COMMUNICATION SKILLS INTRODUCTION jo avon commana atie uN HHA cH Hate Hie Latin yond usununicare, which means to feipate! Communication can he defined as the ea hange of information, ideas, and share ot ly iinet moniter anil ‘iver Hough an accepted code of symbols, In community ‘ron y coninnneations wkill fo any eaiontial paranneter for in order to interact with patients and health cate profeantanaly A good communication makes the treatment easier and improves Anonleddie athe pationt conyptianee The ability to communicate clearly anit effectively with patients, family members, « professionals is an important skill. Some T communicators, comfortable with all types of people while some one find vecitticult by communicate with health care professionals in perceived or actual positions of physicians) or with patients from different socioeconomic or cultural be learned, Pharmacists with excellent physicians, nutes, pharmactate, and other health «a pharmacists ate shill authority. eg. backgrounds, Fortunately, communication skills ean skills are likely to have very satisfying and successful careers. Poor communication between pharmaciats and patients may result in an inaccurate patient medication history and inappropriate therapeutic decisions; may contribute to patient confusion, disinterest, wand may add to patients’ frustration with the health care system. Poor tw and physicians, pharmacists and nurses, and pharmacists information is not exchanged in an appropriate communication and non-adherence communication between pharmacist and pharmacists may harm patients if Important and timely manner, In general, communication can be classified as formal and informal communication and Informal communication ] get differentiate as fallows Formal communication 1. [tis unplanned 2 Itis independent ofthe official chain of command | 1 Its prep 2 It follows the officially established chain of commands 3, It is fast due to no prescribed path | 4. It consists of both work related and social messages 3 Its slow due to the preseribed path 4 It consists mainly of work related messages 5. The direction of flow is orderly and systematic 5. The direction of flow is erratic and uneystematic 6 Itis easy to fix esponsibility for messages 6, Its not possible to ix responsibilty 7 Istresses on authority and status 7. It stresses on interpersonal relations “Tg ttis usually verbal Ho 10. It does not carry rumors: Tot may ary rumors i he social needs of the members, as well a8, | 11 Itserves the needs of the organization 11. It serves tl the organization | 8. 1Uis generally in the written form 9 Its authentic, rigid and predictablemma | TYPES OF COMMUNICATION SKILLS 1. VERBAL COMMUNICATION Verbal communication occurs when we engage in speaking with others. It can be face-to- face, over the telephone, digital platform, etc. Some verbal engagements are informal, such as chatting with a friend over coffee or in the office kitchen, while others are more formal, such as a Patient-pharmacist communication. Regardless of the type, it is not just about the words, it is also about the caliber and complexity of those words, how anyone using the words to create an overarching message, as well as the intonation (pitch, tone, cadence, etc.) used while speaking When occurring face-to-face then words is very important, they cannot be separated from non- verbal communication. In community pharmacy, communication between pharmacist and Patient during patient counselling is the best example of verbal communication. 2. NON-VERBAL COMMUNICATION Non-verbal communication includes facial expressions, posture, eye contact, hand movements, and touch. For example, if patient engaged in a conversation with pharmacist about medication or health related issues, it is important to pay attention to both the words and non- verbal communication of patient. Pharmacist might be in agreement verbally with the patient, but their nonverbal cues: avoiding eye contact, sighing, scrunched up face, etc. indicate something different. 3. WRITTEN COMMUNICATION It includes all type of written messages like email, prescription at pharmacy, a memo, a report, a facebook post, a tweet, a contract, etc. All forms of written communication have the goal to disseminate information in a clear and concise manner. In fact, poor writing skills often lead to confusion and embarrassment, and even potential legal problems. One important thing to remember about written communication, especially in the digital age, is the message lives on for long time or may be permanent. Thus, written communication should be always proper to avoid any further errors. For example, if writing in Prescription is not clear then it may create the problems while dispensing of medicines. 4, LISTENING Active listening, however, is perhaps one of the most im portant types of communication because if anyone cannot listen to the person sit 8 across then there is a difficulty to engage effective communication. For example, if any patient asks suggestion to pharmacist about OTC medication or self-medication and if pharmacist does not listen the actual health condition oF symptoms properly then there may be errors while dispensing of medicines5, VISUAL COMMUNICATION visual types of communication include signs, maps or drawings as well as colour or graphic design. These typically reinforce verbal communication, and they help to make a point. Visual aids can help a speaker remember important topics, give the audience something to look generally help convey the message being presented. Now a day television and various at, and g digital platforms are available to advertise and selling of products and ideas. INTERACTIONS WITH PROFESSIONALS AND PATIENTS INTERACTIONS WITH PROFESSIONALS Effective interaction between pharmacists and other healthcare professionals is essential. Poor interaction not only leads to frustration and lack of respect among professions but also may -ompromise patient care if important information is misunderstood, ineffectively conveyed, or eft out, Pharmacists are responsible for insuring that “Right drug to right patient at right time in t dose through right route in right way.” So that pharmacists is an integral part of health care em. Pharmacist should make interaction with other health care professionals for effective, safe, and quality medicines and services to achieve optimal health outcomes. It is necessary to keep an open and continued dialogue between pharmacist and other health care professionals in order to define each profession’s respective functions and promote the optimal use of drugs within a framework of transparency and cooperation, all in the best interests of patients. These interactions are useful for, i. Sharing general as well as specific medicine-related information and maintaining a high level of knowledge of pharmacological treatment through continuing professional interaction. e to pharmacological treatment, progress toward ii Monitoring and assessing respons: revising the therapeutic plan in collaboration with therapeutic goals, and, as necessary, pharmacists and other health professionals. adequate storage and dispensing of medicines in compliance iii, Ensuring safe procurement, with the relevant regulations. out medicine, its purpose, potential interactions and Providing information to patients ab side effects, as well as correct usage and storage. edicine-related problems or concerns with regard to the prescribed medic v.Discussing m when appropriate and when requested by the patient. ‘on the selection and the use of non-prescription f minor symptoms or ailments. When self- cian for vi Advising patients, when appropriate, medicines and the patient’s management 0} medication is not appropriate then proper advice to patient to consult proper phy’ diagnosis and treatment. iL Overcome the problems of prescription err ete, ors, adverse drug reactions, drug-drug interactionos PU Modern Concepts in Community Pharmacy and Management INTERACTIONS WITH PATIENT Effective interaction between pharmacists and patient is essential to improve the use of medications by patients and ensure optimal therapeutic outcomes. Pharmacists can improve patient adherence to drug therapy through appropriate strategies, including patient counselling and education. This type of interaction develop the opportunity for pharmacist to suggest methods for accurately and effectively taking prescribed medications, discuss medication safety, identify and manage side effects, and assist in managing chronic health conditions. Interaction of pharmacist with patient requires a level of common sense, good judgment and constant practice. In diverse situations, the following added skills are employed to make use of tact and diplomacy effective. * Listening attentively: The Pharmacist does not need to just talk all through an interaction, there is need to be able to listen to not just the response from the patient but also how the Tesponse is conveyed in order to understand, and react in the most appropriate manner. * Having emotional intelligence: It usually requires people with a higher level of emotional intelligence to more naturally apply tact and diplomacy in a communication session. Emotional intelligence being a measure of how well one partner (in this case the pharmacist) understands the emotions of the patient and the emotions of others. * Showing empathy: To further buttress emotional intelligence, showing empathy is the Pharmacist's ability to see the world or situation from the perspective of the patient. * Being assertive: The act of assertion while applying tact and diplomacy is often to influence or persuade others to think, behave or act in a certain way, in some cases even to come to an agreement about a point of view. + Building rapport: When it comes to rapport building, it is closely related to tact and diplomacy as well as good manners and emotional intelligence are. Being able to communicate well with patients and having a great sense of understanding of their persona. + Being polite: Professionalism considers that the cultural differences, view-points and choices of the patient and others are kindly respected. It also requires as a matter of importance that courtesy is shown in interpersonal relationships. ‘The goals of effective and efficient Pharmacist-Patient interactions are * To improve the quality of care * To improve clinical outcomes * To improve medication adherence * To reduce health care cost « To reduce occurrence of drug therapy problems especially adverse drug reaction VERBAL COMMUNICATION SKILLS (ONE-TO-ONE, OVER THE TELEPHONE) Essential verbal communication skills include the ability to listen, understand, and respond to what people say (active listening) and the ability to interpret respond in a way that encourages continued interactionCer eh alle a ‘ONE TO ONE COMMUNICATION One-to-one communication occurs when one person speaks with or writes to another individual. This happens when a care professional meets with a person who has health worries or personal concerns. ‘Active listening: It is based on the complete focus of the listener on individual In this case center of attention should be an individual. Convey an open, relaxed, and unhurried attitude. Set aside all professional and personal distractions and really focus on the person. Prevent or minimize interruptions (e.g., beepers, cell phones, consultations). The tone and modulation of voice and number and placement of pauses may disclose how the person feels and may provide clues regarding the reliability of the patient-provided information. People who respond with a low level of energy and flat affect may be depressed. People who respond to questions tentatively and hesitantly may give unreliable information. Pauses may indicate that the person needs time to recall the information or find the right words or that the person is censoring the response or preparing to lie. Observation and Assessment: Effective two-way communication requires continual observation stures provide and assessment of how the other person is communicating. Body language and ge important clues for the pharmacist, as well as the patient and health care provider. Sit or stand at eye level, maintain eye contact, and use a focused body posture to convey interest and attentiveness. Sitting or standing at eye level or lower is an on threatening, equalizing body position that facilitates open communication. Be physically close enough to the patient, family member or health care professional for clear and comprehensible communication but do not intrude on the other person’s personal space. Invasion of personal space induces discomfort and may be perceived as physically threatening; in either case, communication is compromised. Be aware of non-verbal messages. Certain gestures and postures provide clues regarding the other person’s feelings, although the clues are not always reliable. Change tactics to re-engage the person if his or her body language indicates closure to communication. Some of the barriers are as follows i. Physical barriers: Communication across oF through physical barriers is extremely difficult. Physical barriers commonly encountered 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. 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 a aera by people standing over them; interviews may be strained or limited pacer the Patient's level of discomfort one way to minimize patient discomfort is to make conversations take place face to face at or below the patient's eye level. Barriers to verbal communications: ii, Lack of privacy: Lack of privacy is a common communication barrier. Although lack of privacy of ten is identified as a barrier to effective communication with patients, it also is animportant barrier when communicating with other health care professionals. Breach of privacy is Possible whenever patient information is discussed in public areas. Do not discuss or debate specific or non-specific patient information or health care issues in public areas such as hall ways, walk ways, elevators, cafeterias, libraries, and parking lots. Do not discuss patient-specific information with family or friends without the permission of the patient. Lack of privacy is a common problem in most health care settings. Few community Pharmacies have private counseling areas. Most hospitalized patients have at least one toommate; three or more patients may share some hospital wards. The lack of privacy makes the voicing of personal concerns and the exchange of accurate and complete information difficult for many patients. Given a choice, patients may withhold potentially embarrassing Personal information or avoid asking potentially embarrassing or “stupid” questions if they think the conversation may be overheard. 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. Ambulatory institutionalized patients may be able to walk to nearby conference rooms, private consultation rooms, or vacant waiting rooms. OVER THE TELEPHONE The telephone is an important communication tool used to communicate with patients, patient family members, physicians, nurses, other pharmacists, and other healthcare 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. When answering telephone calls, provide self-identity 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. Most telephone calls are directly related to patient care and need to be dealt with as soon 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. Nothing is accomplished if one or both parties let their emotions rule the interaction. WRITTEN COMMUNICATION SKILLS Pharmacists must be able to accurately and effectively document patient information in the patient medical record, in pharmacy medication profiles, and in other pharmacy records, and correspond with patients and other health care professionals. Many pharmacists routinely document written drug information responses. The patient medical record is the primary written communication tool for all health careite progress notes after each jents in the inpatient setting, Jical record (charting) is @ professionals fh this practice ing wri < Health care professionals in the outpatient se professionals who care for pat arts. Writing in a patient med jon to individual health care arting privileges, althoug} or interaction, Healthcare aly PR granted by eac tions and onganiz. gress notes in patient ¢ h institution or onganiz tions grant pharmacists ch: medical record ordinaril and communicate information about to assess, usually retrospectively, the quality and appropriateness of activities and services for remuneration: Health care and professional standards when documenting ore clearly than other colors and is photocopied (¢.8, subpoenaed for a legal institution or practice). Clear documented information ly is used to document nts progress: and to document patient care here to legal, ethical, Black ink is photocopied ‘ad just in case the patient record has to be onals outside the arded to health care profe: e risk of misreading or misinterpreting the important. Errors are dealt with by crossing out the error with ake), This format clearly documents the error and record. Products that paint over type written OF hand ments because they hide the error and could be patent a? anals must adi atormation recom hearing oF fon, otocopies reduce the Clear and legible handwriting line and initialing the error (@g- ™ cgentities the individual who changed the not used on legal docu ge the record. ion and restrict assessments and judgments to those during a patient medication t may learn iskey and a six-pack of beer daily. Tt 3s rmacist to give the patient 2 written information are sad by anyone at any time to chan, Document factual informat appropriate for pharmacists. For example, a pharmacis| seeh interview that the patient drinks a fifth of whi appropriate to document the facts but inappropriate for the phat contains a descriptive heading (e.g., clinical cardiology consult), the date and d other information, and the signature and ies the type of information found in the kly when searching for e information in context diagnosis of alcoholism. record Every note in the patient medical pharmacy, pharmacokinetics, nutrition support, attending, time the note was written, patient-specific data an: title of the health care professional. The heading identifi note and enables individuals using the chart to scat the pages quicl specific information. The date and time are nportant details that put the with other patient-related data and information. For example, a pharmacist may assess a patient and make drug and dosing recommendations before that day’s laboratory results are available. of the recommendation allows the other members of the health care team to text of the most up-to-date patient data. The (Gubjective, Objective, Assessment, and ersally recognized structured format. 4 organizational structure. The health care nnd of the note. Documents or notes written igned by the licensed professional who is Knowing the time accept or reject there comme content of the note is organized u: Plan) or a freestyle format. The SOAP formal format has no acceptet whereas a frees’ professional writing the note signs the note at the é y students and other non-licensed trainees are cos upervising the non-licensed individual. and individual practices are transitioning from nt clinics, nic medical record (EMR), and Most institutions, outpaties arts, known as the electro: hand written charts to electronic ch“ electronic health records (EHRs). The EMR is the document created in the clinic or during the hospitalization; whereas the EHR is a longitudinal record that includes the EMR as well as information from multiple other sources. Data are entered and viewed from any computer in the system, which eliminates “competition” for the single copy of the written chart. The electronic format limits access to confidential patient information to individuals with approved passwords but expands access to the charted information by allowing access to anyone within the Password-protected system. The computer automatically labels entries with the date and time of entry and may link the entry to the password. Advantages Euroa The advantages of written communication are as follows: Itis taken more seriously It can be expressed more precisely after due thought It provides a record. The content of the message can easily be verified afterward. PeN It can be transmitted to several people at the same time. The message can be repeated at regular Intervals. 5. It is more suitable when the message is long and a well-considered response is desired. Disadvantages The disadvantages of written communication are as follows: 1. It is time consuming and expensive, particularly for sending lengthy messages to distant places. 2. The necessary explanation and clarification cannot be given immediately. 3. Itdoes not provide instant response or feedback 4, It lacks personal touch and tends to be rigid. It does not carry feelings and emotions. BODY LANGUAGE Body language isthe use of physical behaviour, expressions, and mannerisms to communicate nonverbally, often done instinctively rather than consciously. Whether anyone aware of it or not, when anyone interact with others, individual continuously giving and receiving wordless signals, Human beings do not communicate through words whether written or spoken, only There are several other ways as well for them to communicate. These include the body movement or gestures, etc. It is observed that the bodily movements or the body language is the most popular and effective means of communication. The study of the aspect of body language thus is ‘very important area of the study. Hence body language refer to use of body movements in communication and is also knows as kinesics. The body language in general parlance is 4 communication without any involvements of words. Example of body language include * Breathing rate # Facial expression « Fidgeting # Any swaying or other movement: see with their arms or hands « The way they are standing or sitting + Eye contact (or lack thereof) « Swallowing or coughing ny body language includes anything they are doing with body besi recognize this communication instinctively without having to be told what it means. Features of body language: The basic features of body language are mentioned here as « Body language is an art of communication without any use of words. + Body language is an expression of one feelings and status. head, face, gestures, bodily movements etc. is of communication. ides speaking. We Basi under- # Body language involves use of eyes, « Body language tends to be the most popular mean: « Body language does not require any formal education for being understood. and their implications are mentioned in table Some Body languages "Gesture or Posture | Implication Steepling the hands [ Confidence Raising the hand | Desire to interrupt Shifting body position Desire to interrupt Crossing the arms Shutting out of the other person Leaning toward the speaker | Receptiveness Raising the hands and then letting them fall imply | Hopelessness Frequent throat clearing Disagreement PATIENT INTERVIEW TECHNIQUES: The pharmacist, not the patient, controls the patient pharmacist interaction. The pharmacist controls the interaction by controlling the types of questions asked and the time allowed for patient response. Controlling the interaction does not mean, however, that the pharmacist should fire off a rapid sequence of yes/no questions or abruptly cut off patient response. Questioning skills improve as the pharmacist gains experience interacting with a variety of patients, including pleasant and not so pleasant, cooperative and uncooperative, verbose and recalcitrant, and interested and disinterested patients. Early in the interview, ask open-ended questions that allow patients to talk freely about their medications and concerns. This technique clues the patient that the pharmacist is interested in what he or she has to say and gives the pharmacist feedback regarding the patient's level of Sewledge and ability to communicate this information. A good initial question for both acute os chronic care patients is, “What medications are you currently taking?” Use minimal ors such as “yes,” “uh huh,” and “what else?” and provide nonverbal encouragement bv— vod shag ntl ST Concepts in Community Pharmacy and Man, ohne smiling and nodding when appropriate. the patient time to answer. Some patients can © Wellorganized and detailed information without much additioral direction; ho other patients ramble Wever, and shift to nonrelated topics. Some patients cannot Provide any information without Specific targeted questions. Some patients have told their sto; times that they Ties So many automatically recite their stories or what they think the pharmacist wants to hear without focusing on the Pharmacist’s questions. Ask directed and structured duestions after the patient has presented his or her story or has begun to stray from the initial question. Narrow the focus of the question as at Discuss one topic at a time and avoid asking leading questions, multiple questions, duestions. Simple yes/no questions are information when used excessively, 'PPTopriate, and yes/no useful screening questions but inhibit the patient's flow oj 1. Establish rapport Respect patient privacy Recognize face value Move to the patient's field of vision Consider how you look Ask open-ended questions One thing at a time 2SNAaP OR Leave the medical terminology alone 9. Listen 10. Culture matters Important key points in Patient interview are as follows, I. Medication Information To obtain or verify a list of the patient's current medications * Prescription medications. * Over-the-counter (OTC) drugs. * Vitamins. ¢ Herbals Nutraceuticals /Health supplements.« Respiratory therapy-related medications (e.g., inhalers). Full dosing information should be captured, if possible, for each medication. This includes: «Name of the medication. Strength: | Formulations (e.g., extended release such as XL, CD, etc.) «Dose. « Route. Frequency. + Last dose taken. 1. Medication History Prompts incorporating various types of "probing questions” into the patient interview may help trigger the patient's memory on what medications they are currently taking. Here are some suggestior © Use both open-ended questions (e.g., "What do you take for your high cholesterol?) and Gosed-ended questions (e.g., "Do you take medication for your high cholesterol?) during the interview. «Ask patients about routes of administration other than oral medicines (e.g., "Do you put any ‘medications on your skin?"). Patients often forget to mention creams, ointments, lotions, patches, eye drops, ear drops, nebulizers, and inhalers. «Ask patients about what medications they take for their medical conditions (e.g., “What do you take for your diabetes?"). «Ask patients about the types of physicians your ‘arthritis doctor’ prescribe any medications for you?"). «Ask patients about when they take their medications (eg,, time of day, week, month, as needed, etc.). Patients often forget to mention infrequent dosing regimens, such as monthly. «Ask patients if their doctor recently started them on any new medicines, stopped medications they were taking, or made any changes tO their medications. «Asking patients to describe their medication by colour, size, shape, etc., may help to determine the dosage strength and formulation. Calling the patient's caregiver oF their community pharmacist may be helpful to determine an exact medication, dosage strength, and/or directions for use. that prescribe medications for them (e.g, Does + For inquiring about OTC drugs, additional prompts may include: * What do you take when you get @ headache? + What do you take for allergies? * Doyou take anything to help you fall asleep? * What do you take when you get @ cold? * Do you take anything for heartburn?10. REVIEW QUESTIONS The word ‘communication’ comes from the Latin word a, Communicare b, Communicate ¢. Communicareon d, Communica At each stage in the process of communication, there is a possibility of interference whic hinder the process. Such interference is known as a. Sender c. Barrier h may b. Receiver d. None of them The person who transmits the message is called a. Channel. b. Sender c. Receiver d. Response Communication through and .. called verbal communication a, Written material and gestures b. Gestures and spoken words c. Spoken words and written material d. Body language and gestures . is an exchange of facts, ideas, opinions, or emotions by two or more persons. a. Communication b. Combination c. Conversation d. Connection Includes sounds, words, language, and speech. a. Verbal communication b. Non-Verbal communication c. Both of the above d. None of the above Which of the following skills are important to communicate properly? a. Reading b. Writing 4. All of these In body language, implication of Frequent throat clearing is a. Hopelessness c. Speaking b. Respectiveness c. Disagreement d. Confidence Prescription is the example of a. Verbal communication b.Wiitencommancaton c. Visual communication Identify the example of body language a. Breathing rate d. Non-verbal communication . Facial expression 4. All of these 2. Barrier c. Coughing 1. Communicare 3. SenderCommunication 69. Verbal communicatin on 9 Write ny COMMUNICA 4, Spoken words and written material 8. Disagreement 7 All of these 10. Allot these SHORT ANSWER QUESTIONS communication skills between formal and informal communication. nication. 1 Write notes OF ce the difference note on telephonic commu bal communication. kills while interacting with 2 3, Write short 4. Explain the barriers in ve she required pharmacist sI patients. health care professionals in parent care? 5, Explain # 6, What is the importance of interaction of pharmacist with other 7, Write the features of Body language: TONG ANSWER QUESTIONS divantages e written communication including its advantages and diss techniques. skills and explain the 1. Explain th 2. Write in brief about patient interview 3, Enlist the different type of communication 4, Explain in brief about one to one communication. 5, Write a brief note on body languages ym in short