Communications Test2 Set2

Front 1

Mr. Raymond comes in saying bad things about Dr. Johnson (doesn't seem like he cares/takes forever to get in and seem) responding by:

"Ive had so many pts tell me the same thing about Dr. Johnson" is an ex of....

Back 1

Generalizing

Front 2

"If I were you, I'd find a different Dr" is an ex of...

Back 2

Advising

Front 3

"I bet you've just seen him on his busiest days" is an ex of....

Back 3

Placating/ressuring

Front 4

"How long do you usually have to wait before getting into see him?" is an ex of....

Back 4

Quizzing/Probing

Front 5

"Your prescription is ready. Will that be cash, check, or charge?" is an ex of....

Back 5

Distracting

Front 6

Emotional Responses to Change (9)

Back 6

1)ambivalence
2)fear/anxiety
3)anger, blaming, scapegoating
4)going numb or avoidance
5)excitement/joy/relief
6)frustration
7)depression
8)feeling out of control/alone in world
9)shame/guilt

Front 7

Ambivalence response to change (4)

Back 7

1)state of contradictory emotions @ the same time related to the same situation
2)most common reason for RESISTING CHANGE*******
3)doesn't mean person is unwilling to change
4)just they're conflicted about wanting to change and wanting to stay the same

Front 8

Fear and anxiety response to change (1 and questions I ask (5))

Back 8

1)question our capacity to make the change and our ability relative to the change

1)do i have the necessary skills?
2)do i know what is reqd of me?
3)is the change really going to be beneficial?
4)is training needed?
5)will i look stupid?

Front 9

Anger, blaming, scapegoating response to change (3)

Back 9

1)common when feel like not involved in process
2)fear + anxiety = anger
3)anger = blaming + scapegoating

Front 10

Going numb or avoidance response to change (3)

Back 10

1)denial
2)act as though nothing has changed
3)if I don't think about it, it will go away

Front 11

Excitement, joy and relief response to change (3)

Back 11

1)if change means something better for them
2)relieved to know what is wrong with them
3)feel more in control of life again

Front 12

Frustration and response to change (4)

Back 12

1)similar to anger response
2)not involved in the process
3)not asked for feedback
4)explore reasons for frustration rather than minimize them

Front 13

Depression response to change (3)

Back 13

1)sometimes see this w/ life-long disease (HTN/DM)
2)listening and reflecting back your understanding is more powerful
3)avoid statements that minimize the importance of person's feelings

Front 14

Feeling out of control response to change (3)

Back 14

1)especially w/ sudden or chaotic change
2)revert back to old ways to feel more in control
3)understand reasons and help examine ways to feel more in control

Front 15

Shame or guilt response to change (3)

Back 15

1)result of past "sinful" behavior
2)deserve the "punishment" being inflicted on them
3)use active listening and empathy, but stay focused on task at hand

Front 16

Feeling alone in the world response to change (3)

Back 16

1)feel it's all up to them
2)let patients know you're there to help them
3)be emotionally available and understanding

Front 17

Transtheoretical Model of Change desc... (5)

Back 17

1)several stages must be passed thru BEFORE action occurs
2)object is to move ppl from 1 stage to the next, NOT directly to axn
3)assess how ready a person is for change
4)stage-specific communication skills and strat's are reqd
5)intevene to assist person in moving toward making a change

Front 18

5 stages of readiness for change according to Transtheoretical Model of Change

Back 18

1)Precontemplation (I Wont)
2)Contemplation (I might)
3)Preparation (I will)
4)Action (I Am)
5)Maintenance (I have)

Front 19

Motivational Interviewing Principles (5)

Back 19

READS
1)Roll w/ resistance
2)Express Empathy
3)Avoid argumentation
4)Develop discrepancy
5)Support self-efficacy

Front 20

Roll w/ Resistance desc (3)

Back 20

1)resistance leads to heightened attempts to persuade pts
2)resistance from pt is signal to respond differently
3)communication that expresses understanding of problems the pt encounters are preferable

Front 21

Express Empathy desc (3)

Back 21

1)ID and understand reasons for resistance from pt's perspective
2)respect the pt and their struggle
3)create a climate for change thru trust

Front 22

Avoid argumentation desc (4)

Back 22

1)arguing increases resistance to change rather than increasing motivation to change
2)confront, don't argue
3)feelings aren't arguable
4)avoiding argumentation sets you up as being on "their" side

Front 23

Develop Discrepance desc (5)

Back 23

1)ask about good things and less good things associated w/ present behaviors (and changes that are needed)
2)develop discrepancy b/w a pt's present behavior and the desired behaviors
3)people are more motivated to change when discrepancies exist b/w current behavior and desired personal goals
4)repeat back pros and cons stated by pt
5)Ask q's about behaviors that dont support goals set by pt

Front 24

Support Self-efficacy desc (first 5)

Back 24

1)notice that postitive, including statements (not just behaviors)
2)let the pt know you've noticed
3)notice successful attempts at adherence (even if short lived)
4)pt is responsible for choosing and carrying out change
5)praise ideas that pt comes up w/ to solve problems

Front 25

Support Self-efficacy desc (second 5)

Back 25

1)your belief in pt's ability to change becomes a self-fulfilling prophecy
2)let pt know how you feel
3)praise the behavior, not the person
4)offer realistic hope and express confidence in the pt's ability to succeed
5)continue to support self-efficacy thruout the process

Front 26

Opening Strategy--lifestyle (5)

(motivational interviewing strategy)

Back 26

1)talk in general about the pt's lifestyle from the pt's own perspective
2)does pt view it as healthy or unhealthy
3)what does he like/dislike
4)are there aspects he thinks need to change?

5)gives general pic of pt's health habits and desire to change unhealthy habits

Front 27

A typical day strategy (4)

(motivational interviewing strategy)

Back 27

1)allows you to do a better job of realistically tailoring medication regimens to fit the pt's daily routines
2)ID lifestyle needs/probs
3)helps build rapport w/ pt
4)what's their routine?

Front 28

Good things and less good things strategy (2)

(motivational interviewing strategy)

Back 28

1)allows exploration of how a pt perceives his illness and its treatment
2)explore perceived barriers and facilitators to treating illness (pros/cons)

Front 29

Good things and less good things strategy Q's to ask (5)

(motivational interviewing strategy)

Back 29

1)what do they like/dislike about the proposed changes?
2)do they agree w/ their physician
3)do they believe they can do what is asked of them?
4)what will help?
5)what are the barriers?

Front 30

Ex of Good things and less good things w/ pt w/ DM

Back 30

What do you see as the benefits of getting your DM under control? (response is I don't know)

Say: may I tell you what i see as the benefits or may i tell you what benefits other pts have found?

Front 31

Provide (exchange) information strategy (3)

(motivational interviewing strategy)

Back 31

1)ask if pt wants additional info
2)don't try to tell pts more when they are NOT ready to listen
3)provide in an unbiased, nonjudgmental manner

Front 32

Future and present strategy (2)

(motivational interviewing strategy)

Back 32

1)allows pts to discuss what they want to have happen as a result of treating an illness
2)address pt's concern or dissatisfaction in a compassionate nonjudgmental manner

Front 33

Help w/ decision-making strategy (2 and 2 ex Q's)

(motivational interviewing strategy)

Back 33

1)assist pts in making decisions about managing their illness
2)ask neutral, nonjudgmental questions

1)what are your thoughts now about managing your...?
2)where does this leave you now?

Front 34

Envelope Method strategy

(motivational interviewing strategy)

Back 34

1)"If I were to hand you an envelope, what message would have to be inside it for you to consider quitting smoking?"

Front 35

Ruler strategy concepts (3) and 3Q's

Back 35

1)readiness
2)importance
3)confidence

1)how ready do you feel to do this?
2)how important is this change for you?
3)how confident are you that you can make this change if you want to?

Front 36

Readiness Ruler strategy (4)

(motivational interviewing strategy)

Back 36

1)On scale of 1 to 10, how important to you is taking your meds properly to manage your DM?
2)response is 3
3)why a 3 and not a 1?
4)what do i have to do to move you to a 5?

Front 37

Pt: "i don't like the idea of taking BP meds. i hear it can have bad ADRs"

DPh: "it really is your decision. i would like to address your concern about ADR's if i might..."


This is ex of.....

Back 37

Roll w/ resistance

Front 38

Pt: "you're not my doctor! i don't have time to wait for some pharmacist to tell me about this medicine"

DPh: "mrs. rogers, I see you're in a hurry, so I will only cover 2 critical things you need to know about taking the med. Would that be ok?"


This is ex of....

Back 38

Avoid argumentation

Front 39

"on the other hand, mr jones, you want to reduce your risk of losing your vision by controlling your blood sugar, but on the other hand, you don't like taking meds"


Ex of....

Back 39

develop discrepancy (repeat back pros/cons stated by pt)

Front 40

"Mr. brown, you haven't filled your BP med in several weeks. what are your thoughts on how this might affect the goal you told me last time about reducing your risk of stroke?"


Ex of....

Back 40

Develop discrepancy (ask q's about behaviors that don't support goals set by pt)

Front 41

"mr simmons, its great that you take your DM med every day as you planned. keep it up! what things do you do to stay on track?"


Ex of....

Back 41

support self-efficacy

Front 42

"i really believe you're on your way to better health since you are thinking about lowering your cholesterol"


Ex of....

Back 42

support self-efficacy

Front 43

Pt: I know i have to get my blood sugar down. and I really want to lose weight. but I just can't stick to that diet. i love fried chicken and biscuits and gravy and sweets too much to cut them out"

DPh: "it sounds like you resent having to cut down on foods you love. But, it also sounds as if you would like to lose wt and get your blood sugar levels down"

Tool used?

Back 43

Develop discrepancy

Front 44

DPh: "what have you tried before t has been successful in changing your diet or exercise habits?"

Pt: "i did start a diet and exercise program when i first found out i was DM. I lost 25lbs. But I only stuck w/ it for 3months"

DPh: "25lbs is a lot. those 3 months show you can be successful"


Tool used?

Back 44

support self-efficacy

Front 45

Reasons why pharmacists document (in SOAPs) (6)

Back 45

1)permanent record of interaxn
2)outline a thought process
3)communicate w/ other disciplines
4)allow for auditing (if it wasn't documented, it was NOT done)
5)legal
6)reimbursement

Front 46

Characteristics of a well written SOAP (first 5)

Back 46

1)purpose is identified
2)includes date of encounter
3)must be legible
4)concise and accurate
5)approved abbreviations

Front 47

Characterisitcs of a well written SOAP (second 4)

Back 47

1)recommendations are clear
2)actions taken are clearly indicated
3)follow up plan is documented (RTC= return to clinic)
4)Signature w/ clearly printed name below the signature

Front 48

Subjective part of a SOAP (4)

Back 48

1)gathered from pt/caregiver
2)descriptive information (observation of pt/how does pt feel?)
3)usually not confirmed w/ a test or procedure
4)matter of opinion and may not be accurate

Front 49

Objective part of a SOAP (5)

Back 49

1)data that is measurable
2)labs, BP, wt, exam findings
3)meds (from computer profile)
4)observable
5)reproducible

Front 50

Assessment part of a SOAP (3)

Back 50

1)what going on based on S and O
2)includes assessment of current tx (is it reasonable/appropriate/any CI's?)
3)serves as a rationale for the tx plan

Front 51

Plan part of a SOAP (6)

Back 51

1)axns to be taken by pt/provider
2)goals of therapy
3)changes in tx (add/deletions/changes)
4)monitoring
5)pt education
6)follow-up

Front 52

Compliance def (3)

Back 52

1)extent to which a person's behavior coincides w/ the medical advice given
2)pt complies w/ what physician says/does as he is told
3)paternalistic relationship

Front 53

Adherence def (3)

Back 53

1)extent to which a person's behavior is consistent w/ the agreed upon regimen
2)pt adheres to plan
3)therapeutic relationship

Front 54

Concordance def (2)

Back 54

1)agreement reached after negotiation b/w a pt and HC professional
2)it respects the beliefs and wishes of the pt in determining whether, when, how meds are to be taken

Front 55

Prevalence of nonadherence for long-term therapies

Back 55

50% adhere; 50% are nonadherent

Front 56

Reasons for nonadherence (4)

Back 56

1)HC system
2)pt perceptions
3)medications (regimens)
4)self-efficacy beliefs

Front 57

HC system and reasons for nonadherence (3)

Back 57

1)access to meds
2)insurance tiers/formulations
3)economic concerns

Front 58

Pt perceptions and reasons for nonadherence (3)

Back 58

1)illness severity
2)value of taking meds
3)value of following prescribed regimen

Front 59

Self-efficacy beliefs and reasons for nonadherence (2)

Back 59

1)beliefs in the positive outcomes of therapy
2)confidence in own ability to adhere

Front 60

Factors that influence adherence (4)

Back 60

1)incr social support = incr adherence
2)incr therapeutic relationship = incr adherence
3)collaborative communication style (shared decision making)
4)negative mood (depression/anxiety) = higher nonadherence

Front 61

2 major types of causes of nonadherence (w/ 0,2)

Back 61

1)unintentional or inadvertant (forgetting)

2)intentional
a)decisions to alter a med regimen
b)decisions to dc a med regimen

Front 62

7 false assumptions about pt understanding and med adherence

Back 62

1)MD has already discussed med w/ pt
2)pt understands all med info (dosing freq, missed dose info)
3)if pt understands what is reqd, he will be able to take med as prescribed
4)nonadherent pts don't care, aren't motivated, lack intelligence, or can't remember
5)pts who start taking their meds correctly will continue to do so in the future
6)physicians regularly monitor pts medi use and intervene when necessary
7)pts who are having probs will ask questions or volunteer info

Front 63

Fixing these false assumptions:
1)MD has already discussed med w/ pt

2)pt understands all med info (dosing freq, missed dose info)

3)if pt understands what is reqd, he will be able to take med as prescribed (2)

4)nonadherent pts don't care, aren't motivated, lack intelligence, or can't remember

Back 63

1)ask pt what MD told them about medication (prime questions)

2)verify pt understanding by asking for feedback

3a)facilitate change in pt behavior
3b)monitor pt adherence and outcomes

4)assess reasons for nonadherence

Front 64

Fixing these false assumptions:
1)pts who start taking their meds correctly will continue to do so in the future (2)

2)physicians regularly monitor pts medi use and intervene when necessary

3)pts who are having probs will ask questions or volunteer info

Back 64

1a)reinforce adherence
1b)monitor pt adherence and outcomes

2)monitor pt adherence and outcomes

3)initiate follow-up to inquire about problems or questions

Front 65

BEST strategy to help pts adhere to their medication regimens (2)

Back 65

1)MONITOR THE PATIENT
2)educate the patient

Front 66

Techniques to improve pt understanding (4)

Back 66

1)key information
2)instruction phrasing and presentation
3)supplement w/ written info
4)final verification

Front 67

Key information (technique to improve pt understanding) (3)

Back 67

1)emphasize key points
2)give reasons why key pieces of advice should be followed
3)provide at beginning and at end

Front 68

Instruction Phrasing and Presentation (technique to improve pt understanding) (2)

Back 68

1)use terms the pt can understand
2)give definite, concrete, explicit instructions (visual aids maybe, photos,demos, tailor to pt)

Front 69

Supplement w/ written info (technique to improve pt understanding) (2)

Back 69

1)provide written info and direct appropriate attention to it
2)highlight most important info and go over it WITH PT

Front 70

Final verification (technique to improve pt understanding) (3)

Back 70

1)end the encounter by giving pts opportunity to provide feedback about what they've learned
2)check that they have understood all important info/misunderstanding and correct them
3)check for info you left out

Front 71

Techniques to establish new behaviors and enhance adherence (4)

Back 71

1)integrate new behaviors into pt lifestyle
2)provide or suggest reminder aids
3)monitoring
4)pt referral

Front 72

Integrate new behaviors into pt life style (techniques to establish new behaviors and enhance adherence) (4)

Back 72

1)tailor med regiment to pt habits
2)when is pt taking other meds?
3)what is pt's daily routine? (link to habitual behaviors)
4)when is most convenient time for pt to take med?

Front 73

Provide or suggest reminder aids (techniques to establish new behaviors and enhance adherence) (2)

Back 73

1)suggest cues if existing habits cannot be tied to regimen demands (alarm/pill box)
2)obtain pt input and/or seek confirmation from pt

Front 74

Monitoring (techniques to establish new behaviors and enhance adherence) (2 w/ 2,2)

Back 74

1)suggest ways pt can self-monitor
a)monitor medication-taking is by calendars
b)monitor treatment effects (BP, goals, how to monitor, etc)

2)monitor med use on an ongoing basis
a)pt assessment
b)review Rx records

Front 75

Pt Referral (techniques to establish new behaviors and enhance adherence) (2 w/ 2,0)

Back 75

1)social service agencies
a)public/govt (medicare.gov)
b)private/religious (needymeds.com)

2)Specialists