understanding, empathy
• Get clarification
• New prescriptive are invited, not imposed
• Resistance is not directly opposed
• Resistance is a signal to respond differently
• The patient is primary resource in finding answers and solutions
o EXPRESS empathy
• Acceptance facilitates change
• Skillful reflective listening to fundamental
• Identify and understand resistance and reasons for unhealthy behaviors without judgement
• Empathy creates a climate for change through trust and must be shown throughout the process
o AVOID argumentation
o DEVELOP discrepancy
• Discrepancy= dissonance
• Point out the good things and bad things about change, the pros and cons
• Discrepancy throws the patient’s system out of killer
• Restate the discrepancies heard
• The patient should identify the arguments for change
• Change is motivated by a perceived discrepancy between present behavior and important personal goals or views
o SUPPORT self-efficacy
• A person’s belief in the possibility of change is an important motivator
• The person, not the counselor, is responsible for choosing and carrying out change
• Notice the positive, including statements, not just behaviors
• Let the person know you’ve noticed
• Let them know how you feel
• Praise the behavior, not the person
• Continue to support self-efficacy throughout the process
Identify the five stages of change.
5 stages of change
By identifying patient’s position in the change process, health care providers can tailor intervention, usually with skills they already possess
Focus is not to convince patient to change behavior but to help patient move along stages of change
- Pre-contemplation
- Contemplation
- Perpetration
- Action
- Maintenance
Understand primary goals and benefits of (hospitalized) patient discharge counseling.
o Counseling goals
• Prevent adverse effects of medication
• Provide effective patient education
• Enhance the knowledge of the patient
• Ensure medication compliance
• Prevent hospital re-admission
o Procedure for in-patient counseling
• Receive call from RN
• Review/screen the medication profile
• Print the list of medications to be counseled
• Provide verbal/written information (patient leaflets)
• Resolve pertinent issues with physician
• Document the session in patients medical chart/hospital’s web based interventional tool
• Empathize eitht he patient (cultural/social needs)
o Discharge counseling
• Review with the patient and family (remember HIPAA)
• Important- 5 or more chronic daily medication
• Focus on new medications started (in-house) or dose adjustments
• Create a table/chart with all information (drug, dose, timing, food, condition, being treated
• Confirm with MD any new Rx that have been written
• Review any DC medications that must be stopped
o Counseling checklist
• Introduce yourself
• Make sure the patient wants to listen
• Explain the purpose of your visit
• Listen carefully/display empathy
• Address the issues (meds, indication, AE, duration)
• Assess for non-adherence
• Emphasize benefits of adherence
• Explain what to do if a dose is missed
• Ask for feedback
• Always use laymen’s terminology
o Benefits/Outcomes of Discharge counseling
• Establishes safety/adherence to medication therapies
• Reduces emergency room visits
• Reduces hospital re-admission rates
Discuss the numerous roles of the hospital pharmacist and role in counseling.
o Roles
• Medication experts
• Draw upon pharmacology/pharmaco-therapy
• Counsel on drug interactions, side effects etc
• Improve patient outcomes
