Helping patients with_change


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Helping patients with_change

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