Communications week 5

Key principles in communicating with children

1. Children want to know. Pharmacists should communicate directly with children about medicines. 2. Children's interest should be encouraged, and they should be taught hot to ask questions of pharmacists, parents and other caregivers about medicine. 3. Children, parents and pharmacist should negotiate the gradual transfer of responsibility for medicine use - little autonomy 4. Children's medicine education should balance what children want to know and what the pharmacist think children should know

Initial steps to cultural competence

1. Examine your cultural background 2. Assess your level of cultural competence (CCHPA the cultural competence health practitioner assessment) 3. Immerse yourself in a community that you would like to learn about 4. Work wit culturally / ethnically organized student groups, patient groups or community groups 5. Read about culture - specific disease states and evidence based interventions and practice 6. Host a brown bag lunch focused on cultural competency 7. Reach out to religious leaders and community groups 8. Seek out traditional cultural healer 9. Talk with patients form diverse backgrounds in your community 10. Continue to learn

Check back

A closed loop communication to verify and validate information exchanged. Sender transmits a message, receiver accepts and confirms understanding, sender verifies message delivered EX: doc: prepare Benadryl 25mg IV push Pharm: 25 mg Benadryl iv push DOc: that's correct

TeamSTEPPS

A framework to optimize team performance Evidence based tools for improving communication and teamwork Learnable abilities in communication, leadership, situation monitoring and mutual support

Empathy

Action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another. It is a cognitive attribute that involves an ability to understand the patient's inner experiences and perspective and a capability to communicate this understanding

Huddles

Ad hoc to reestablish situation a awareness, reinforce plans and assess the need to adjust the plan

Prejudice

African American patients are seen as less intelligent, less educated, more likely to abuse drugs or alcohol

Debreifs

An informal information exchange session Reviews team performance and effectiveness

Key

Assess how the patient is responding - assess nonverbal ques and ASK ; for feedback

Learning objectives

Assess the specific communication needs of a targeted patient population Identify the appropriate communication techniques for a targeted patient population Deliver an appropriate counseling education to a selected audience by identifying and employing the most effective communication techniques

Communication toolbox

Be prepared for discussion with your team Introduce yourself Make sure the interaction is perceived as efficient use of time for all parties Share the problem in a way that does not blame Focus on the problem for the patient - not that you think the drug or dose of frequency is wrong Fact resistance by staying focused on the problem at hand Reflect what you understand the other party's resistance to be about your proposed solution.

Red flags

Boy dealing with this chronic pain is no fun. How much of this stuff (oxymoron ever) would it take to kill someone ? I cant believe what is happening to me. I went to the doctor because i was feeling low. She gave me a prescription for ambien. It helps me sleep, but i still feel depressed. Did you ever wonder if life was with the hassle ?

Tools to facilitate leader's role and promote teamwork

Briefs Huddles Debriefs

Patients battling mental illness

Check your own preception (do i have a stigma about mental illness) How much information to share (how much are they able to understand, sometimes mental illness can affect comprehension at certain times) Ways to gauge the patients' extent of understanding about the medication therapy Involving other healthcare professionals (tell doctor what you are informing patient of)

Plain language

Communication audiences can understand the first time they read or hear it, language that is plain to some may not be plain to others

Strengthening of trust relationship

Consistent behavior over time Common goals and visions Mutual respect Reaction in times of strained professional relationship ( med error) Mutual understanding of economic gain form the partnership

Older adults

Consumes disproportionate amount of prescription and nonprescription medications Accounts for ~30% of all prescription medications and ~40% of all OTC medications Tow out of three persons take at least one medication daily

Now and near future

Continued and expanded use of electronic communication with your patients Common themes: medication management therapy, ongoing communication with patients, physiological monitoring Outcomes: clinical outcomes, quality of life, knowledge (educating)

Reasons for cultural competency

Diversity in demographics (changing, Chinese vs Mexican, baby boomers to lots of elderly) Health disparities (healthcare provider not Abel to deliver, patient refusal to get treatment) Patient safety (incompetent, language barriers, med errors) Healthcare workforce shortages (not enough diversity to help eliminate these barriers; ideal world, Polish pharmacist could speak polish to polish patients)

Background

Early 1990s- introduction of World Wide Web Explosion of public health interest Emails popularity - free instantaneous In may 2010 : 78% adult Americans use internet daily, 94% use email daily, 87& use search engine, 83% look for med information, 75% get news

How can a culturally competent HCP improve patient safety

Effective use of interpreter and translation Correct judgement regarding complementary and alternative medicine (CAM)

Common tools used in inter professional communication

Emails and listservs (one group thread email) Improves coordination Reduces frustration Quicker rendering of health service Text messaging Immediate and informal way of communicating between providers Social media (FDA, conferences, updates) Twitter (drug recalls, live pharmacy conferences, coordination between first responders)

Inter professional use of electronic communication

Enhance or coordinate care of patients (asynchronous visits of different healthcare professionals, leave notes) Disseminate information Influence decision making and behavior Create or strengthen research collaboration

Terminally ill patients

Fear of saying the wrong thing Meet the patient where they are (most people know where they are in the stage of life) Ways to gauge their willingness to engage in conversation Assess your own feeling about death Assist family members in special need

Mutual support

Feedback - timely, respectful, specific, directed toward improvement, considerate

A person with unique communication needs

First check your perception of that problem Ex: older adult may appear frail but may not be forgetful or hard of hearing, assumptions are made based on perception fo the elderly as a population

Health care disparities

Gaps in the quality of health and healthcare and can include differences in rates of disease or illness, access to healthcare or general health outcomes

Patient explanatory model (PEM)

How a person understands and experiences health 1. What do you think caused the problem (illness)? 2. Why do you think it started when it did? 3. What do you think your sickness does to you? 4. How severe is your illness? Will it be a long or short course? 5. What kind of treatment do you think you should receive? 6. What are the most important results you hope to receive from this treatment? 7. What is the chief problem this illness caused you? (Functional goals) 8. What do you fear the most about the illness (misperceptions)?

I pass the baton

I - introduction (introduce yourself and your role/job, include patient) P - patient (name identifiers age sex location) A-assessment (presenting chief complaint, vital signs, symptoms, and diagnosis) S- situation (current status/circumstances, including code status, level of certainty, recent changes, response to treatment) S-safely concerns (critical lab values/reports, social economic factors, allergies, alerts (falls isolation)) The B- background (comorbidies, previous episodes, current medications, family history) A- actions (what actions were taken or are required ? Provide brief rationale) T-timing (level of urgency and explicit timing and prioritization of actions) O- ownership (who is responsible, nurse/doctor/team, include patient/family responsibilities) N- next (what will happen next? Anticipated changes? What is the plan? Are there contingency plans?)

CUS (assertive statements)

I am concerned I am uncomfortable This is a safety issue (stop the line)

Opportunity

Identifying the technology/platform that best fits the needs of the patients and suits the work flow of the provider (informatics)

Clinical uncertainty

In setting of language barrier, physicians rely on observation and inferences (what they think is happening) greater chance that treatment decisions are influenced by personal biases and stereotypes

How can a culturally competent HCP reduce health disparities

Include a key community member during treatment Utilize otherwise over looked resources (family, religious ties) Goal: increase patient trust, increase patient adherence to treatment

Situational awareness

Individual outcome - state of knowing the condition of the situation

Culture

Integrated pattern of human behavior that includes thoughts, communications, languages, practices, beliefs, values, customs, courtesies, rituals, manners of interacting and roles, relationships and expected behaviors fo a racial, ethnic, religious or social group

Good qualities fo social media

Interactive User generated (you create content) Collaborative (blog) Fosters communication (open) Can be used for patient - provider communication Can be used for inter professional communication

Empowerment

Involves patient assumption of choice, control, and responsibility for treatment decision-making Community empowerment involves gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences or concerns

Working with patients form diverse cultures

LEARN L-listen to the patients perspective of health with open mind E- explain your perceptions and empathize with the patient A- acknowledge commonalities and differences in the approach to understanding health and treatment options for the patient R- recommend a treatment plan in a way that is respectful of the patient's culture and beliefs N- negotiate a plan to navigate through the healthcare system

E professionalism

Lessening in social restraint and invisible audiences Quick replication the message and distribution to anyone Maintenance fo personal vs profession attitude on the internet (social media)

Learning objectives

List the Social determinants fo health Identify key reasons for the cultural competence in healthcare Demonstrate effective cross-cultural communication skills

Children- why the need for education

Majority of pharmacists reported that physicians give little information about medicines to children despite their need Majority of children interviewed reported difficulty in remembering when to take their meds Majority of public school children reported learning about medicine from their mothers Some children self medicate, form purchasing to taking medicine without supervision

Patient factors

Minority patients are more Isley to refuse services, non adherent to treatment regimens and delay seeking treatment Contributing reasons - mistrust of providers, misunderstanding of directions (non adherence), fewer encounters with healthcare system

Internet as a source of information

More patients are utilizing the internet as a trustworthy source 66% internet users look up specific disease/problem 56% internet users look up specific treatment/procedure 44% internet users look up doctors or other healthcare professionals Recognize the trend and prepare to respond to patients - keep up with the internet and be able to direct patients to more trustworthy sources

Caregivers

No direct communication with patient Difficulty in assessing patient's perception or adherence to the medication therapy Instruct the caregivers on: disease states, monitoring for response, refill status (Basic things they can do) Understand the needs of the caregivers themselves

Strategies for effective cross cultural communication

Observe nonverbal cues for patient;s comfort with eye contact, personal space, physical contact Observe verbal cues (first or last name, what they like to be called, how they introduce themselves, small talks) Use vocabulary consistent with culture and the patient's education background Patients with limited English proficiency (LEP) - work with trained interpreters and translated materials

A patient is picking up a medication that is typically prescribed for schizophrenia. The patient asks you for more info about he medication, particularly its use and all the possible side effects. How would you respond

Offer general info about med *** Have the patient wait while you call and speak to physician XXXX Print out the medication information leaflet an give to the patient to read at his leisure time XXX Go over the use and the comprehensive list of AE of the medication *** its your job

Engagement

Opportunity for patients to be informed and active partners in their care. Engagement among health providers is essential for providing safe, high quality health care

Implications of high internet use

Patient desiring to communicate with providers using emails or secure messaging systems Privacy and security of the message: email communication subject to provision of the health insurance portability and accountability act (HIPPA) - creation of "portal" (keeps messages secure with login, messages are not directly delivered to recipients) - creation of generic messages without revealing sensitive health information Reimbursement: scarce reimbursement opportunity to the physicians who provide serve via emails Challenges in workflow: unclear expectation leading to confusion and frustration - clear role of emails in health care provision (scheduling) - clear delegation of roles (who handles emails)

Patients with disabilities - wheelchair bound patients

Patient is lower than you Sit next to person Don't talk above them Come to eye level However some dont want the special treatment Figure out what each person would prefer

Paradigm shift

Patients are no longer the obedient non expert in health care Providers are no longer the dominant expert voice in health care Recognize patients have access to internet sources too

Team strategies and tools to enhance performance and patient safety (Team STEPPS)

Performance Attitudes Knowledge Patient care team Mutual support, situational monitoring, leadership, communication

Disadvantages fo the use of the internet for patient provider communication

Reluctance to use secure email communication (both patients and providers) Concerns over confidentiality and security Decreased compliance with guidelines, less regulations

Learning disabled patients

Repetition of key info Written info with lower reading level

Stages of development (Piaget)

Sensory motor = birth to 2 years - learning is centered around the child; little connection to outside object Preoperational = 1-6 years = thinking involves a single aspect of situation, known as Magical thinking; difficult to see connection between their health and health related behaviors Concrete operational = 1-12 years = concrete objects can be linked to mental operation; they understand health and illness and disease as preventable event (link health and behavior) Formal operational = 13+ = they are capable of hypothetical and abstract thinking; increasing awareness fo degree of illness as well as personal control of their health

Situational monitoring

Situational monitoring (individual skill): actively scanning and assessing the situation

Briefs

Team meeting Discusses - team membership and roles, clinical status of the patient(s), plan of care, issues impacting the team

Shared mental model

Team outcome - each team member maintaining his/her situation awareness and sharing with the entire team. On the same page

Cultural competency

The attitudes, knowledge, skills, and values that an individual has and uses in working effectively in a cross cultural environment

Culture

The learned and shared beliefs, feelings and knowledge that individuals and/or groups use to guide their behavior and define their reality as they interact with the world

Assess

The pharmacist assess the information collected and analyzes the clinical effects fo the patient's therapy in the context of the patient's overall health goals in order to identify and prioritize problems and achieve optimal care. This process includes assessing: -each medication for appropriateness, effectiveness, safety, and patient adherence -health and functional status, risk factors, health data, cultural factors, health literacy, and access to medications or other aspects of care -immunization status and the need for preventive care and other health care services where appropriate (religious backgrounds)

Collect

The pharmacist assumes the collection of necessary subjective and objective information about the patient in order to understand the relevant medical/medication history and clinical status of the patient. Information may be gathered and verified from multiple sources including existing patient records, the patient and other health care professionals. This process includes collecting: -a current medication list and medication use history for prescription and nonprescription medications, herbal products, and other dietary supplements -relevant health data that may include medical history, health and wellness information, biometric test results, and physical assessment findings - patient lifestyle habits (hours of sleep, alcohol), preferences and beliefs (drugs vs natural products), health and functional goals (what person is able to do), and socioecomic factors (impact access to care, insurance) that affect access to medications and other aspects of care

Cross cultural communication

Threats to effective patient communication -language difference -cultural difference -low literacy level -age or gender difference in provider -prejudice of lack of familiarity in providers background

Patients battiling sexually transmitted diseases

Understand you patients as they deal with serious diseases and Social stigmas- feel ostracized Know available sources of assisted and referral Keep updated on the research

Guidelines for e professionalism

Use good judgement when posting information that may mislead others Consider all potential members of the audience Avoid frequent posts that may depict you as a complainer Avoid any type of post that depicts you as a substance abuser Understand that many people may be uncomfortable communicating personal information via social media Do not solicit social media connections with patients or subordinates Do not violate patient privacy Educate yourself on employer expectation on social media use Remember that anything posted online may remain there indefinitely

Food for thought

What similarities/differences do you see in how your patients access the internet? (Similar both look up symptoms; differ in sources) Are barriers in place that can impede your ability to communicate with patients? Are there opportunities to enhance communication with patients?

Home bound patients

Work with patient's caregivers when they visit pharmacy Present clear and concise written information Consider use of electronic communication After persons to go through must be as clear and concise as possible

Social determinants of health

age sex and hereditary factors - genetic components Individual lifestyle factors - how active you are, type of work Social and community networks Living and working conditions - work environment (air), education, agriculture and food production, unemployment (self esteem, $), water and sanitation, health care services, housing General social economic, culture and environment conditions (Not just family history)

Considerations for internet use

-Broadband access at home - are certain patients/ groups at a disadvantage? (Maybe some dont have WiFi at home and can't open portal at home etc) -digital divide - consider 80% white Americans go online while 71% African Americans go online (what about age, 85 vs 25) -mobile technology- cell phone data applications growing in Americans aged 30-49. Minority cell phone users are more likely to use data applications than white cell phone users - be cornices of disadvantages of certain groups of people.

DESC script

A constructive approach for managing and resolving conflict D= describe the specific situation or behavior; provide concrete data E= express how the situation makes you feel/what your concerns are S= suggest other alternatives and seek agreement C= consequences should be stated in terms of impact on established team goals, strive for consensus

Cultural competence: cross model

Cultural destructiveness: beginning of the continuum and most negative stage. Attitudes and policies support bigotry, racism, discrimination, and exploitation harmful to cultures and patients. Behavior can be intentional or unintentional. In the Tuskegee study, the us Public Health Service withheld syphilis treatment from African American men. - a health care provider judges a patient who is using CAM and assumes patient is not well educated or informed Cultural Incapacity: organizations or providers do not have any programs or services to respond to needs of patients from other cultures. Ethnocentrism often exists in which a dominant culture makes assumptions about other cultures - a pharmacy may not carry candles requested by several patients in service area. The common, inexpensive adjunct self care therapy is perceived to not be important (prayer and candles) Cultural blindness: organizations or individuals try to remain unbiased. Assumptions is that culture or race makes no difference; treat everyone "equally." Organizations have programs but do not tailor them to address cultural needs of different groups - bandage is "flesh" colored and would be camouflaged on anyone regardless of skin tone Cultural Precompetence: (skewed toward positive end of continuum) healthcare organizations or individuals recognize that cultural differences exist. Organizations may reach out to cultures by hiring diverse workforce, interpreters or translators for written materials. Organizations limit their efforts to several initiatives and may become frustrated with lack of progress. - providers might be quick to point to an herbal product line available in their pharmacy targeted for a specific cultural group and assume that this action suffices to care for different cultures Cultural competence: acceptance and respect for differences among cultural groups is ongoing. Providers and organizations continually increase their cultural competence knowledge and skills. Models are implemented to deliver culturally appropriate care with a true commitment to improve outcomes of patients from diverse cultures. Providers strive to assess personal cultural biases and beliefs. Concerted efforts are made to meet and work with people of diverse backgrounds in the community. Assessments to improve care for different cultures are ongoing. -organizations may be committed to training their personnel to better understand the self care needs of patients from different cultural groups Cultural proficiency: highest level of the continuum. Organizations and providers have a true commitment to culturally competent practices by engaging in research, evaluating new approaches to care, publishing and disseminating findings, advocating for improvements, and conducting training. Work to achieve cultural proficiency is continual, and the positive impact and the transformation of understanding and engaging different cultures are valued. - providers may work with community members to identify commonly used self care and herbal products. Ongoing training for staff and students on community health beliefs and values is provided.

Communicating via email messages

- do not use patient identifying information if not encrypted, use portals they are encrypted - double check "to" field before sending message - consider sending up an automatic reply to tell patients or providers that messages were received (vice versa) - a permanent record of patient information should be backed up - consult with malpractice carriers on plans for email use in patient care - request that senders use a subject time to summarize the content of the message (vice versa) - make action requests and time frame for response (vise versa) - separate unrelated topics into separate messages - make email messages one page or less if possible - check email at defined times and let people know how to reach you on short notice

Advantages fo the use of the internet in patient - provider communication

-Health related content distribution to patients from anywhere in the world to any internet connected device -Synchronous and asynchronous communication -Provision of patient generated health info to the providers -Collaborative agreements to help patients an age chronic medical conditions

Call out

-Informs all team members simultaneously during emergent situations -helps team members anticipate next steps -important to direct responsibility to a specific individual responsible for carrying out the task (must delegate responsibilities to a specific individual) EX: leader: airway clear? Member: airway clear. Leader: breath sounds Member: breath sounds decreased on right Leader: blood pressure Member: blood pressure 160/80

Key things to remember

-barriers to successful inter professional collaboration -ways to strengthen trust relationship with other HCP -elements that exist in a successful inter professional collaborative relationship -communication and teamwork techniques in inter-professional practice setting (TeamSTEPPS)

Effective team leader

Designated Situation al

Potential barriers

-No clear definition of the collaboration -Supportive culture does not exist at a public or institutional level -legislations do not clearly describe professional responsibilities -economic rewards for collaborations scarcely exist to offset investment cost -educational programs supporting inter professional collaborations are scare- but rapidly changing now - patients do not perceive benefit of inter professional collaboration -lack of communication technology to support inter professional collaboration

Learning objectives

-Understand the background for the current use fo the internet for healthcare -Describe issues and opportunities pertaining to electronic communication in (1) patient-provider relationship and (2) inter professional relationship -identify the issues and opportunities with social media use in health care -demonstrate understanding fo legal issues pertaining to electronic communication in health care in patient cases -state guidelines for using emails and Social media in health care communication

Summary

-When communicating with children, the content and the style of communication should be tailored according to the child's need and to the child's developmental stage. -older adult patients or others with specific sensory or learning impairment may require modifications in how health information is communities to them. -communication with patients who are terminally ill requires aided sensitivity and effort in understanding and meeting where the patient and the family members are -it is important to know additional resources for assistance fo the optimal communication with patients with sexually transmitted diseases or mental illness -Communicating with suicidal patients must be done in caring and empathetic manner, free from false assumption about this patient population.

Learning objectives

-identify potential barriers to effective inter professional collaboration -understand key strategies in building trust between healthcare professionals -stage critical elements that facilitate building successful collaborative relationships -practice critical communication and teamwork skills for inter professional collaboration

Communication Techniques for children

-involve both the child and the parent - tell the parent that you are going to talk with the child -use ice breaker (school, grade, backpack, shirt cool...) -start with general questions to get an idea of child's developmental level (fav subject?) -use open ended questions and simple declarative sentences (take this medicine with water.) - ask the child to show you how to use a medicine device - ask the child what question he/she has for you - pay attention to nonverbal communication

Case study

A woman from an African country of Somali is reluctant to giver her mother medication for pain. When asked, she explains that she would prefer to help her mother's pain through massage.

Social uses of the internet

Assess your personal, social uses of the internet Do you connect with friends and family? Do you network with your pharmacy organizations? Has any patient sent you a friend request? Do you follow any bog regularly? Is your pharmacy using internet platform to advertise/provide information to patients?

Hand off

Enhances information exchange during transition of care (shift) Transfer fo responsibility Clear information Verbal communication Acknowledgement by receiver Opportunity to review

Age specific tools toddler to preschool

Ice breaker Putting a label of the the child's medicine Teaching what the child should do if he/she sees a pill on floor or sees other kids getting into medicines (safety instructions)

Age specific tools school aged

Icebreaker Simple open ended questions Encourage some level of autonomy Present simple anatomy and mechanism of the medicine (med will make you feel better and bring down your fever)

Qualities leadership

Identifies goals and plan Assign tasks Share the plan Monitor the progress Modified the plan and communicate to all members Review performance

Respect

Is related to positive attitudes toward human worth and the dignity of every individual; maintaining nonjudgmental attitudes toward human diversity and uniqueness among patients and colleagues; support for patient autonomy; suitable attention to privileges and codes of conduct and maintain privacy and confidentiality Respect should be shown in all interactions with patients, colleagues and team members

Summary

Know trends, advantages, disadvantages, how and why internet is used As future pharmacists, you must be prepared to utilize and capitalize no the use of emerging electronic communication technologies for the advance meant fo health care and patient health outcomes Use of electronic communication offers both challenges and opportunities to reshape the provision of health care It is important to keep in mind additional guidelines when using electronic communication in order to disseminate correct message, maintain appropriate professional attitude and protect patient's personal health information

Older adults

Learning speed - ability to process new information diminished in some elderly, set short term goals, gradual change in behavior, break down learning into several components Differences in perspectives (technology use) Sense of loss Visual impairment - offer alternative forms of patient education material, allow more light Hearing impairment- conductive (hearing aid works), sensorineural (inner ear), and central (brain) impairment; use a lower tone of voice; beware of speech reading (reading lips, might not understand if mouth blocked standing behind a screen); slow the rate of your speech Speech impairment Dysarthria - loss of control over speech mechanism (cant speak the words); respond by offering written form of communication Aphasia- impaired ability to understand others and express oneself (cant think of worlds); may help to involve caregiver into the medication management, yet still primarily focusing on the patient

Behaviors noticed in a successful collaborative relationship

Long term and short term goals exist No hierarchical relationship Patient perspectives are taken into account when setting goals and practices Trust and shared visions exist between partners Cultural differences of different professions are respected

Suicidal patient myths

People who talk about committing suicide just want attention and do not actually kill themselves people who have seriously attempted or actually committed suicide wanted to die Suicidal risk is greatest when individuals are the depths of a major depressive episode (actually when just coming out of depression state) Asking depressed individuals whether they are suicidal is dangerous because it may get them to consider suicide when they hadn't been thinking of it before Once a person decides to commit suicide, there is nothing anyone can do to stop him/her (many times people dont wanna die but nobody interveined)

Cultural competence - Campinha-Bacote Model

Not spectrum Cultural Awareness; providers explore their culture and profession through a process of understanding personal biases and assumptions about different cultures - providers acknowledge cultural differences in home remedies and self care treatments used such as chicken soup and hot tea with lemon to alleviate cold symptoms. Cultural knowledge: process of gaining more info about diverse cultures, values, beliefs, and practices - providers learn about common herbs and alternative therapies used in the Vietnamese American Buddhist population living in the neighborhood surrounding the pharmacy or clinic Cultural skill: providers have the ability to collect, assess, evaluate and adapt cultural information from diverse patients to improve care. - providers recognize that when obtaining information about religion and culture in the social history that a woman who identifies as Islamic May prefer to have a female provider to discuss medication for a yeast infection Cultural encounters: providers actually have the opportunity to interact with one or more patients and families in diverse cultures to enrich their awareness, knowledge, and skills - providers are able to see multiple patients who are Hispanic each day and over time understand the importance of family in making decisions about diet and diabetes management. Cultural desire: provider are sincerely motivated to grow in their capacity and skill to navigate across cultures. In addition to working with patients from the large catholic parish nearby, the Hindu provider volunteers at the parish community and outreach events.

Key concepts

Place of cultural, socioeconomic factors in pharmacist patient care process PPCP Key reasons for cultural competence as a HCP Treats to effective cross cultural communication Strategies to become a culturally competent HCP

Peeer model for effecting healthcare team-patient caregiver communication

Plain language Engagement Empathy Empowerment Respect Providers - expressive and receptive communication - patient and caregiver

Provider factors

Prejudice, stereotypes of behaviors of minorities, greater clinical uncertainty = health disparities

Importance of confidentiality, privacy and security of personal health info

Providers must implement actions to protect patient information - whatever your pharmacy decides to do must be acceptable for minimum guidelines

Critical elements that facilitate building successful collaborative relationships

Sharing- responsibilities, values, views on patient care, planning and intervention Partnering- honest two way feedback, mutual trust and respect, value each other's points fo view, work toward goals with agreed outcomes Interdependency - work to meet partners needs Power- partners share power and include patients in power sharing, based on knowledge not titles

Why the popular social uses of internet for health related activities

Social networking Participation Apomediation (Find out who is the best, bridge us to new information) Collaboration Openness - provides pros and cons

Purnell Model for Cultural Competence

Unconsciously Incompetent: providers do not realize what they do not know about other cultures or the influence fo culture across persons, family and community - a provider encourages influenza vaccine for an individual not recognizing that the family home is multigenerational and everyone should be vaccinated Consciously incompetent: providers recognize that they have challenges working with persons form diverse backgrounds. - a provider realizes that there may be different values about contraception in a Nigerian culture and takes time to research information about the beliefs Consciously competent: providers are aware of their effort to work effectively within or across different cultures - a provider trains the entire staff on a new refugee population resettled in the community. Key cultural leaders are invited to help role play and address potential cultural beliefs and practices Unconsciously competent: providers are more easily able to navigate within a different culture or actress new cultures; there approach may seem effortless- provider has worked with Mexican American patients with diabetes over time and understands different cultural barriers to self management

SBAR

Used to for a conversation, one needing immediate attention and action S- situation (what is going on with the patient) B- background (what is the clinical context) A- assessment (what do you think the problem is) R- recommendation (what would i do to correct it)

Age specific tools adolescents

Value private conversation without parent Provide similar level of education as to an adult patient

Targeted population

Very old person (85-95) Children (8-10) Limited English proficiency Caregiver of the terminally ill patient

Social media category

Video sharing Wikis Social networking Blogs Microblogging Podcasts Photo sharing Virtual worlds Real simple syndication RSS Social bookmarking Local based services Platform aggregators