communication skills ( for pharmacist),factors influencing communication,barriers to communication

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2.  To be professionally effective ,pharmacists
need to be aware of:
a) The different messages they are sending.
b) How these could be perceived
c) The messages others are sending to us
d) The ways in which we are interpreting these
messages,which may be inaccurate.
e) How to ensure that communication is
tailored to the situation and supports good
pharmacy practice and human relations.
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4.  Non-verbal communication includes
messages conveyed through body postures.
Eg:a person who is sitting with their arms and
legs crossed signals a ‘closed’ body posture
or hinders the free flow of communication.
 Other non-verbal signals like looking away
,doing something else at the same time or
allowing people to interrupt you can also
signal inattention and inhibit communication.
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5.  Sometimes the non-verbal signals from
others we notice can be used to modify
communication.
 Eg:a person who is appearing restless can
signal that they are uneasy and want to
change the topic or end the
communication.
 In such a case action needs to be taken
,like changing the topic temporarily or
asking if they are uncomfortable.
 Facial expression is an important indicator
of emotional state.
 Eye-contact can indicate the level of
attention or honesty or confidence.
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6.  An effective communicator will be aware of
the exchange of non-verbal messages and
not only of other’s reactions ,but of his or
her own behaivour and impact.
 Another form of non-verbal message is to
convey information through the use of
diagrams.
 These could be used in place of medicines
labels for the illiterate or may demonstrate
how to administer a dosage form such as
eye drops.
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7.  It takes place using the meaning of words.
 Can be spoken or written.
 The meaning of words can however be altered by
the non-verbal aspects of voice tone or
emphasis.
 Writing is less sensitive than spoken
language,but there are different writing styles
that can be used for different purposes and to
convey different meaning and tone.
 As in spoken communication ,written materials
should be carefully composed to suit the needs
of the particular audience.
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8.  For reliable communication ,it is important to
use a language in which both parties are
fluent and comfortable.
 Developing and using a professional
vocabulary as well as being familiar with
everyday terms are important facets of
clinical pharmacy education and practice.
 The abbreviations and terms used for
prescribing medicines represent a specialised
type of communication,usually to the
exclusion of patients.
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9.  Two activities are principally involved in
communication: the sending and receiving of
messages.
 The passive, one-way verbal process of
traditional lecturing is a relatively inefficient
communication .
 Effective communication and learning are
essentially two-way,interactive processes:
both parties are actively participating in
speaking and listening and in interpreting
the meaning of communication
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10.  Developing good listening skills is important to
promote a good interactive communication and
to obtain information.
 It is important that the listener maintains
undivided attention and is not distracted by
external or internal matters.
 Non-verbal cues such as keeping eye contact can
indicate attention, as can nodding,or asking
questions.
 If the speaker moves off the topic then it is
appropriate to politely interrupt and reintroduce
the topic from the point of deviation.
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11.  When all the messages have been received
by the patient ,it is important to
emphasise and check for correct
understanding of the main points by
summarising or stating the main points.
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12.  In pharmacy practice ,communication
frequently lasts only a few minutes.
 This makes it more imporatant that the time
is used properly.
1) Introduction: establishes a connection
between those communicating.It can
promote rapport,build up trust,engage
interest and encourage open interaction.It
involves the exchange of ordinary courtesies
and general enquiries.
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13. 2) Opening:the topic to be covered is
introduced and briefly explained.
3) Business: the main messages are delivered or
informations are obtained .
4) Reconnection: it is important that a personal
reconnection is made as a preparation for
ending the interaction.It is often helpful at
this point to make sure the patient
understands the detail and relevance of the
material and can obtain clarification.
5) Closure:during this stage non-verbal
language can play an important role in
signalling the end of a session.Concluding
courtesies will round off the encounter
positively.
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14.  All forms of professional writing require
clarity and precision.
 Short sentences and paragraphs ,simple
words and sentence structure ,are among the
most important qualities of the best writing.
 Words need to be chosen carefully,with
correct grammar ,easily legible handwriting
or font ,and format and structure that are
clear,accessible and effective.
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15.  Written messages require a logical
structure which may be similar to the one
suggested for verbal messages earlier.
 There should be a brief and thorough
introductory summary ,outlining the
purpose of communication .
 The ideas should be presented in a clear
,logical structure with sub-headings .
 Lastly,a concluding summary ,repeating
the main messages should be written.
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17.  People interact best when they feel
comfortable with their surroundings ,are at
ease with and feel respected by those they
are communicating with.
 Hospital wards or busy dispensary counters
are very difficult environments for effective
communication.
 Clothing and presentation are also important.
 A clean ,pressed ,white coat conveys the
appearance of professionalism and a link with
the medical profession.
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18.  Pharmacist-Physician Communication:
 To communicate effectively, pharmacists must be
comfortable with their role on the health care
team and confident in their unique knowledge
and contributions to patient care.
 Be prepared with specific questions or facts and
recommendations when initiating a patient care–
related conversation with physicians.
 Stay within the pharmacist’s area of expertise.
 Choose the right time and place for the
conversation.
 Never interrupt a physician-patient interaction,
except in a life-threatening situation.
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19.  Do not go to an attending physician when the
question or recommendation is more
appropriate for a less senior member of the
medical team.
 Do not interrupt teaching rounds with trivial
questions and observations better
communicated one to one with individual
physicians.
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20.  Pharmacists and nurses must treat one another
with respect; both professionals must realize that
they share the same goal (e.g., optimal patient
care) and are on the same patient care team.
 Communication should be clear, to the point, and
timely.
 An added barrier to effective pharmacist-nurse
communication is the use of the telephone as the
primary means of communication.
 It is easy to be rude, either intentionally or
unintentionally, during telephone conversations.
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21.  Pharmacists on the patient care team need to update consulting
pharmacists frequently.
 Consulting pharmacists should be aware that the primary team
may have more information than that documented in the patient
record; they should not make recommendations in isolation.
 Inpatient patient-focused care takes place 24 hours a day, 7
days a week.
 Continuity between shifts requires clear communication of
patient information, plans for the patient, and other patient
issues.
 A common communication system is the exchange of patient
information during sign-out rounds or the discussion of patient
specific issues and the passing on of patient monitoring forms
and other types of written documentation between the
pharmacist leaving the service and the pharmacist assuming
responsibility for the patient.
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22.  Effective communication between
pharmacists and patients or family members
is extremely important to pharmaceutical
care.
 Ineffective communication leads to confusion
and misunderstanding and may contribute to
inappropriate decisions regarding drug
therapy.
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23.  Common courtesy dictates that patients be
addressed by appropriate title (e.g., Mr., Mrs.,
Ms., Rev., Dr.).
 Use the correct title by asking each patient
how he or she wants to be addressed.
 The one exception to this approach is in
addressing disoriented, confused, or sedated
patients; these patients usually respond
better to their first names than to their titles.
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24.  Display a genuine respect for the patient.
 Respond to the patient as a person, not a
prescription or case.
 Maintain a professional relationship and avoid
exchanging personal information and
confidences with the patient.
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25.  Respect for the patient is conveyed by
acknowledging, without judgment, patient-
specific attributes that may be different from the
pharmacist’s value system or even offensive to the
pharmacist.
 Attributes such as smoking, excessive drinking,
use of illicit drugs, self-destructive behaviors,
nonadherence to prescribed regimens, deficient
hygiene, and gross obesity may be offensive but
must be dealt with nonjudgmentally.
 Other patientspecific traits such as beliefs in folk
physiology or use of alternative medications or
unorthodox medical treatments also must be
acknowledged without judgment.
 Pharmacists also must be able to acknowledge
differences in socioeconomic backgrounds and
ethnic origins without passing judgment.
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26.  Arrange adequate time for patient interaction
and minimize interruptions from phone calls,
beepers, and other patients or health care
professionals.
 Introduce yourself, obtain permission to
interact with the patient, and explain the
purpose of the interaction.
 Explain who will see the information obtained
by the pharmacist and how the information
will be used.
 Pharmacy students need to clearly identify
themselves as students and explain who will
see information obtained during the student-
patient interaction and the way inwhich the
information will be used (e.g., for teaching
purposes, for patient care, for research).
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27. A. Medication History Interviews:
 When health professionals are making
decisions about treatment it is important
that a complete medication history is
available.
 A well-prepared ,structured approach helps
to avoid ommissions.
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28. Following information is commonly
recorded:
 Currently or recently prescribed medicines
 OTC medicines
 Vaccinations
 Alternative or traditional remedies
 Description of allergies or reactions to
medicines
 Medicines found to be ineffective
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29. B. Labelling Medicines:
All containers of medicines should be clearly
labelled to identify:
 The medicine
 Dosage form,number of dosage units supplied
,strength
 Number of dose units to be taken at one time.
 Frequency and specific precautions
 The patient’s name
 Date of dispensing
 Batch numbers and expiry dates for non-
prescription medicines and medicines not
likely to be used immediately.
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30. C. Patient information leaflets(PILs):
 PILs are used to outline key information to
assist patients and their caregivers in the
effective and safe use of a medicine.
 Where computer technology is available PILs
can be customised for individual patients or to
be prepared for groups of patients.
 Following information is commonly included
1. Trade and generic names
2. Indication for which the medicine is being
taken
3. Administration advice
4. Information on the action required if a dose
is missed.
5. The common or serious side effects.
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31. 6.Action to be taken if a side effect is
experienced.
7.Storage information
8.Name and contact details of the institution
providing the information
9.Author and date of publication
All sheets should be regularly reviewed and
updated.
When writing PILs it is important to include
all essential information without making a
document too lengthy or small.
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32. D.Patient Medication Sheets:
 When patient are taking several medicines
,handwritten or computer – generated
medication records can improve
compliance and understanding.
 A tabular form will present the
information clearly.
 Dose –timing can be identified as a specific
time ,meal times,or a phase of the day.
 Other information such as when a
medicine should be stopped ,history of
adverse reactions experienced and
purpose of the medicine can be recorded.
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33. E.Medication counselling for patients:
 Effective patient counselling can assist
patients in using their medicines safely and
reliably.
 All the principles of effective verbal
communication are important to the success
of an encounter.
 The medication record can be used to focus
an interview,supported by patient information
leaflets or product demonstrations.
 Before giving information,it is important to
check the patient’s level of understanding and
what they remember of their doctor’s
instruction so that the information to be
provided can be acoordingly tailored.
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34.  Physical Barriers
 Lack of Privacy
 The Telephone
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35.  Physical barriers commonlyencountered in
community pharmacies include the large
countertops and display areas behind which
many pharmacists work, windows with
security bars and protective glass, drive-
through windows that isolate the pharmacist
from the patient, and the elevated pharmacy
work area that accentuates the pharmacist’s
position of authority and places the patient in
an inferior position.
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37.  Hospital and other institutional pharmacists have
fewer physical barriers to contend with but have
the additional problem of communicating with
patients who are in bed.
 Patients in bed are easily intimidated by people
standing over them; interviews may be strained
or limited depending on the patient’s level of
discomfort.
 One way to minimize patient discomfort is to
make sure that all conversations take place face
to face at or below the patient’s eye level.
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39.  Lack of privacy is a common communication
barrier.
 Although lack of privacy often is identified as a
barrier to effective communication with patients,
it also is an important barrier when
communicating with other health care
professionals.
 Do not discuss or debate specific or nonspecific
patient information or health care issues in
public areas such as hallways, walkways,
elevators, cafeterias, libraries, and parking lots.
 Do not discuss patient-specific information with
family or friends without the permission of the
patient.
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40.  The lack of privacy makes the voicing of
personal concerns and the exchange of
accurate and complete information difficult
for many patients.
 patients may withhold potentially
embarrassing personal information or
avoid asking potentially embarrassing
questions if they think the conversation
may be overheard.
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41.  Provide as much privacy as possible. Ideally,
converse with patients and discuss patient-
specific information with other health care
professionals in private counseling or
consultation rooms.
 If physically separate space is not available,
converse in a space that is as private as
possible.
 In community pharmacies, converse with
patients in a corner of the pharmacy away
from the cash register, drop-off windows, and
pickup windows.
 In hospitals and other institutions, create a
sense of privacy by closing the door to the
room and pulling the curtain around the bed.
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42.  The telephone is an important
communication tool used to communicate
with patients, patient family members,
physicians, nurses, other pharmacists, and
other health care professionals.
 Speak clearly, listen carefully, be organized,
and state facts clearly and calmly.
 Those initiating the telephone conversation
should identify themselves by name and state
the purpose of the call.
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43.  Be prepared to repeat the request several
times before being connected to the right
person.
 When answering telephone calls, identify
yourself and ask for the caller’s identity.
 Make every effort to deal with the call
immediately; avoid putting the other
person on hold.
 If you are too busy to speak with the caller
at that moment, explain the situation to
the caller immediately and arrange to call
back at a mutually convenient time rather
than placing the person on hold.
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44.  Most telephone calls are directly related to
patient care and need to be dealt with as soon
as possible.
 Interruptive telephone calls should be dealt
with as unhurriedly and professionally as
possible.
 Pharmacists sometimes receive telephone calls
from angry and upset patients, patient’s
family members, nurses, physicians, and other
health care professionals.
 The best way to deal with these types of calls
is to stay calm, listen to what the person has
to say, clarify the issue, and then handle the
problem as professionally as possible.
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45. A. Antagonistic Patients:
 Antagonistic patients do not want to be bothered
with medication histories, interviews, or other
pharmacist-patient interactions.
 The natural response to these patients is to leave
them alone and avoid them if possible or to become
angry or patronizing.
 The best way to deal with such patients is to be as
professional and direct as possible.
 These patients may be frightened or simply fed
upwith the entire health care system; therefore
clarification of the purpose of and reasons for the
interaction and the ways in which the information
obtained from the interaction are used may be
helpful.
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46.  Chronically ill patients present unique
communication challenges.
 Chronically ill patients may be sophisticated
and/or demanding health care consumers.
 Some chronically ill patients know more about
the management of their disease than many
health care professionals; this situation may be
threatening for the pharmacist.
 Some chronically ill patients may be completely
disillusioned by repeated unsatisfactory
interactions with the health care system and may
be bitter, cynical, and difficult to engage in
conversation.
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47.  The intensive care unit is a highly
depersonalizing environment.
 Patients have little privacy or sense of control.
 Patients are surrounded by high-tech equipment
and may be sleep deprived, drowsy from pain
medication, or uncomfortable from procedures,
tests, or surgery.
 This environment makes it difficult to relate to
the patient as a person.
 Nevertheless, it is important to communicate
directly with the patient.
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48.  Never assume that the patient cannot hear or
comprehend what is said in her or his presence.
 Make eye contact with the patient.
 Endotracheal intubation renders patients mute,
but do not assume that intubated patients cannot
communicate.
 Intubated patients can respond to yes/no
questions by blinking their eyes or raising an
arm.
 Acknowledge and communicate directly with the
patient’s family and friends, who may be very
anxious or frustrated.
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49.  Talk with the patient about his or her beliefs
and work to integrate the patient’s beliefs
into the prescribed regimen.
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50.  Elderly patients may have impaired hearing
and vision.
 The hearing loss associated with aging is
characterized by loss of ability to distinguish
between high-frequency sounds, which
makes it difficult for patients to differentiate
conversational tones from background
noises.
 Take the time to engage elderly patients in
unhurried conversation.
 Speak slowly and distinctly.
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51.  Treat elderly patients with respect.
 Do not assume that every elderly person
has impaired hearing.
 Speak directly to the patient and do not
assume that the patient is incompetent or
that the person accompanying the patient
is a caregiver or guardian.
 Use large-print labels and printed
materials and reinforce written information
with verbal communication.
 Touching the patient lightly on the arm or
shoulder may reassure the patient and
reinforce the context of the conversation.
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52.  Hard-to-reach patients include those of low
socioeconomic status, minorities, and
illiterate persons.
 They may have little knowledge about health
care in general and their own health in
particular and may have different coping
mechanisms and expectations.
 Help illiterate patients organize complex
medication regimens by using different-sized
bottles for each medication or color-coding
the labels.
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53.  Be sensitive to the cost of medications and
the ability of the patient to pay for the
medication.
 Low-income elderly patients in particular
may be too embarrassed to ask about the
cost of medications and may accept
expensive medications they cannot afford.
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54.  Communicate as clearly as possible with
hearing impaired patients.
 Verbalize slowly and distinctly; minimize
background noise.
 Face patients who can read lips and avoid
turning away from the patients during the
conversation.
 Written communication may be necessary for
two-way communication.
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55.  communicate clearly and directly with the
patient’s caregiver.
 Many degrees of mental retardation are
possible; be flexible enough to assess the
level to which each patient can participate
and communicate appropriately for each
situation.
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56.  Noncommunicative patients never volunteer
information or express much interest in
anything anyone has to say.
 These patients answer all questions with
unenthusiastic yes/no responses.
 To facilitate communication, get the patient
talking about any topic and then ask simple,
open-ended questions that will provide at
least some of the information being sought
during the interaction.
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57.  Overly communicative patients digress
when asked even simple direct questions.
 Pharmacists eventually obtain the
information being sought, but only after
investing a lot of time in the interview.
 The best way to deal with this type of
patient is to take firm control of the
conversation from the start and redirect
the patient when he or she wanders off the
subject.
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58.  Communicate directly with the pediatric
patient as well as with the parent or guardian.
 information must be age appropriate.
 In-depth information exchange is appropriate
for many preteens and teenagers.
 Direct communication with preteens and
teenagers who have chronic disease for which
they follow long-term medication regimens is
especially important.
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59.  The best way to develop professional
communication skills is through intelligent
observation and regular practice and
discussion with colleagues.
 As competence develops ,a pharmacist can
move from taking medication histories to
providing medication counselling under
supervision for a limited and then an
increasing range of medicines.
 This approach helps develops skills and
confidence and also protects patients
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