Clin Comm Exam 1
Describe the process of addressing a patient's concerns about quality.
- take patient to private place - document all communications with patient, doctor, hospital, etc. - offer empathic response - thank patient for bringing it to you - there is nothing more important than this right now - let the patient talk and express feelings - be in control of situation - provide brief explanation of error (facts only) - DO NOT ARGUE - offer a safe apology - remedy the error - follow up as necessary
Offer potential solutions for minimizing med errors.
- tall man lettering - repeat back all verbal orders - keep most up to date drug references - counsel!!!!! - patient education materials - promote staff communication
Identify barriers to documentation.
- time - knowledge - comfort level - lack of reimbursement - reports generated for workload analysis, accreditation - paper documenting = inconsistent reporting
Identify how to accurately interpret nonverbal messages.
- usually interpreted as intentional to interpret correctly: 1. use background 2. use context clues (cue clusters)
Identify how to create and use a PERT chart.
- working backwards from deadline 1. list steps 2. estimate time to complete steps 3. add up time 4. count backwards from deadline
List 6 responses used in place of empathy and classify a response as: - judging - advising - placating - generalizing - probing - distracting - understanding
"I'm sure you just happened to see him when he was having a bad day. I bet if you keep going to him, things will improve" - placating "I don't blame you for being upset. You shouldn't have to wait that long when you have an appointment." - understanding "Let me talk with you about the new prescription you're getting." - distracting "No one feels that they have enough time to talk with their doctors." - generalizing "Tell him how you feel about the way he treats patients. Otherwise, find a different doctor." - probing "You seem to feel there's something missing in your relationship with Dr. Johnson - that there isn't the caring that you would like." - judging
Write a SOAP note incorporating qualities of well-written documentation.
(refer to pic)
List at least 4 reasons for less-than-optimal adherence.
- cost - too many pills - too many changes in dose/strength - some just tired of taking meds - too busy/forget - meds make them feel unwell
Explain purpose of patient counseling.
- educate - prepare - build relationship - avoid DTPs
Identify techniques to improve patient understanding when given a patient case (don't assume anything).
- emphasize key points - give reasons for key advice - give specific instructions - repeat key info - give opportunity to provide feedback - supplement counseling with written info
Recall the purpose of the patient interview.
- ensure everyone has the most accurate and up-to-date medication list - assess drug-related needs - identify drug therapy problems - develop a therapeutic relationship
Identify recommended components for med info for pediatric patients.
- how does med taste? - how long do they have to be on med? - when do they have to take med? - how will it make them feel better? - what is dosage form? - what side effects does it have?
Identify counseling points that pharmacists should include to decrease medication administration errors in children.
- involve child and parent/caregiver - counsel parents on importance of appropriate med administration - tell parents to check with child's school about med rules - encourage children to ask questions
Identify the types of errors that could occur.
- misfill - order gets 'lost' - controlled drug legitimacy - private facts disclosed publicly - support personnel overstep boundaries - generic instead of DAW brand - promise is not fulfilled - handwriting misreading
Provide examples of where/when a pharmacist might use motivational learning.
- obesity - diabetes - hypertension - medication adherence - psychiatric illness - behavior disorders - substance abuse - nicotine dependence - pharmacy - clinical setting - health fairs
List 3 reasons pharmacists document their care.
- proof that it happened - being able to reflect on info you may need in the future/ may have forgotten - provide info on future issues that could be helpful to a lawsuit, law enforcement, etc.
Explain how learning to better read nonverbal cues can help improve your listening skills.
- read other's nonverbal cue clusters *** helps you understand other person - paraphrase your understanding - offer feedback to show you are listening - withhold judgement - use perception checks
Recall 5 critical behaviors of collaborative partners.
- similar agendas - nonhierarchical relationships - consideration of patient perspectives - trust and shared vision - demonstration of respect
Articulate pharmacy practice's philosophy of practice (PoP).
a set of professional values and beliefs that every practitioner has that guides their actions and decisions in practice - meeting a societal need - fulfilling specific responsibilities - utilizing a patient-centered approach - caring through a therapeutic relationship ('caring paradigm') - working as a collaborative member of the health care team
Define 7 feedback terms.
formative feedback: occurs before or during instruction, may not be graded - low/no stakes - objective ex: clicker questions summative feedback: occurs at the end of instruction, graded - high stakes - subjective ex: final exam feedback: describes person's performance in given activity that guides performance - formative - objective evaluation: renders judgement - summative - subjective constructive criticism - summative - negative connotation - can crate defensiveness and barriers to communication encouragement: focuses on being nice and only telling positive news - vague - doesn't focus on skill development or improvement self-reflection - important and useful
Contrast hearing vs. listening and passive vs. active listening.
hearing: physical ability listening: skill, implies understanding - helps make sense of what other person is saying - active, factual, empathic listening --------------------------------------- passive listening: interested, but assume we heard and understood correctly active listening: interested and restate or paraphrase understanding of message - reflect back to sender for verification - verification process is distinguishing factor
Compare and contrast sympathy and empathy.
sympathy: acknowledges someone in distress - feel compassion, pity, pass judgement - offering words of support/comfort - about words, not emotion - drives disconnection empathy: ability to perceive and understand a person's feelings - includes perspective taking - taking on, understand, communicate the person's feelings - about emotion, not words - fuels connection
State the first step for responding to a person experiencing loss.
understand the stage of grief they are in
State how to use rubrics to provide feedback.
use rubric chunks to evaluate big areas/categories of strength and areas of improvement and to set goals
Suggest 3 clinical conditions commonly encountered in older individuals that directly influence communication.
vision impairment hearing impairment cognitive impairment
Identify 3 problems that can occur during feedback.
1. sender focuses on message; misses feedback - looking away - looking at surrounding objects - focused on delivering message without paying attention to nonverbal cues 2. receiver fails to provide appropriate feedback - planning response/ don't hear message - seeking to respond, not to understand - using too big of words 3. sender and receiver are overconfident and assume it was interpreted/ understood correctly
List & define the 5 stages of loss - and newest 6th stage.
1. Denial and Isolation - in state of shock - acts as buffer or temporary defense 2. Anger - necessary stage in healing process - can manifest itself in different ways - feeling it will help it dissipate 3. Bargaining - entering into an agreement to postpone the inevitable or reverse what has occurred - guilt can be a companion in bargaining 4. Depression - mood disorder that can lead to persistent sadness, prolonged loss of interest, disruption to daily functioning - not a mental illness, appropriate response to loss - reactive depression: occurs in response to past losses *** verbal interactions & active interventions from others may be helpful - preparatory depression: occurs in response to impending or future losses *** may signify loss of hope *** nonverbal communication or silence is most helpful here 5. Acceptance - there is not an end to grief - can signal recognizing a new reality - void of feelings (not happiness) - time & assistance help people reach this stage *** hope persists through all stages 6. Meaning - move forward in a way that honors our loved ones - as you move through grief, gratitude can appear - finding meaning may be appreciating that the person or experience meant something
Recall 3 prime counseling questions and associated counseling content to provide to patient.
1. What did your doctor tell you the medication is for? - name of med - strength of med - indication/purpose of med - mechanism of med 2. How did your doctor tell you to take it? - dose of med (in tablets or mg) - ROA - frequency of administration - other guidance about administration (with food, TID, etc.) - refill info - missed dose instructions - expected duration of treatment - storage of med 3. What did your doctor tell you to expect? *** how did your doctor say you'd know the medication is working? *** what side effects did your doctor tell you to watch for? - technique and criteria for self-monitoring response (efficacy) - common or important side effects and whether they will go away with time (safety) - what to do to manage side effects - interactions with other meds
State 2 main reasons people use passive or aggressive communication styles.
1. reinforced or rewarded, therefore strengthened 2. irrational beliefs that interfere with assertiveness - fear of rejection/anger - overconcern for others - believe it's unchangeable personality characteristics - perfectionist standards
Use the 2 steps of empathic listening when communicating.
1. rephrasing content 2. reflecting feelings
State the 3 parts of a perception check.
1. describe behavior or nonverbal you observed - "I notice that you seem angry" 2. two possible interpretations of the behavior or nonverbal cue - "are you angry at something I've done or are you just having a bad day?" 3. a request for clarification about how to interpret the behavior or nonverbal cue - "can you tell me what you are feeling so I can see how to help?"
Name 2 main categories of barriers and reflect on environmental barriers present where you work.
1. environmental/physical - pharmacist visible? - easy to get pharmacist's attention? - pharmacist available to talk? - prescription are allows private conversation? - speak to pharmacist using third party? - background noise or other distractions? 2. personal: pharmacist or patient
List the 6-step process of providing feedback.
1. establish feedback timetable 2. prepare to offer feedback - use grading tools 3. strengths - self reflection and discussion - avoid false praise 4. weaknesses - self reflection and discussion - discuss remedial weaknesses 5. goal setting - identify goal and plan 6. follow-up - meet to discuss goal and progress - renegotiate goals after observation
Analyze the 2 primary functions of empathy.
1. establish rapport - increased trust - patient feels cared for 2. improve communication - patient feels understood and feelings are validated - provider can identify emotions or summarize a situation better
List two primary functions of communication.
1. establishes an ongoing relationship 2. provides the exchange of information necessary to provide the best care
Evaluate 10 strategies to improve cultural competence KSAs.
1. examine your implicit/explicit biases and participate in unconscious bias training 2. learn about your cultural background 3. attend cultural events 4. read about different cultures to build knowledge 5. assess your competence by completing cultural competence inventories - look at scores and areas/categories of improvement 6. immerse yourself in a community that you would like to learn more about or work with 7. work with culturally/ethnically student organizations, patient groups, or community groups 8. learn about culture-specific disease states and evidence-based interventions and practice 9. identify resources for addressing language barriers 10. commit to increasing cultural KSA over lifetime
Prioritize drug therapy problems given.
1. extent of potential harm 2. patient's perception of the potential harm 3. the rate at which this harm is likely to occur
List 12 barriers to listening well.
1. information overload 2. noise (external & internal) 3. rapid thought 4. not paying attention 5. learning not to listen - tune out 6. preparing to speak instead of listening 7. talking instead of listening 8. selective listening 9. bias or prejudice 10. language differences or accents 11. message too complex (too many details) 12. speaker's needs not clear
List 7 specific communication resources and strategies to use with diverse patients.
1. interpreters/translators 2. create culturally sensitive materials 3. know community resources and where to refer diverse patients 4. understand spirituality and religious beliefs 5. consider verbal communication techniques to use with diverse patients 6. LEARN about views of others 7. use general communication strategies
Identify at least 1 strategy each for overcoming 6 types of pharmacist-related barriers.
1. low confidence or shyness - practice/counsel more 2. internal monologue/noise - competing thoughts - compartmentalize 3. value of communication - prioritize patients over self 4. discomfort in sensitive situations - understand what patient needs; acknowledge and validate feelings 5. focus on delivering message - slow down and think about feedback as well as message delivery 6. overgeneralizing: treating all patients the same - personalize each patient
Recall required content in patient counseling per Oklahoma Administrative Code (OAC) Title 535.
1. name and description of drug 2. dosage form, ROA, duration of drug therapy 3. intended use of drug, if known, and expected action 4. special directions and precautions for preparation, administration, and use by patient 5. common severe side effects/ adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur 6. techniques for self-monitoring drug therapy 7. proper storage 8. prescription refill info 9. action to be taking in the event of missed dose 10. pharmacist comments on patient's drug therapy
Identify the three key components of pharmaceutical care practice.
1. patient care process 2. philosophy of practice 3. practice management system
List 5 types of patient-related barriers.
1. perceptions of healthcare providers 2. perceptions of illness 3. perceptions of what to do when ill 4. information overload 5. personal space
List 15 strategies that pharmacists can use to gain rapport with children and adolescents.
1. sit at same height as child 2. keep eye contact 3. introduce yourself to child and caregivers 4. make sure you know how the adults in the room are related to child 5. use normal tone of voice 6. remain calm (even if child isn't) 7. focus on them rather than doing other things during session (esp. adolescents) 8. find an ice breaker; ask a question to determine what interests them, look for clues in what they wear/ toys they bring 9. try to keep parents from speaking badly of their children 10. involve children in interaction 11. if they are anxious, let them play with stethoscope or spacer before using 12. give them plenty of time to answer your questions 13. if child is old enough to contribute, ask what questions or concerns they have 14. even if you don't agree with patient or their perspective, allow them to express their concern 15. explain to child what their role in med taking is and what their parent's role is
State the 3 reasons for the decline in empathy.
1. social media 2. technological advances provide alternate forms of communication 3. decreased amount of face to face interactions
Identify 4 reasons for health disparities.
1. socioeconomic status factors 2. poor health literacy 3. language barriers 4. acculturation - the degree of one's integration into a majority culture
Evaluate the 6 barriers to empathy.
1. too much time, attention, focus needed 2. fear of saying the wrong thing 3. stereotype people 4. depersonalization 5. hesitant to take on too many feelings 6. compassion fatigue
List the 5 dimensions of patient-centered care.
1. understand all aspects of the patient's illness 2. perceive each patient as a person 3. foster egalitarian relationship with patients 4. build a therapeutic alliance with patients 5. develop self-awareness of personal effects on patients
State 5 ways to become more culturally competent.
1. value diversity 2. examine your attitudes towards different cultures by assessing your beliefs and biases 3. raise your awareness and be conscious of the dynamics inherent when cultures interact 4. have knowledge of different cultures, cultural practices, and strategies/resources for interacting with different cultures 5. develop skills and adaptations to patient care delivery that address health disparities
List 3 main health literacy websites and resources for helping pharmacists improve health literacy (AHRQ, CDC, Plainlanguage.gov).
AHRQ Agency of Healthcare Research Quality - provides further explanation about health literacy and its effect on health outcomes - provides health literacy evaluations for pharmacies CDC Center for Disease Control and Prevention - provides further explanation about health literacy and its effect on health outcomes - references for training (state-specific info) PLAINLANGUAGE.GOV
List 5 factors that affect health literacy.
AGE SOCIOECONOMIC FACTORS EDUCATION LEVEL CULTURE & RACE LANGUAGE SPOKEN
Describe 4 potential barriers to effective communication during a pharmacy encounter and suggest ways to overcome these barriers.
ATTITUDES & BELIEFS false expectations - dismissing problems as normal part of aging stereotyping age - old people are always sick, always complain, lonely, confused, don't care, etc INTERFERING BEHAVIORS controlling behaviors - paternalism: 'we know best' by health professionals AND caregivers - discourage active participation DEPERSONALIZING ATTITUDES & ACTIONS - talking to caregiver instead of patient - failure to personalize the interview - using a scripted monologue PHYSIOLOGICAL vision impairment - glasses - lighting - printing (small type & font) - can't read instructions or label hearing impairment - inattentive, request repetition, speaks loudly - no response to questions - inappropriate answers cognitive impairment - memory & learning decline > age 70 - dementia, delirium, depression
Identify your conflict management style and compare advantages/disadvantages of the 5 conflict styles.
Accommodating Teddy Bear COMPETING SHARK advantage: if shark's decision is correct, better result is achieved and don't need compromise disadvantage: may breed hostility and resentment toward the shark AVOIDING TURTLE advantage: helps maintain relationships that would be hurt by conflict resolution disadvantage: conflicts remain unresolved, leads to others walking over them ACCOMMODATING TEDDY BEAR advantage: accommodating maintains relationships disadvantage: giving in may not be productive, may get taken advantage of COMPROMISING FOX advantage: relationships maintained and conflicts are removed disadvantage: compromise may create less than ideal outcome and game playing can result COLLABORATING OWL advantage: both sides get what they want and negative feelings eliminated disadvantage: takes great deal of time and effort
State the 6 resilience domains.
COLLABORATION - social support - manage perceptions - support networks *** mentoring programs, seek help, develop good relationships TENACITY grit: quality that makes us willing to commit long-term goals and see them through despite adversity & obstacles - persistence - realistic optimism - bounce back - maintain positive outlook HEALTH - nutrition, sleep, exercise - self care - mindfulness - hobbies REASONING - active problem solving - resourcefulness (avoid procrastination) - anticipate & plan - time management skills COMPOSURE - evaluate your feelings - finding your stressors - recognizing social battery - realistic expectations for yourself - positive self talk - increase self-efficacy (time) VISION - purpose, goals, congruence - those who have passion can persist longer than those who just have willpower - people with purpose can persist even longer than those who have passion
Describe 3 key elements of motivational interviewing.
COLLABORATION vs confrontation EVOCATION vs imposing AUTONOMY vs authority
Describe at least 1 time each of the 5 conflict styles is appropriate to use.
COMPETING SHARK - conflict involves personal differences that are difficult to change - unpopular decisions need to be implemented AVOIDING TURTLE - confrontation will hurt a working relationship - disruption outweighs benefit of conflict resolution - little chance of satisfying your wants - others can more effectively resolve the conflict ACCOMMODATING TEDDY BEAR - maintaining relationship outweighs other considerations COMPROMISING FOX - all conflicting people are equal in power and have strong interests in different solutions COLLABORATING OWL - maintaining relationships is important - peer conflict is involved
Compare and contrast compliance, adherence, and concordance.
COMPLIANCE - extent to which a patient's behavior matches the prescriber's medications - implies patient passivity ADHERENCE - patient's ability and willingness to take a therapeutic regimen recommended by the prescriber - implies patient actively participates in decision about medication regimen CONCORDANCE - an agreement reached after negotiation between a patient and health care professional that respects the beliefs and wishes of the patient
Describe a CPA and identify an appropriate disease state for which a CPA would be appropriate.
Collaborative Practice Agreement - formal relationship between provider and pharmacist - defined activities delegated - pharmacists seen as under-utilized resources - promotes team-based approach - recommended by major health organizations used for chronic illnesses mainly
State how to assertively communicate in 4 situations.
EXPRESSING HURT FEELINGS - must tell people who have upset us what they have done - be simple, honest, direct - time window (don't bottle) - be open and act in a way that encourages others to share their feelings with you - pay attention to your body language and voice - focus on a person's behavior rather than personality - focus on your own reactions rather than other people's intentions - "I" statements - be specific - focus on goal and resolving problem, not just venting - private setting MAKING REQUESTS - asking for what you want from others in direct manner - use "I" statements - be specific about what you want SETTLING LIMITS/REFUSING REQUESTS - have difficulty saying "no" and become angry for being taken advantage of by others - decide how much you are willing to do in fulfilling request - delay response is ok as long as you respond within established timeline - use "I" statements - be persistent - calmly repeat your decision RESPONDING APPROPRIATELY TO CRITICISM - when another person is being aggressive towards you - devastating to people who are people pleasers and perfectionists
Evaluate text using the Flesch-Kincaid readability tool.
FK measures how difficult a text is to understand - Flesch Reading ease % = the LOWER the number, the more difficult (0-100) - FK grade level = 5th grade - college graduate
List 6 ways to respond to criticism.
IGNORE PROVOCATIONS - focus on solving underlying problems - don't escalate hostility by becoming defensive, angry, sarcastic CLARIFY CRITICISM - don't react until you are certain you understand exact nature of problem - impossible to improve performance when you don't know what you did wrong AGREE WITH CRITICISM - don't try to excuse your behavior - correct your behavior or apologies are empty - hard for others to hold anger when we acknowledge our mistakes DISAGREE WITH CRITICISM - important to state your disagreement and why - not justified bc it's personal attack or based on value judgments you don't agree with - not speaking your truth leads to resentment or loss of self esteem FOG - acknowledge truth in what people tell you about yourself - makes it clear your own standards guide your behavior without provoking confrontation - fogging accepts truth of your behavior but not judgement about it DELAY A RESPONSE - criticism takes you by surprise and you're confused about how to respond - give yourself time to think about problem before responding
Provide examples of questions which can be used to collect important info during a patient interview.
INDICATION - what medications are you taking for ________________? - how many mg is the tablet you're taking? - how often do you take that medication each day? - what time of day do you take that medication? - how long have you been taking that medication? - have you tried any other medications for that condition? ------------------------------------------ EFFICACY - did the (symptom) resolve or improve after you started taking this medication? - how often do you monitor your blood pressure/blood sugar/etc at home? - do you have any recent lab results? ------------------------------------------ SAFETY - have you experienced (side effect) since starting this medication? ------------------------------------------ ADHERENCE/COMPLIANCE - how often would you say you forget to take a dose of medication? - where do you keep your medication? - how much assistance with taking your medications do you receive from other family members? - what kind of assistance do you have/need to pay for your medication?
Categorize drug therapy problems according to drug-related need: indication, effectiveness, safety, and compliance.
INDICATION unnecessary drug therapy - duplicate therapy - no medical indication at this time - nondrug therapy more appropriate - addiction/recreational drug use - treating avoidable adverse reaction needs additional drug therapy - preventative therapy - untreated condition - synergistic therapy EFFECTIVENESS ineffective/inappropriate drug - more effective drug available - condition refractory to drug - dosage form inappropriate dosage too low - frequency inappropriate - incorrect administration - drug interaction - incorrect storage - duration inappropriate (too short) needs additional monitoring - needs labs - need to read blood sugar levels - needs BP readings SAFETY adverse drug reaction - undesirable effect - unsafe drug for the patient - drug interaction - incorrect administration - allergic reaction - dosage increase/decrease too fast dose too high - excessive dose - frequency inappropriate - incorrect administration - drug interaction - duration inappropriate needs additional monitoring - needs labs - need to read blood sugar levels - need EKG COMPLIANCE adherence - doesn't understand instructions - patient prefers not to take - patient forgets to take - drug product not available - cannot swallow/administer drug cost - cannot afford drug - more cost-effective med available
State the steps of ISBAR and use them to create a plan for communicating with a provider
Introduce "Hi, I'm Poppy Pomfrey, and I'm a pharmacist in the Family Medicine Clinic. I received a call today from a mutual patient." Situation "Mrs. Weasley describes a sharp, pulsing headache near her eyebrows which occurs a couple of times per week x 1 month. Turning her head worsens it and acetaminophen resolves it temporarily. She states it's worrisome and bothersome." Background "She reports experiencing seasonal allergies for which she is taking loratadine with pseudoephedrine. She has never had a migraine and has no family history. No history of hypertension. Denies dizziness, visual changes, or any other symptoms." Assessment "Would you consider sinus headache and or/ rebound headaches in your differential?" Recommendation "Could consider holding APAP as tolerated."
List 4 factors influencing the communication process with the older adult.
INTERNAL FACTORS pharmacist - personal experience and communication skills - education level - cultural issues - attitudes & values (ageism) - stress - time patient - cultural heritage - educational level - health literacy - religious beliefs - attitudes & values - stress - time - patient expectations of pharmacist COMMUNICATION STYLES listening habits - very common complaint that health care providers don't listen - listen without interrupting other communication habits - tone & volume - eye contact - language (ed level and patterns) - professional vocabulary SENSORY & EMOTIONAL FACTORS health issues affecting communication - pain - vision & hearing deficits - altered cognition or speech aphasia: inability to communicate verbally (receptive vs. expressive) - CVA/stroke - dementia - psychiatric disorders - traumatic brain injury aging - presbyopia: age-related vision changes in lens shape and ability to focus causing reduced acuity for near objects - presbycusis: age-related hearing changes typically causing reduced perception of higher pitched sounds - noise-induced hearing loss - med-induced hearing loss - glaucoma: increased ocular pressures - cataracts: clouding of lens reducing passage & scattering of light through the lens - macular degeneration: central retinal changes due to vascular exudates (wet form) or tissue atrophy (dry form) - damage to visual or aural nervous tissues due to trauma, stroke, infection, tumors, toxins ENVIRONMENTAL FACTORS physical barriers - lighting, noise level, space and temp - counters & barriers - telephone systems and technology - distance (pharmacy at back of building) - drive thru pharmacy work-flow barriers - personnel - steps to physically speak with a pharmacist often not conducive to communication and leads to patient reluctance
Name the 5 steps of the LEARN model.
L - listen to patient's perception of the problem with empathy and understanding E - explain your perceptions of the problem A - acknowledge and discuss the differences/similarities R - recommend treatment option/ respect the person and choices N - negotiate agreement on treatment plan
Compare and contrast loss and grief.
LOSS - process of losing something or someone - state of feeling grief when deprived of someone or something of value - name loss "grief" so we can feel it (need to feel it to heal it) GRIEF - reaction to any form of loss - the death of something; alters life *** death of loved one, loss of job, end of relationship - very personal, not linear
Identify 2 barriers to health literacy (medical jargon and low numeracy).
MEDICAL JARGON - special words/expressions used by particular profession/group that are difficult for others to understand ex: myocardial infarction = heart attack LOW NUMERACY - ability to understand or calculate numbers ex: calculate nutrition labels, calibrate temp, determine proper dosage and timing of meds
When given a clinical case, identify 3 physiologic barriers to effective communication based on patient characteristics and a way to overcome each of the identified barriers.
Mrs. G is long-time patron of your community pharmacy. She has recently moved into a senior apartment building due to reduced physical functioning and inability to maintain her house where she lived over the past 55 years. She's 93 y/o and her husband passed away 6 years ago. She comes in the pharmacy once or twice a month with her daughter or DIL to pick up her prescriptions. Mrs. G had a stroke 10 years ago with residual right sided weakness and expressive aphasia. After extensive rehab, she has recovered most strength (uses a quad cane) some word searching difficulties and slowed speech. BARRIERS 1. 2. 3.
Name the 4 steps of the NURS acronym for developing an empathetic response.
Name emotion Understand response Respect patient Support patient
Give an example of 10 communication strategies discussed for motivational interviewing.
OPEN-ENDED QUESTIONS - invites others to tell their story without leading in specific direction example: tell me more about how you're paying attention to your diet. REFLECTIONS - repeating, rephrasing, paraphrasing, reflection of feeling/emotion example: it sounds like you are uncomfortable with taking this medication, tell me more. EXPRESS EMPATHY example: it can be so challenging to know if you're making the right decision. DEVELOP DISCREPANCY - acknowledge ambivalence - what I should do vs what I am actually doing example: I know you don't want your child to get sick and you also feel that it seems overwhelming to quit smoking, both can be true. SUMMARIZING - helpful at transition points to ensure heard/interpreted correctly example: so, you've been saying... is that correct? AFFIRMATIONS - recognize patient's strengths - acknowledge behaviors that lead in direction of positive change, no matter how big or small example: your honesty is very encouraging. ROLL WITH RESISTANCE - avoid direct argument example: I can see that this is a touchy subject for you, we don't have to touch that today, let's talk about... SUPPORT SELF-EFFICACY - belief in one's capabilities to organize and execute the course of action required to make a change/accomplish a goal example: you were doing a great job at this time, how do you think we get you back to that place? ELICIT & REINFORCE CHANGE TALK - statements by patient revealing consideration of, motivation for, commitment to change example: discuss range of steps that could be taken to get closer to health goals, rather than promoting all or none thinking SET SMART GOALS - specific, measurable, attainable, relevant, time-based example: I'm going to check my blood sugar every morning until my next visit with my pharmacist.
Compare/contrast passive, aggressive, and assertive.
PASSIVE - avoid conflict at all costs - put other's needs above their own - avoid saying how they feel in fear of others disagreeing - have high need for approval - may feel angry, resentful, victimized, or manipulated - may blame others AGGRESSIVE - seek to win conflicts by domination or intimidation, exploit power differential - promote their own interests or POV - are indifferent or hostile to feelings, needs, thoughts of others - are easily angered and have low tolerance for frustration - may "win" battles short term but suffer from negative long term consequences ASSERTIVE - engage conflict by expressing ideas, opinions, and desires directly - stand up for themselves to solve problems in ways that do not damage relationships - respect other's feelings as well as own feelings - facilitate atmosphere of trust and mutuality - act in ways that are consistent with standards they set for their own behavior - realize that they can only control and change their behaviors, not others - take responsibility for own behavior
Differentiate the 3 types of listening.
PASSIVE - listener attends to hearing the other's POV, but doesn't attend to nonverbal cues - assume we heard and understood correctly, but don't verify ACTIVE - listener interested in understanding what other person is thinking, wanting, or what their message means - actively checks understanding before responding using verification process including paraphrasing EMPATHIC - seeking to understand a person's emotions while listening and verifying understanding - puts emphasis on understanding the other person's emotional experience and verifying the emotion by naming it
List your responsibilities as a sender and a receiver related to: messages, feedback, and barriers.
SENDER - responsible for assuring *** message transmitted using simplified terminology *** congruent verbal and nonverbal messages sent *** message delivered in barrier-free environment - should ask for feedback from receiver *** don't assume understanding *** watch nonverbal cues - obligation as sender isn't complete until you have determined if the person understood it correctly RECEIVER - responsible for listening to what is transmitted (message) by the sender - responsible for reducing barriers - responsible for awareness of nonverbal messages you send - should provide feedback to sender by describing what you understood the message to be
Describe the 4 stages of cognitive development in children.
SENSORIMOTOR - occurs from birth - 2 years - no communication possible PRE-OPERATIONAL - occurs from 2 - 7 years - can only see situations from their POV - unable to relate cause and effect relationships with their health - simple messages for communication; no explanation necessary CONCRETE OPERATIONS - occurs from 7 - 12 years - children can problem solve - children learn that diseases can be preventable - more in depth communication; explanation on baseline level is possible FORMAL OPERATIONS - occurs 13 - adulthood - able to embrace abstract and hypothetical thoughts - more capable of understanding their individual role in their health and more aware of illness in their lives - basically can communicate how you would with an adult
Determine the appropriate med education to provide to children in various stages of cognitive development.
SENSORIMOTOR counsel parents only PRE-OPERATIONAL "This medicine helps your kidney. Your mom or dad will give it to you when you wake up and before you go to bed. It tastes good and I think you will like it." CONCRETE OPERATIONS "This medicine will keep your body from harming your new kidney. Work with your parents to take the medicine at 8am and 8pm every day." FORMAL OPERATIONS " Tacrolimus prevents rejection. It will keep your immune system from attacking your new kidney. Take it at 8am and 8pm every day."
Identify correct location of information in a SOAP note.
Subjective - chief complaint - history of present illness - medication history - past medical history - allergies - family history - social history - review of systems Objective - vital signs - physical exam (by body system) - weight, height - blood pressure - labs/test/imaging (if none, state none) - current medication list Assessment - current status - goals of therapy - DTPs identified - plans to resolve DTPs including therapeutic alternatives - succinct rationale (guidelines or primary lit that guided your decision making) Plan for each condition: - start/stop/continue specific medication dose, route, frequency, duration - monitoring parameters for efficacy, safety - follow-up (who, what, when)
Evaluate 3 primary sources of conflict.
TASKS - job responsibilities - asking people to do task - "not my job" - task does not = goals - territory PROCESS/STYLES - how work gets done - quality - "not how we do that" INTERPERSONAL - poor communication - people's personalities and values
Define resilience.
adapting and responding positively to stress and misfortune
Define medication error.
any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient, or consumer
Define/ illustrate 5 communication elements.
communication is transactional 1. sender - forms and sends message 2. receiver - receives message from sender *** decodes and reacts to message *** receiver assigns meaning the sender intended (interprets correctly) 3. message - element transmitted *** verbal (10%) and nonverbal (90%) *** nonverbal is how you look and sound when you say them *** nonverbal is also words (changing subject) 4. feedback - receiver communicating back to sender understanding of sender's message 5. barriers - environmental/physical or personal
Contrast congruence and incongruence and interpret an example of each.
congruence = verbal + nonverbal match - smiling and agreeing incongruence = verbal + nonverbal do not match - say thanks with angry tone
Define 14 key terms related to culture and DEIA.
culture: a particular society or group that has its own beliefs, ways of life, art, behavior patterns, values, customs, communications, and thoughts that guide their worldview and decision making. race: a socially defined category that artificially divides people into groups on the basis of distinct physical traits and characteristics. ethnicity: large groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background. identity: the sense of belonging to a culture. stereotype: a generalized belief about a particular category of people; it is an expectation that people might have about every person of a particular group. stigma: a mark of disgrace associated with a particular circumstance, quality, or person. cultural competence: having the ability to provide care to patients with diverse values, beliefs, and behaviors and to tailor that care to patient's social, cultural, and linguistic needs. cultural humility: a lifelong practice of examining one's own beliefs and cultural identities along with learning about another's culture. cultural intelligence: the ability to adapt to new cultural settings. health disparities: preventable differences that are experienced by socially disadvantaged populations that create barriers to achieving optimal health outcomes. diversity: representation of varied identities and differences (race, ethnicity, gender, disability, sexual orientation, gender identity, national origin, tribe, caste, socio-economic status, thinking and communication styles, etc.) equity: seeks to ensure fair treatment, equality of opportunity, and fairness in access to info and resources for all. inclusion: builds a culture of belonging by actively inviting the contribution and participation of all people. accessibility: an environment that provides individuals with disabilities an opportunity to participate in events, programs, benefits, and services that is equal to that of their peers without disabilities.
Select the best statement describing a drug therapy problem.
initial: This 29 year-old is having continued breakthrough seizures due to subtherapeutic phenytoin concentrations. better: This 29 year-old is experiencing continued breakthrough seizures due to subtherapeutic phenytoin concentrations secondary to forgetfulness of taking her phenytoin therapy. ------------------------------------------ initial: This 61 year-old male is experiencing gastrointestinal bleeding secondary to aspirin therapy. better: This 61 year-old male taking low-dose aspirin as prophylaxis for secondary myocardial infarction is experiencing an initial episode of gastrointestinal bleeding secondary to aspirin therapy.
Identify the type of nonadherence when given a patient case.
intentional vs. nonintentional
Identify the distances of the 4 personal space zones.
intimate : 0-18" - partners/core family personal : 18"-4ft - friends/extended family social : 4-12ft - acquaintances/colleagues public : 12+ft - passer-by/stranger
Compare and contrast literacy with functional literacy, including the 3 components of literacy.
literacy: more than being able to read; includes ability to use printed and written info functional literacy: ability to use literacy info to function in society - print literacy: ability to read or write; understand written language - oral literacy: ability to speak or have speech comprehension - numeracy: ability to understand or calculate numbers
State what grade level health content is currently written at and what grade level it should be written at.
most health info is written at 12th grade level aim for lower than 8th grade level to be inclusive
Define 7 terms: nonverbal communication, paralanguage, open and closed body posture, mirroring, congruence, incongruence.
nonverbal communication: messages sent through body language, gestures, tone, body posture, facial expressions, eye contact; NOT words. open body posture: not closing off personal space in communication - uncrossed arms and/or legs closed body posture: closing off personal space in communication - crossed arms and/or legs mirroring: copy other person's body language and/or mood - cross legs, downer mood paralanguage: tone, volume, pauses/hesitations, noises congruence: verbal and nonverbal match incongruence: verbal and nonverbal do not match
Define paraphrasing and how to use it to help others improve their active listening skills using organizing and elaborating.
paraphrase: restate what was said, in your own words - help patients chunk info *** organize content around prime questions or patient info sheet *** verbally prioritize what info is most important
Discuss the importance of expressing empathy and sympathy without admitting wrongdoing.
patient wants to hear I'm sorry that it happened, not necessarily what went wrong
Explain connection between patient care and communication.
patient-centered care depends on effective communication - builds rapport - productive information exchange
State 4 reasons we use nonverbal and 4 ways nonverbal communication is delivered.
receiving SUBSTITUTES - interact with babies (overexaggerate) - communicate with those at distance - demonstrate agreement/listening with head nod - flip someone off - thumbs up REPEATS/COMPLEMENTS - talk with hands for emphasis - head-nod while saying yes REGULATES - eye contact - taking turns when talking CONTRADICT - smiling/sad (say ok when crying) - laugh at bad news/awkward situations -------------------------------------- delivering BODY MOVEMENTS - gestures - posture *** open vs. closed body posture *** mirroring FACIAL EXPRESSIONS - congruence vs. incongruence EYE CONTACT - regulated by culture (direct eye contact) - staring - wide eyes = shock, surprise PARALANGUAGE - tone *** whining, sarcastic, angry - volume *** soft, loud - pauses & hesitations *** uh, um, ya know - noises *** sighs, growling, clearing throat
Recall examples of proven benefits/impact of having a pharmacist on an interprofessional team.
reduced medication errors and overall costs improved adherence MD-PharmD management of hypertension leads to more consistent and higher rates of blood pressure control pharmacist collaboration in diabetes treatment leads to better A1c control
Define rubrics and compare rubrics to other types of performance assessment tools (checklists and rating scales).
rubric: scoring guide evaluating student performance using full range criteria vs single numerical score - makes the evaluator's thinking visible if given in advance - promotes students' self-reflection - can help the evaluator provide feedback checklists: rater selects from list of dichotomous criteria - forces rater to make absolute decision (yes/no) rating scales: rater scores along a continuum of criteria - offers more feedback to student by rating on scale (always-never, poor-excellent)
List what to do and say in a discussion with a patient regarding concerns about quality.
safe apologies I'm sorry : for your trouble you've been inconvenienced this has caused you such concern closing statement "this rarely happens, but it happened to you and I want to do everything I can to resolve it."
Evaluate 2 ways pharmacists can help patients overcome health literacy barriers (verbal and written communication).
simplify verbal communication - assess patient's baseline before providing extensive info - speak slowly - use simplified language - emphasize 1-3 key points - encourage questions by using open-ended questions - use teach back method so patient can demonstrate understanding simplify written communication - printed info should reinforce, not replace oral communication - printed materials should be in easy-to-read format - written at < 8th grade reading level - highlight/circle key info - supplement with relevant visual info
Write a SMART goal related to behavioral change.
weak goal example: I'm going to get fit. SMART goal example: I'm going to follow the Nike app training program to run a marathon 6 months from now without stopping. --------------------------------------- weak goal example: I'm going to write a book. SMART goal example: I'm going to write a 60,000-word novel in 6 months, finishing on May 31st. I will do this by writing 2,500 words per week. ---------------------------------------- weak goal example: I'm going to get my diabetes under control. SMART goal example: I'm going to check my blood sugar every morning until my next visit with my pharmacist.
