Transcript The Pharmacist

To learn the elements of
communication.
To understand the
importance of verbal and
non-verbal communications •
To appreciate the Patterns of
behaviour.
To study the questioning and
listening techniques •
Be able to handle difficult
situations.
Be able to counsel
customers more effectively.
The purpose of
communication is to get
your message across to
others. This is a process
that involves both the
sender of the message
and the receiver. This
process leaves room for
error, with messages
often misinterpreted by
one or more of the parties
involved.
Portrays
communication as
unidirectional process
It highlights the need
for the message to be
understood by the
recipient
Noise is a technical term
meaning additional
extraneous information .
Noise may come from the
environment e.g. traffic
noise, other conversation
in the room.
Noise may be inherent in
the message e.g. accent,
quality of handwriting.
Noise may be perceptual.
Feedback influences the
way in which the sender
sends the message e.g.
when the receiver’s
expression remains blank
, possibly indicating non –
comprehension.
Takes into account the fact
that communication is a two –
way process.
It also takes into account the
influence of the setting &
mediating factors .
The setting refers to the
environment e.g. hospital
ward, community pharmacy;
social setting e.g. status of
the two communicants.
Mediating factors refer to
aspects such as motivation,
prejudice, goals etc
Sender
Receiver
Message
Linguistic component
refers to all aspects of
speech & languish and
the non –linguistic
component e.g.
appearance & posture.
Verbal components are
the actual words used.
Paralinguistic component
includes the pauses,
pitch, speed
• By successfully getting your
message across, you convey
your thoughts and ideas
effectively. When not
successful, the thoughts and
ideas that you convey do not
necessarily reflect your own,
causing a communications
breakdown and creating
roadblocks that stand in the
way of your goals – both
personally and professionally.
•
• The Importance of
Removing Barriers:
• Communication barriers
can pop-up at every
stage of the
communication process
(which consists of
sender ,message ,
channel ,receiver ,
feedback and context see the diagram below)
and have the potential to
create misunderstanding
and confusion.
•
•
•
•
•
•
To be an effective communicator and to get
your point across without misunderstanding
and confusion, your goal should be to lessen
the frequency of these barriers at each
stage of this process with clear, concise,
accurate, well-planned communications. We
follow the process through below:
Sender...
To establish yourself as an effective
communicator, you must first establish
credibility. In the business arena, this
involves displaying knowledge of the
subject, the audience and the context in
which the message is delivered.
You must also know your audience
(individuals or groups to which you are
delivering your message). Failure to
understand who you are communicating to
will result in delivering messages that are
misunderstood.
•
•
•
Message...
Next, consider the message itself.
Written, oral and nonverbal
communications are effected by
the sender’s tone, method of
organization, validity of the
argument, what is communicated
and what is left out, as well as
your individual style of
communicating. Messages also
have intellectual and emotional
components, with intellect allowing
us the ability to reason and
emotion allowing us to present
motivational appeals, ultimately
changing minds and actions.
• Channel...
• Messages are
conveyed through
channels, with verbal
including face-to-face
meetings, telephone
and
videoconferencing;
and written including
letters, emails,
memos and reports.
•
•
Receiver...
These messages are delivered to
an audience. No doubt, you have
in mind the actions or reactions
you hope your message prompts
from this audience. Keep in mind,
your audience also enters into the
communication process with ideas
and feelings that will undoubtedly
influence their understanding of
your message and their response.
To be a successful communicator,
you should consider these before
delivering your message, acting
appropriately
• Feedback...
• Your audience will
provide you with
feedback, verbal and
nonverbal reactions to
your communicated
message. Pay close
attention to this feedback
as it is crucial to ensuring
the audience understood
your message.
•
• Context...
• The situation in which
your message is
delivered is the
context. This may
include the
surrounding
environment or
broader culture (i.e.
corporate culture,
international cultures,
• Removing Barriers
At All These Stages
• To deliver your
messages effectively,
you must commit to
breaking down the
barriers that exist in
each of these stages
of the communication
process.
• Let’s begin with the
message itself. If your
message is too lengthy,
disorganized, or contains
errors, you can expect
the message to be
misunderstood and
misinterpreted. Use of
poor verbal and body
language can also
confuse the message.
• Barriers in context tend to
stem from senders
offering too much
information too fast.
When in doubt here, less
is oftentimes more. It is
best to be mindful of the
demands on other
people’s time, especially
in today’s ultra-busy
society
• Once you understand
this, you need to work to
understand your
audience’s culture,
making sure you can
converse and deliver your
message to people of
different backgrounds
and cultures within your
own organization, in this
country and even abroad.
Good communication
is DIFFICULT to
achieve and.
An AWARENESS of
this fact is an
important first step in
IMPROVING it •
Learning new
techniques.
Confirming an already
existing ones.
To Begin lets look at this.
Everything we do in life
depends on
communication.
Pharmacists communicate
with; doctors, patients,
other health professionals.
Pharmacy staff, suppliers
.................
The extended role of the
community
pharmacy.............
Increasing emphasis on
talking to patients, and
medical staff, even in
hospitals
To begin....................... 2
Poor communication with
health care professionals
can cause a range of
problems.
Incomplete communication
with a doctor on correct
dosage or use of medication
can lead to potential harm to
the patient.
There is a NEED for
EFFECTIVE communication
skills.
Assumptions &
Expectations.
"YOU NEVER GET A
SECOND CHANCE
TO MAKE A FIRST
IMPRESSION“.
We often put people
into categories and
the assumptions we
make, lead us to
judge their behaviour,
jobs and character.
Assumptions ............. 2
Our initial judgment is
often based on:WHAT WE SEE AND
HEAR. It includes:Appearance. dress, age,
gender, race and
physical disabilities.
It is important that we are
aware of these
assumptions in order to
avoid stereotyping
people.
Assumptions .......
3 = What about us
A pharmacist wearing a
white coat?
A pharmacist wearing aragi
and tagia? Or a training suit
(jumper)? •
A clean pharmacy?
Shelves full of dust? • Age?
Gender?
NEVER MAKE AN
ASSUMPTION ABOUT A
PERSON IN A
WHEELCHAIR IN THAT
THEY CANNOT
COMMUNICATE
EFFECTIVELY!!!!!
People make judgment of social status &
trustworthiness based upon style of dress.
Many professions adopts dress code e.g. nurses
wear uniforms with different insignia to designate
rank or superiority.
Doctors wear white coats as a protective
clothing & to designate their status.
Doctors may also use the badge of a
stethoscope as a further sign of status.
Traditionally paediatrician & psychiatrists do not
wear white coats in attempt to remove any
barriers to communication with their patients.
It is the way people
present themselves.
Aggressive approach!!
How do you feel? Hesitant approach!!
How do you feel?
Both situations will affect
the way we behave, our
attitude and how we will
communicate with this
person.
What affect our
communication?
Tone of speech,
e.g. whining or complaining
tone a friendly welcoming
manner Accents.
Common expressions.
No one experiences the same
situation in the same way!!!
It is always useful for us to
consider how aware we are of
our own behaviour and
appearance and what message
this may give to other people.
EXERCISE... 1
Test your awareness of communication and
assumptions.
Spend 5 minutes talking to the person next to
you, on condition that you do not know him very
well.
No particular topic, just let the conversation flow.
After you finish answer the following questions?
Refers to the actual words
used & their pronunciation.
Used to assess the social
status of the speaker,
determined by occupation,
education, capital wealth.
Accent is the pronunciation
used & used as indicator of
geographic origin of the
speaker.
Dialect refers to the actual words used e.g.
words to describe a small bread roll (bap, cob) ,
it is an indicator of geographical origin .
Several politicians who maintain regional accent
in order to appeal more to the electorate & to
appear as “one of the boys”.
Greater trust & effectiveness of communication
is achieved when pharmacists adopt a speech
style which converges with that of the client ,
“many pharmacists thus have different voices for
different occasions”
Non-Verbal communication.
The meaning of what a person
says is made up of several parts: The words that Are spoken.
One of the important features of
communication is silence.
If the speaker pauses at the end of
a sentence , it indicates that the
receiver is expected to respond .
After a question a long pause is
seen as a forceful cue ,demanding
some form of response.
Long pauses are often are used in
interview situations by the
interviewer
WHAT WE SEE AND HEAR. It
includes:Appearance, dress, age, gender,
race and physical disabilities.
It is important that we are aware of
these assumptions in order to
avoid stereotyping people
Non-Verbal ............... 2
Actual words convey about 10% of the
message. • THIS IS CALLED VERBAL
COMMUNICATION.
The 90% is conveyed by NON-VERBAL
COMMUNICATION.
Non-verbal communication consist of how
it is said (40%) and body language (50%)
Vocal communication.
Also called
paralanguage, concerns
the vocal characteristics.
Quality of voice: tone,
pitch, volume and speed.
Tone can be harsh or
warm and that affects the
meaning of what you say.
The speed of the speech
& the pitch are interpreted
as indicators of emotion .
Loud speech may
represents excitement or
anger.
Higher pitch is related to excitement.
Apprehension is characterized by
speech dysfluences.
Volume must be adjusted to suit the
circumstances and can emphasize
key words.
If a client is speaking in a low , quiet
voice to tell the pharmacist of a recent
bereavement, it is appropriate for the
pharmacist to respond in a low voice.
Often misinterpretations of anger or
excitement occur when a deaf person
speaks or is spoken to loudly.
Laryngitis may be interpreted as
depression or distress.
Speed of speaking must enable the
listener to understand.
Vocal communication ..2
Varying the speed and pitch
can make the words more
interesting and hold the
listener's attention.
Avoid using the words "you
know", or "like“.
It indicates nervousness or
uncertainty or a lack of
confidence.
Effective use of vocal
communication requires that
we become proficient at
speaking with a warm confident
tone of voice, appropriate
speed and volume, without
interruptions.
Non- Linguistic
Kinesics
Proxemics
Tacesics
BODY LANGUAGE
The term kinesics refers to
movement and gestures.
Our first impressions of a
person are either reinforced
or discarded once we know
the person better.
In many situations
opportunity does not
present itself to get to know
someone better The first
impression is the one that
remains.
If a good impression
was given, then future
communications will
be easy.
If a poor impression is
created, it may cause
problems at future
meetings.
Body language ....2
Pharmacists who create
a friendly approachable
impression are more
likely to find customers,
patients and doctors
receptive to what THEY
SAY.
Pharmacists who make
negative impressions
will have to work
considerably harder to
gain other people's
confidence.
Components of Body
Language
Gestures. Used
appropriately can greatly
enhance communication.
Do not overuse them!
May become a distraction
from the spoken word.
Pharmacists should
use gestures to
describe a particular
procedure.
Do some "people
watching", you will be
surprised how much
information about
people you can pick
up!!
Components Body
language .....2
Facial expressions:
after the spoken
work, facial
expression is the
most important part
of communications.
The facial expression
of the pharmacist
may very well
determine how
receptive the patient
will be to any advice
of information.
Facial expression
say a lot about
mood and emotion.
EYES AND
MOUTH. •
You should be able
to read the patients
facial expression
Fear
Happiness
Sadness
Anger
Pain
Disgust
Components of
Body.......... 3
Eye contact: Avoiding
eye contact is a very
successful way of
avoiding
communication. (class
of students).
In general people
looked more as they
listened than as they
spoke.
Very vital for continuation of a
conversation. It indicates
interest in the subject.
Useful in determining who will
speak next.
Prolonged eye contact of the
listener with the speaker
indicates a desire to interrupt,
whilst eye contact by the
speaker denies the possibility
of interruption.
HOWEVER DO NOT
STARRE.
Excessive eye contact may be
expressed as aggression.
Lack of eye contact is
submissive and may indicate
disinterest, incomprehension
or denial.
Components of ........... 4
Tacesics:-concern body contact
Physical contact: used to enhance
verbal communication. •
Sympathetic touch on the arm.
BUT remember touch is always
governed by SOCIAL rules!!!! Vary
greatly among cultures.
Be aware of these cultural
differences!!
The extent of touching in a
professional context is normally
limited to hand shaking & offering
assistance e.g. arm holding for the
very old & the very young.
Components of
.............5
Body posture: We can
control the words we
say, but we are not good
at controlling our body
language.
We may give a positive
verbal message but our
body posture may be
giving a negative
message!!
A customer may pick up
this and the verbal
message will be lost
Components of .............. 6
Closed body position: a person
standing with his arms folded.
Always seen as a negative
posture. Does not encourage
communication.
Feet Position: Often found that
a person's feet will be pointing
in the direction he wants to ac.
NOT ATTENTIVE.
Positive Body Posture: Leaning
towards the person who is
talking, sitting in a relaxed
fashion are both examples of
non-verbal language. Can
encourage communication
Components of .................... 7
Personal space:Proxemics:- the use &
interpretation of the space &
environment surrounding the
individual.
General area: 3 m or more. A
space we normally prefer
around us if we are
addressing people or working
alone.
1-the intimate zone(0.5m):conversation is muted, usually
personal , people are
selective about whom they
allow into this region.
2)The personal distance
zone(0.5-075m):-is
commonly used in
healthcare settings e.g.
when giving preoperative
instructions, or explaining
a procedure to a patient.
3)The social distance
zone(1-3m):-is the norm
for work settings & social
events
4)The public distance
zone(3-6m):-appropriate
for lectures, public
speeches and
presentation.
Orientation is a feature of proxemics.
Subjects undertaking a collaborative task
frequently sit next to each others at a table.
Competitive tasks results in the subjects sitting
opposite each others.
Subjects taking part in a simple conversation
usually sit across the corner of a table.
Competitive or adversarial interchanges take
place face-to-face, while social or cooperative
interchanges take place diagonally.
Patterns of Behaviour
ASSERTIVENESS: standing up
for personal rights and
expressing thoughts, feelings and
beliefs in DIRECT, HONEST and
APPROPRIATE ways.
Being assertive involves
LISTENING to others and
understanding their feelings.
Assertive behaviour requires a
forceful ,but relaxed ,posture with
firm eye contact & appropriate
loudness of speech
Formulate your aims and
objectives clearly
Treat other people as EQUAL.
Assertiveness
is it useful?
A means to
communicate
effectively in awkward
situations. In conflict,
negotiations,
leadership and
motivation.
When giving and receiving
information, in meetings &
business Assertive people
achieve what they are set
to do, WITHOUT violating
other people's rights.
Does not mean other
people do not achieve
what they are set to do.
Aggressive people
achieve what they want at
the expense of other
people. Submissive
people rarely achieve their
goals.
Patterns of .................2
Aggressive Behaviour: violates other
peoples' rights.
Aggressive person seeks to achieve
goals at the expense of others.
Aggressive behaviour is often
frightening, threatening and
unpredictable.
Gives a negative message and
communication becomes very difficult
Aggressive behaviour is charcterized
by the speaker speaking too loud ,
standing too close with a tensed
posture ,& using gestures such as
finger pointing or fist shaking.
Patterns of ................3
Passive Aggressive: People who
give a mixed message.
Might agree with what you are
saying then raise their eyebrows
and pull a face behind your
back''..111.
Submissive behaviour: people
who have very little confidence in
themselves and poor self-esteem.
Allow others to violate their
personal rights and take
advantage of them.
Submissive behaviour is
characterized slumped posture
with fidgeting , embarrassed
smile , unwillingness to make or
maintain eye contact and a weak
Personal Rights
To state my own
needs & priorities.
To be respected as an
intelligent and
capable equal •
To express my
feelings
To express my own
opinion •
To say "Yes" or "No“
To make mistakes
Personal Rights
To change my mind.
To say :I do not understand“
To ask for what I want
(realizing that the other
person has the right to say
"No".
To decline responsibility for
others' problems.
To deal with others without
being dependent on them
for their approval.
Techniques in Assertive
Communication •
Use of "I & "YOU"
statements.
Using 'I' places the
responsibility on the
asserter.
It can minimize
negative reactions &
anger.
Examples!!!!!!
Accusation
Observational
• Techniques .............2
• Repeating the message:
• • If a request is not met directly by the
receiver, repeat the request, firmly and
without aggression, until a reply is
obtained.
• • It is not useful, when an answer is
already given, which may be not the
desired response.
•
•
•
•
Techniques .............. 3
• Clear Communication:
Use verbal and non-verbal communication
When dealing with patients in a community
pharmacy observe both verbal and nonverbal
gestures of the patient.
• When asking a patient if they understood the
instructions!!!!!!!!!!!!!!!!!!!!!!!! Answer is yes. BUT
facial expression NO
• Acknowledge true criticisms but do not be
distracted by side issues!!!!!!!!!!!!!!!!!
• Self-talk
• • Conflict: we can always
work ourselves up and
loose control of a situation.
• You can talk to yourself
and clarify the issues in a
situation, consider all
points of view and rights of
those involved.
• • We are then ready to
undertake clear,
unconfused communication
which will lead to a more
successful outcome
• How to increase your Assertiveness • Choose
the right situation
• • Prepare for the situation
• Clarify your objectives, your own and other
peoples rights, turn faulty situations into sound
ones.
• • Behave assertively during the situation
• Buy thinking time
• • Review the situation afterwards
• Be honest, do not play down or exaggerate your
success
• Empathy
• The ability to enter into the life
of other people and to
accurately understand their
meaning and feelings.
• Very important in
communication skills and
an essential part of
assertiveness.
• Needed in information
gathering, when interviewing
customers and patients and
when educating and
counselling.
• Resolving conflict.
• Elements of Empathy
• Facilitating Empathy:
• Readiness and willingness to listen to other
people and establishing a safe atmosphere,
where patients can express themselves.
• Much of this is NON-VERBAL, like eye contact,
tone of voice and body posture.
• Show respect and assurance that there is no
need for embarrassment or fear of being
criticized.
• Elements of Empathy ...2
• • Perceiving feelings and meaning:
• • For the pharmacist, the correct
identification of feelings and their meaning
is important in their work.
• • Patients express a combination of
feelings like being unfairly treated, hurt,
depressed and angry.
• • You need to identify these feelings before
you can respond to the patient properly. •
Pat attention to verbal and non-verbal and
body language.
• Elements of Empathy..3
• • Be aware of your own bias, prejudices,
stereotyped impressions or a preoccupation
with personal concerns, when identifying those
feelings.
• • We have our own assumptions regarding
patients with depression, drug abuse etc...
• • WE SOMETIMES ASSUME THAT ALL DRUG
ADDICTS, FOR EXAMPLE, ARE THE SAME
• Elements of Empathy .... 4
• • Responding to the patient.
• •
Cc not start by saying you understand, this normally
brings about the answer "No you don't ".
• •
Respond by restating and reflecting feelings in
slightly different words.
• •
Or try to help the patient to clarify his/her feelings by
verbalizing implied meanings or ask for further
clarification.
• • Understanding and focusing is very effective
communication.
• Listening Skills
• • True listening involves
both the eyes and ears
• • Remember body
language.
• • Never show inattention,
NEVER PRETEND YOU
ARE LISTENING. It is a
major reason for
communication failure.
• • Use a quiet area for
listening to patients.
• • Avoid distraction,
especially in a busy
pharmacy.
• Questioning skills
• • Good questioning is one of the most widely
used social skills. It can be an asset to the
pharmacist.
• • 'JVHY ASK QUESTIONS?
• • To get essential information from the patient in
order to respond to his enquires. • POM and
OTC medicines.
• • Type of question and the way in which it is
asked will dictate the level of response given
• Use of questions
• For the pharmacist, this
might prove to be difficult
sometimes, why? Busy
pharmacy!
• Other customers waiting!!!
• Temptation to ask closed
ended questions The
patient feels as if he is
interrogated!!!! You could
miss vital information
• You must learn to develop
good questioning skills to
enable them to build an
accurate picture
• Use of questions
• Questioning skills
are also needed
when dealing with
other health
professional, staff
training,
implementation of
procedures,
ordering and
supplying goods.
• Types of Questions •
• Open ended questions:
• • It allows people to respond in
their own way, to provide more
detailed information and
elaboration on the their complaint
or enquiry.
• • EXAMPLES!!!!'
• • Closed ended questions: •
Answer is YES or NO.
• Encourage the respondent to
become involved in the
interchange & enable answers to
be provided with relative ease.
• • Funneling technique!!!!
Leading questions lead the respondent
towards an expected response.
Commonly used by media interviewers &
take the form of ‘it would be true to say ,
would it not?, the respondent is almost
obliged to answer ‘yes’
Probing questions are designed to explore
responses & elicit further information.
They are particularly useful in exploring the
patient’s medical history, may take the form of,
‘what do you mean exactly by “stomach ache”?
Pausing is a technique linked to probing, which
can be used before & after questioning.
Pausing before commencing questioning serve
to draw the respondent’s attention in preparation
of the beginning of an interaction.
Pausing after questionning suggests to the
respondentthat further information is required.
Closed questions permit answers which are
short, factual or which are selected from a
limited number of options.
1-The selection question [forced choice
question] e.g. do you want dissolvable or nondissolvable tablets?
2-The yes /no question. E.g. has there been any
bleeding?
3-The identification question which requires the
respondent to provide a considered response
containing information e.g. can you tell me the
medication you are currently taking?
Questions are classified according to their
cognitive levels into:A- recall questions:- which are lower order
cognitive questions, involve simple recall of
information& testing of memorized information.
Recall questions are essential in diagnosis of
illness.
B-process questions:-higher order cognitive
questions e.g. opinion, justification, analysis of
information. Why do you think this medicine is
making you feel ill?
• Needed also for
communications over the
phone when talking to
doctors, patients'
relatives, nurses
etc..........
• Finally some people feel
awkward Answering
questions, encourage
them by nonverbal
communication. e.g. eye
contact, posture... to give
a relaxed open
appearance.
• Barriers to
Communication •
• Environment:
• A busy pharmacy,
gives an impression
that the pharmacist
has little time for the
patient
• Lack of privacy Noise
• Physical Barriers,
counters, windows.....
• Barriers to ......2
• • Patient Factors: Physical
disabilities Comprehension
difficulties Illiteracy
• • The Pharmacist Lack of
confidence Lack of interest
Laziness
• Delegation of responsibilities
to assistants Feeling of being
under pressure
• Being preoccupied with other
matters
• • Time