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Lecture 10 Communicating with Special Groups Communication Skills in Pharmacy Practice, Chps 10-11 PHA 3002C IPPE-II Professional Communications Janet.

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Presentation on theme: "Lecture 10 Communicating with Special Groups Communication Skills in Pharmacy Practice, Chps 10-11 PHA 3002C IPPE-II Professional Communications Janet."— Presentation transcript:

1 Lecture 10 Communicating with Special Groups Communication Skills in Pharmacy Practice, Chps 10-11 PHA 3002C IPPE-II Professional Communications Janet P. Barber, PhD March 28, 2011

2 Lecture Overview Older adults patients Patients w/ communication impairments Patients w/ disabilities Terminally ill patients Patients w/ HIV/AIDS* Patients w/ mental health problems* Suicidal patients* Patients w/ mental health problems* Patients w/ low health literacy* Cultural competence* Caregivers Young patients and adolescents *See textbook 2

3 3 General Advice If you believe that a person has a special problem, check to see if your perception is accurate – Look for non-verbal clues – Use open-ended questions Avoid stereotyping patients... Be patient !!

4 4 Adult Patients Today’s adult patient population takes a more active role in the control of their health and well-being Adults are more knowledgeable about – Treatments – Costs – Benefits – Medications

5 5 Print Advertisements and Commercials

6 6 Older Patients

7 7 Increased Interaction with Older Adults Percentage of the elderly population increasing (12.9% in 2009; projected to be 20% in 2030) Elderly consume a disproportionate share of prescriptions drugs (30%) and over-the- counter medications (40%) 2 out of 3 older adults take at least 1 medication per day

8 8 Barriers to Communicating with Older Patients Pharmacists may not fully recognize elderly patients’ limitations and the effect of disabilities Attitude of the pharmacist – be cognizant of age-related perceptual differences

9 9 Limitations of the Older Patient Hearing Loss Vision impairment Dementia Language disorders Altered pain threshold Difficulties eating, swallowing Altered taste and thirst Transportation difficulties Mobility limitations Propensity to fall Limitations in activities of daily living Reduced economic resources Loss of physical energy Isolation Depression

10 10 Physiological Changes in Older Patients Physiological changes alter the pharmacokinetics of many drugs in the elderly – Age-related changes relevant to drug pharmacology Absorption: > in absorptive surface & < gastric pH Distribution: > in total body water and lean body mass Metabolism: > in liver blood flow, enzyme activity Excretion: > in renal blood flow – Result is an < risk of adverse reactions and interactions in the elderly—nearly double that of younger adults

11 11 Aging Affects Learning Some older adults learn at a slower rate – Have the ability to learn but process information at a slower rate Short-term memory, recall, and attention span may be diminished

12 12 Accommodating Learning Deficits Speak slower Break down learning into smaller tasks Build on past experiences Encourage feedback Ask patient politely to repeat instructions

13 13 Methods to Deal More Effectively with the Older Patient Recognize feelings Attend to drug-use problems Provide extra time Deal with disabilities Consider patient-specific needs Provide follow-up Provide privacy

14 14 Communication Impairments Vision Hearing Speech Aphasia

15 15 Communicating with Patients with Visual Impairment Large print Pastel paper Adequate light Braille

16 16 Patients with Hearing Impairment Due to birth defects, injury, exposure to loud sound, aging Different types: – General types: conductive, sensorineural, central – Presbycusis – hearing loss associated with aging; affects more than half of older people People with hearing problems often ‘speech read’ – Watch lips, facial expressions and gestures

17 17 Communicating with Patients with Hearing Impairment Do not shout Do not speak directly into ear Slow down rate of speech Facilitate speech-reading by standing in front of patient (~ 3-6 ft away) Use a lower tone of voice Remove environmental barriers Use written communication

18 18 Patients with Speech Impairments Dysarthria – Interference with normal control of speech mechanism due to disease (e.g., Parkinson’s, MS), strokes or accidents – Involves slurred or difficult-to-understand speech Laryngectomy - removal of larynx – Learn to speak again (esophageal speech or with aid of electronic device) Aphasia – following stroke – Reduced ability to understand and speak – Recall problems; sequencing problems; short sentences

19 19 Communicating with Patients with Speech Impairments Be patient Do not fill in words Speak in brief sentences Do not be offended by involuntary responses that seem inappropriate

20 Communicating with Patients with Disabilities Wheel chair bound patients Learning disabled patients Homebound patients 20

21 21 Communicating with Terminally Ill Patients

22 22 Communicating with Terminally Ill Patients & Their Families Be sensitive to stage of adjustment of patient – Ask open-ended to questions (“How are you doing today?”) – Be aware of and honest about your own feelings about death (I don’t know what to say right now.” “Tell me how I can help you.”) – Show concern

23 23 Stages of Dying Kubler-Ross, MD (1970) Natural progression of dying process Patients come to terms with impending death Psychological reactions to their situation Five stages 1.Avoidance and denial (“No, not me”) 2.Anger, hostility, resentment (“Why me?) 3.Bargaining with God to postpone inevitable (“Yes, me, but…”) 4.Depression (“Yes, me”) 5.Acceptance–productive ways of dealing with death (“I’m ready”) Applies to most major stresses/losses in life

24 24 Pharmacist Response to Dying Patient DenialUnderstand, listen; do not try to convince AngerDo not respond in anger; let patient vent feelings; empathize; realize patient is not angry with you BargainingListen; help patient focus on what is possible DepressionAllow patient to express sorrow; listen if patient wants to talk AcceptanceBe affirming

25 25 Definition of Caregivers Caregivers are an formal/informal network of individuals who take care of impaired relatives/friends who can not take care of themselves. Caregiving refers to – Activities and experiences involved in providing direct assistance to relatives or friends who are unable to perform independently normal activities of daily living

26 26 Communicating with Caregivers Caregivers can be people who – Take care of older adults with chronic conditions – Parents who take care of children during acute illnesses – Take care of family members, friends – Are hired assistants Certain strategies must be used since you can’t communicate directly with patients

27 27 Sources of Caregiver Stress Primary sources – Care recipient’s cognitive status – Care recipient’s problematic behavior – Number of activities for which impaired recipient is dependent on caregiver – Extent of dependency of each activity – Caregiver overload or burnout

28 28 Outcomes of Stress Depression Anxiety Physical health decline Giving up caregiver role

29 29 How Pharmacists Communicate with Caregivers Help caregiver understand the patient’s condition and treatment and how to communicate specific instructions to the patient Teach caregiver how to monitor patient therapeutic response to a specific medication Encourage caregiver to contact you if they have questions/problems

30 Communicating with Young Patients and Adolescents

31 31 Communicating with Young Patients and Adolescents Certain patient characteristics affect the emphasis that needs to be placed on certain aspects of counseling Different than communicating with adults in two distinct ways: Communication typically involves 3 people RPh needs to communicate at a level that is appropriate for the cognitive developmental level of the child

32 32 Four Stages of Cognitive Developmental in Children (Based on work of Jean Piaget, 1932) Sensory motor stage (birth to 2 yrs) – Learning centered around child; no concept of objects outside of self Pre-operational stage (2 to 7 yrs) – Children consider only a single aspect of a situation; concrete reasoning of here and now Concrete operational stage (7 to 12 yrs) – Separate internal and external worlds; become problem solvers; begin to understand disease prevention; still objective Formal operational stage (age 13 to adult) – Capable of hypothetical, abstract thought; reason logically; understand idea of personal control of one’s health

33 33 Communicating with Young Children Attempt to communicate at child’s level Ask open-ended questions so that you can assess what the child understands Use simple sentences for all children Ask whether the child has questions Use both written and verbal communication Don’t ignore child!

34 34 School-Aged Children & Adolescents At 5 or 6 child can be more involved in education about their medicines Adolescents may want to speak with pharmacist without parent present – Allows you to build trust with the teen – Oral contraceptives and STD’s Teenagers can be given educational messages that would be given to an adult, but are more responsive to shock appeal

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