HEALTH COMM Exam II study 6-8

interview considerations

- type info - type environment - start - end

precontemplation - defining characteristics

- unwillingness to change - lack recognition of problem - deny seriousness of risks

aggressive behavior

- win - dominating or intimidating - promote own POV - indifferent ab others feelings - beneficial in short term - distorted view of reality - constant feeling of under attack - low tolerance for frustration - long term negative consequences

Match preparation with the corresponding communication approach that most closely fits

ask ab barriers to change

Match Maintenance with the corresponding communication approach that most closely fits

assist in problem-solving in case of a lapse

What is a double-barrel question?

two questions disguised as one

How can we turn a double-barrel question (which we should NOT use) into a question we should ask?

we should separate the question into two separate ones.

Which example best describes the MAINTENANCE stage of behavior change?

"It's been nine months and I've been smoke free. It's still hard sometimes and I have had a couple of 'slips', but I think I'm doing well overall."

Rapport - demonstrate respect ex

(giving strong eye contact) "Mr. Stinson, I can see where taking this medication seems pointless in your circumstances. Let's talk about that."

Rapport - desire to connect w individual ex

(smiling) "It sounds like your kids definitely keep you on your toes!": "Wow, you spend a lot of time volunteering at the animal shelter! What a great way to spend your time!"

Define compliance

- "Do as I tell you to do" - HCP is parent - patient should follow instructions wo question

Address if behavior has occurred in the past, then follow up with current behavior

- "Have you ever taken prescription medicine for reasons other than those prescribed by your doctor? - How about in the past 6 months?"

Define Concordance

- "How can we make this work best for you" - W focus on respecting patient beliefs and whishes, the HCP work w patient to collaboratively determine best course of action of med use

Define Adherence

- "Lets talk ab what you should be doing" - HCP needs to talk to patient ab "hows" and "whys" of treatment, attempts to understand patient perspective regarding medication use

address common concerns in non-judgmental way

- "Many of my patients have trouble remembering to take their meds regularly...how often would you say you forget to take - How many alcoholic drinks would you say you have during an average week?

SHOW AND TELL questions - asking for refills

- "What are you taking this medicine for?" - "How have you been taking this medicine?" - "What have you noticed that is different since you have been taking it?" - only count if delivered in open-ended manner

PRIME questions - asking for new script

- "What did your doctor tell you this medicine was for?" - "How did your doctor tell you to take this medicine?" - "What did your doctor tell you to expect?"

contemplation - defining characteristics

- "thinking ab" change - aware of consequences of inaction - willing to change within 6 months

preventing and coping w relapses

- help patients understand the difference between lapse and relapse - help patients identify high-risk situations in most vulnerable to lapsing into old habits - help patients identify what might help them cope w similar situation in future - help patients have plan in place ahead of time to go back to new behavior wo feeling guilty - help patients recommit to goals of change - for patients who are hindered by chronic or sever emotional distress, refer to physician or mental health professional

Is it ok for us to use closed-ended questions?

ONLY IN CERTAIN SITUATIONS

Meaning

what is intended "purpose"

Message

what u say "words"

Provide an example of a reflection statement.

"It sounds like you are saying you are upset with how the nurses treated you. Can you tell me more about this treatment?"

Rapport - warm greeting example

"Hi there, how are you doing today?", "Hi Mrs. Roald, good to see you! How is the weather out there this afternoon?"

What is the appropriate way to ask a patient about the number of cigarettes they smoke on a given day or week?

"How many cigarettes would you say you have during an average day? What about an average week?"

explain why u are asking ex

"I know it might seem silly for me to ask how much alcohol you drink, but it is actually very important since alcohol can affect the medication you are taking for your depression."

If a patient says, "I don't really want to take this medicine for my diabetes. I heard that it has nasty side effects..." how can you demonstrate rolling with resistance?

"It sounds like you are really concerned about the possible side effects that could occur with this medication. Could we take a couple of minutes to discuss these concerns?"

Criteria for useful feedback

- 1- focuses on a person's behavior rather than personality. By focusing on behavior you are directing the feedback to something the individual can change. - 2 - descriptive rather than evaluative. Describing what was said or done is less threatening than judging why it was done. - 3 - focuses on your own reactions rather than the other person's intentions. Assigning "blame" is not part of constructive feedback. - 4 - uses "T statements that take the form When you [do or say]I feel " For example, When you are late for work, I feel frustrated and angry is less damaging than "You're irresponsible You don't care about the patients who are waiting and the coworkers covering for you when you're late - 5 - specific rather than general. It focuses on behavior that has just occurred and avoids dragging in past behavior. It also does not overgeneralize from the specific instance that has upset you (e.g., "you always do »3). - 6 - focuses on problem-solving. The intent is not to let off steam. The intent is to solve a problem in a relationship so that the relationship can be improved. - 7 - provided in a private setting.

Empathetic listening: the dont's

- Avoid telling patient important information just to avoid difficult conversations - Allow personally-held judgments to influence the conversation - Generalize your patient or make them feel like a "number" - Demonstrate distraction or disinterest either verbally or non-verbally

irrational belifes

- Be approved of everyone - Competent in everything we do - Don't make mistakes

Mix sensitive and non-sensitive questions in your interview

- Be aware of how your behavior (verbal and non-verbal) affects patient responses - "You don't do recreational drugs, do you?" - "What recreational drugs (whispered) do you use?"

Goals of counseling session

- Building trust with the patient and assuring them that you are there to assist them in improving/maintaining their health - Identifying what a patient already knows about their condition/medication

False assumptions pharmacist commonly make

- Do not assume physicians or other providers have already discussed w patients the medications they prescribe - Do not assume patients understand all information provided - Dont assume that if patients understand what is required, they will be able to take their medication correctly - Dont assume that when patients do not med correctly they dont care, arent motivated, lack intelligence or cant rembre - Dont assume once patients start takinng meds correclty that they will continue to do so - Dont assume other providers monitor patient meds use and intervere if prob exisrt - Dont assume that if patients are having prioble s they will ask direct questions or volunter rinfomration

What are particular challenges for a patient during a counseling session?

- Emotional - social - physical - financial - educational

motivating patients to change

- Express empathy - Develop discrepancy - Roll with resistance - Support self-efficacy - Elicit and reinforce "change talk"

cognitive theories

- Fear of rejection or anger from others and need for approval (everyone should approve of what I do) - Overconcern for the needs and rights of others (I should always try to help other,be nice to them) - Belief that problems with assertiveness are due to unalterable personality characteris and are, therefore, unchangeable (this is just who I am) - Perfectionist standards (I must be perfectly competent. If I am not, then I am a failure. Others must also be perfectly competent and deserve to be severely criticized if they are not.)

Empathetic listening: the do

- Focus your full attention on the patient - Use nonverbal to reinforce your commitment to the patient - Read your patient's nonverbals - Recognize your patient's emotions - Use reflection statements to gauge patient understanding and demonstrate compassion - Work to develop trust with your patient

What are some indications/clues that a patient might have a health literacy issue?

- Frequently missed appointments - Incomplete registration/pharmacy information forms - Non-adherence to medication - Unable to name medications, explain purpose or dosing - Identifying pills by looking at them, not reading the label - Unable to give coherent, sequential medical history - Asking fewer questions - Lack of follow-through on tests, procedures, or referrals

Some keys to successful interviewing

- LISTEN EMPATHICALLY - ESTABLISH RAPPORT - KNOW YOUR PURPOSE - USE QUESTIONS WELL - KNOW WHEN TO BE SILENT

How can you demonstrate empathy non-verbally? Select all examples that apply.

- Maintaining comforting tone of voice - Head-nodding - Moving from behind the counter to speak to the patient

loaded questions

- Make assumptions that may be untrue - EX. "How is exercising helping your back pain?" [What if they aren't exercising?] - EX. "How is tracking your moods helping you manage your depression?" [What if they aren't using a mood tracker? What if their depression is still out of control?]

leading questions

- Make it difficult to disagree - Ex. "You don't want to talk to the pharmacist, do you?" - Ex. "You are taking your medication as directed, right?"

double barrel questioins

- Make it difficult to interpret the answer - Ex. "So, are you feeling better about taking your new medication for high blood pressure and managing your asthma with the inhaler?" [What would a "yes" answer mean? Yes to the high b/p medication? The inhaler? Both?]

building rapport

- Offer a friendly smile and use open posture - Offer a warm greeting: - Demonstrate respect: - Desire to connect with the individual

Why might silence be productive?

- Patients may need time to process information you have shared - Patients may need time to reflect on a question you have asked - Focus on developing a "talk-listen ratio" in which the patient is the primary speaker

types of interviews common in pharmacy practice include:

- Pre-dispensing / Outside review of Medication ["Brown bag"] - At initial dispensing [New Prescription] * - After initial dispensing [Refill Prescription] ** - Adherence counseling

How can we help patients with literacy or health literacy issues?

- Read through important directions with them slowly and carefully - Be vigilant about using teach-back - Highlight or circle key words or instructions - Create written tools with more "white space" and less jargon - Use photos or pictures to help describe necessary behavior - Perform "phone follow-ups" to see if they are taking the medication correctly

Mead & Bower's dimensions of patient-centered care

- UNDERSTAND all aspects of patient's illness experience: the social, psychological, biomedical factors - PERCIEVE each patient as a person; understand patient's unique experience of illness and the "personal meaning" it entails - FOSTER more egalitarian relationship w patients; allow patients to actively involved in dialogue and in the decision making surrounding treatment - BUILD a "therapeutic alliance" w patients by incorporation patient perceptions of the acceptability of innervations in treatment plans, defining mutually agreed-upon goals for treatment, and establishing a trusting, caring relationship w patient - DEVELOPE self-awareness of personal effects on patients and how your own responses to patients may affect patient behavior

passive behavior

- avoid all conflict at any cost - not say what they think - "hide" - wait for others to initiate - put others first - anxiety - high need approval - secretly angry/resentful - sees as victims subjected to manipulation - damaging to self-esteem

maintenance - defining characteristics

- change established (>6 months) - change incorporated into lifestyle - focus is on avoiding relapse

action - defining characteristics

- change is initiated - challenges experienced - effor to maintian resolve

preparation - defining characteristics

- commitment to change (<1 month) - benefits seen to outweigh costs

maintenance - communications approaches

- continue reinforcement for success - assist in problem solving in case of a lapse

Assertive behavior

- direct, honest, expression of ideas, opinions, desires - communicate in atm of trust - conflict addressed immediately - initiate communication way convey respect - goal communication stand up for oneself and solver interpersonal problems that don't damage relationship

contemplation - communication approaches

- encourage patients to list pros and cons - elicit reasons in favor of change - reinforce pos statements - acknowledge ambivalence - show empathy - identify discrepancy between goals and behavior - encourage small steps

preparation - communication approaches

- help patient formulate spcific plan - tail plan to patient needs - ask ab barriers to change - discuss ways to overcome barriers - provide info and referals as needed

Number skills for assertive communication

- initiating and maintaining conversations - encouraging assertiveness in others - responding appropriately to criticsm - giving negative feedback acceptably - expressing appreciation or pleasure - making requests - setting limits - refusing requests - conveying confidence verbally and nonverbally - expressing opinions and feelings appropriately

strategies to enhance adherence

- integrate new behaviors into patient lifestyle - provide or suggest compliance or reminder aids - suggest patient self-monitoring - monitor use on ongoing basis - refer patients when necessary

Parts of interview

- introduction: who you are, who they are, benefits of counseling, what you will discuss - body: varies by interview-type - conclusion: final verification, key info summary, preview of conclusion, follow-up plan, conclude

what are questions u should avoid?

- leading questions - loaded questions - double barrel questions

key elements of drug therapy

- name of medication - purpose of medication - how medication works - dose/interval - duration of therapy - goals of therapy - how effectiveness will be monitored - possible adverse effects and stratifies to deal w - drug-specific issues

AHRQ health literacy tools for use in pharmacies

- pharmacy health literacy assessment tool & users guide - training program of pharmacy staff on communication - guide on how to create pill card - telephone reminder tool to help refill medications on time - explicitly and standardized prescription medicine instructions - how to conduct post discharge follow up phone call - health literacy tool to improve communication for providers of medicine therapy management

stages of change

- precontemplation - contemplation - preparation - action - maintenance

action - communication approach

- provide pos reinforcemnt - focus on benefits of change - fiscuss stratigies to prevent relapse - discuss "slips" vs "relapse"

precontemplation - communication approaches

- raise awareness of problem - provide info - convey empathy - encourage "think ab" - express willingness to help - avoid arguing

Rogers (1957) empathetic definition

- sense client's private world as if it were your own but without every losing the as if quality - sense client's anger, fear, or confusion as if it was your own, yet without your own anger, fear, or confusion getting bound up in it

listening techniques for interview process

- stop talking - no distractions - react to ideas not person - nonverbal messages - listen to how something said - provide feedback to clarify any messages

Why is it no ok to use close-ended questions?

It can make patients feel as if they are under interrogation. It could possibly lead patients to be passive with their answers and avoid any conversations they truly need.

appreciative listening

Listening for enjoyment - listening u seek situations where u hear and process relaxing, fun, emotionally stimulating info

When can close-ended questions be used?

introduce follow up questions or open ended questions. This allows open-ended questions to probe for more details about the patient's condition.

Why do we have different sets of questions for new medications and refill medications?

Each set of questions are asked at different points of time to the patient: for new medications vs refill medications

True or False: If a patient has a problem with his or her medication, they will definitely contact their healthcare provider for advice.

False

empathetic listening

attempt understand other people feelings - development care and trust relation

Define health literacy

The degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions

why should we not use double-barrel questions?

This can make it difficult for the patient to understand the questions as well as make it difficult for the provider to interpret the answer.

Adherence counseling

Type of counseling session that really relates to patients who has some sort of chronic illness or behavior that they are trying to change

Why is it important to have both new medication and refill questions?

allow us to hit all the key elements of drug therapy, gathering all the important information, all while allowing the patient to provide their perspective.

From a counseling perspective, what is the benefit of exploring what a patient does NOT know about their medical condition, medicine, etc.?

allowing you to help them go through details of their condition.

closed ended questions

can feel like an interrogation for patients and lead to passivity and avoidance; these should be used only as follow-up for open-ended questions

critical listening

challenge speaker's message by evaluating accuracy, meaningfulness, utility

From a counseling perspective, what is the benefit of exploring what a patient does know about their medical condition, medicine, etc.?

determining what information to narrow down at future counseling sessions and setting up the most beneficial patient-provider interaction possible

main difference between empathetic response and paraphrase:

empathy primarily as reflection of patient feelings rather than focus on content of communication

transtheoretical model of change

focusing onstages of a person goes through in making decisions to change their behavior

What is adherence counseling?

for patients who have a chronic illness or a particular behavior they would like to change

Provide an example of a population who could benefit from this adherence counseling

group of smokers who are trying to quit.

Match contemplation with the corresponding communication approach that most closely fits

identify discrepancies between goals and current behavior

In what manner to new medication and refill medication questions have to be asked?

open ended

Match action with the corresponding communication approach that most closely fits

provide positive reinforcement

open ended questions

provide you with more and more accurate information from your patient; use them whenever possible

Match pre-contemplation with the corresponding communication approach that most closely fits

raise awareness

Define new medication questions

regarding the medication and what the patient was told before coming to the pharmacy.

Define refill medication question

regarding what the patient is currently doing: what are they experiencing now?

"why" questions

tend to make patient's defensive; stick to "What" and "How" questions when possible

Why should we use reflection statements when we are working with a patient?

used to gauge a patients understanding and to demonstrate compassion to the patient