Helping patients with_change

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  • 1. Helping Patients With Change
    Including Supportive Communication and Choosing an Appropriate Response
    Rachel Ogden
    December 2, 2010
  • 2. Change
    One of the few constants in life
    Individuals differ in their comfort level with change
    Given the choice – most people would rather prove why its not necessary to change rather than change
    It is normal for people to resist change until they believe is actually good for them
  • 3. Example
    Pt with a diagnosis of Diabetes Mellitus II
    Lifestyle changes need to occur
    The actual administration of the medications
    Then you must consider the monitoring involved
  • 4. Emotional Responses to Change
    Fear, anxiety, ambivalence
    Anger, blaming and scapegoating
    Going numb, or avoidance
    Excitement, joy, relief
    Depression, both existential and clinical
  • 5. Patient’s Readiness to change
    Transtheoretical Model of Change
    Listed the steps of process in previous lecture
    Another method of assessment and way to educate the patient is:
    Motivational Interviewing
  • 6. Motivational Interviewing
    Allows patient to not feel as though they are being scolded when they have concerns or questions or resistance
    Pharmacists see resistance as a pathway to information
    Attempts to allow the patient not to lose “face”
    COMPETENCE FACE
    AUTONOMY FACE
  • 7. Motivational Interviewing
    When we are talking to patients we can’t always assume that we know what their life is like or that we can predict what their questions or challenges would be.
    Pharmacists can also explore the ambivalence a patient may portray
    Once again – ask questions, “what do you see as a benefit to stopping smoking?”
    Or – give choices, “of these three possibilities, what do you see as one that will work for you?”
  • 8. Motivational Interviewing
    What you are doing is trying to negotiate with a patient to make a change
    Through our conversation we need to get the patient to make a commitment to us to make a change – even if it’s a little change or a first step. The is a process
    Allows the pharmacist to explore the benefits and risks with the patient without judgment
  • 9. Strategies for Motivational Interviewing
    Opening strategy: lifestyle
    A Typical Date
    The good things and the less good things
    Providing Information
    The future and the present
    Helping with the decision-making
  • 10. Principles of Motivational Interviewing
    Express empathy
    Develop discrepancy – show how present behavior differs from the desired behavior
    Avoid argumentation
    Roll with resistance
    Support self-efficacy
  • 11. Supportive Communication
    As we have said before – we are social creatures – we have the need to communicate our feelings
    Patient adherence is higher when patients are allowed to voice their concerns and anxiety and when physicians took the time to patiently answer patient’s questions
    Practitioner’s that responded to patients need has higher patient satisfaction and better adherence rates
    Patient’s who characterized their physician as understanding and caring where more likely to follow their treatment plan
  • 12. Supportive Communication
    This is not necessarily trying to “make it all better” for the patient
    What you are doing is – acknowledging their feelings – and confirming what you know to be true
    Patient: My doctor tells me I have hypertension. Am I going to die?
  • 13. Appropriate Responses
    Our responses to our patients needs to be motivated by a willingness to help them or care for them
    Should not come from a need to reduce our anxiety or frustration
    Our frame of reference should be one of serving the client’s needs not our own
  • 14. Major Focus
    Helping the patient to:
    Feel understood and accepted which will also allow them to more openly and freely discuss their problems
    Achieve a more increased and more accurate understanding of their situation
    Discuss alternatives where necessary
    Make decisions about next steps along with specific actions to be taken
    Make adjustments so that the best results can be obtained
  • 15. Empathy
    Good for developing a therapeutic relationship
    Lets the patient know that they are not alone – that they are not “crazy” for what they are feeling
    Downside: can be painful to go through touch issues or times with the patient – but, working through these painful situation are generally good for the patient
  • 16. Reassurance
    Its an attempt to make the patient feel better or more confident
    Good: may be exactly what the patient needs to hear – but make sure they ask for it
    Downside: runs the risk of appearing to minimize the patient’s feelings
    Remember each patient is unique and their feelings are unique
  • 17. Probing or Questioning
    An attempt to gather more information
    Good: many times more information is required to make a good assessment or draw an appropriate conclusion for the patient
    Downside: we are getting away from the patient’s feelings – not always helpful
  • 18. Advising
    Trying to help the patient solve a problem – you have to remember what your realm of expertise is
    Good: very useful when you are the expert
    Downside: not so good when the patient is the expert – asking you questions about decisions in their own life
  • 19. Generalizing or Comparing
    An attempt to state what is generally true
    Good: may be exactly what the patient wants to hear
    Downside: once again – may give the appearance that the patient’s feelings are being minimized – are you getting to their unique feelings
  • 20. Assertiveness
    A response in which there is mutual respect between the patient and the pharmacist
    Good: no subjective or judgemental responses, allows for differing viewpoints to be awknowledged
    Downside: sometimes people just want to vent or let loose – the patient is not looking for a reasonable response
  • 21. Aggressiveness
    This response does not respect the other person’s viewpoint
    Good: there is no positive here – there may be a temporary feeling of satisfaction – but not good for the therapeutic relationship
    Downside: if one of the parties are angry, this will allow for the situation to escalate
  • 22. Nonassertiveness
    In this situation, you fail to respect yourself
    Good: The other party may get what he or she wants
    Downside: sets up a potential future situation where you will be taken advantage of
  • 23. Judging
    Communication where you are telling the patient that they are wrong
    Good: never good
    Downside: Not acknowledging the patient’s feelings, may be demeaning
  • 24. Scenario
    Patient:
    “Oh sir, (holding up a bottle). I just went out to my car and counted my pills and you shorted me 5 pills again.”
    Pharmacist: “Mrs. Smith I saw on your record that you had been shorted in the past so I took special care to count your pills two times. I can assure you that the correct amount of pills were in your vial”
  • 25. Scenario
    Technician: I am so tired of Mr. Jones complaining. He never has a kind word and I can’t stand being around him.
    Pharmacist: You obviously don’t know how to handle Mr. Jones. Don’t take things so personally. You’re overreacting
  • 26. Questions?