Helping patients with_change
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Helping Patients With Change
Including Supportive Communication and Choosing an Appropriate Response
Rachel OgdenDecember 2, 2010
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ChangeOne of the few constants in lifeIndividuals differ in their comfort level with
changeGiven the choice – most people would rather
prove why its not necessary to change rather than change
It is normal for people to resist change until they believe is actually good for them
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ExamplePt with a diagnosis of Diabetes Mellitus IILifestyle changes need to occur The actual administration of the medications Then you must consider the monitoring
involved
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Emotional Responses to ChangeFear, anxiety, ambivalenceAnger, blaming and scapegoatingGoing numb, or avoidanceExcitement, joy, reliefDepression, both existential and clinical
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Patient’s Readiness to changeTranstheoretical Model of ChangeListed the steps of process in previous
lectureAnother method of assessment and way to
educate the patient is:
Motivational Interviewing
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Motivational InterviewingAllows patient to not feel as though they are
being scolded when they have concerns or questions or resistance
Pharmacists see resistance as a pathway to information
Attempts to allow the patient not to lose “face”
COMPETENCE FACEAUTONOMY FACE
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Motivational InterviewingWhen 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.
Pharmacists can also explore the ambivalence a patient may portray
Once again – ask questions, “what do you see as a benefit to stopping smoking?”
Or – give choices, “of these three possibilities, what do you see as one that will work for you?”
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Motivational InterviewingWhat you are doing is trying to negotiate
with a patient to make a change
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
Allows the pharmacist to explore the benefits and risks with the patient without judgment
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Strategies for Motivational InterviewingOpening strategy: lifestyleA Typical DateThe good things and the less good thingsProviding InformationThe future and the presentHelping with the decision-making
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Principles of Motivational InterviewingExpress empathyDevelop discrepancy – show how present
behavior differs from the desired behaviorAvoid argumentationRoll with resistanceSupport self-efficacy
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Supportive CommunicationAs we have said before – we are social creatures –
we have the need to communicate our feelingsPatient 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
Practitioner’s that responded to patients need has higher patient satisfaction and better adherence rates
Patient’s who characterized their physician as understanding and caring where more likely to follow their treatment plan
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Supportive CommunicationThis is not necessarily trying to “make it all
better” for the patient
What you are doing is – acknowledging their feelings – and confirming what you know to be true
Patient: My doctor tells me I have hypertension. Am I going to die?
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Appropriate ResponsesOur responses to our patients needs to be
motivated by a willingness to help them or care for them
Should not come from a need to reduce our anxiety or frustration
Our frame of reference should be one of serving the client’s needs not our own
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Major FocusHelping the patient to:Feel understood and accepted which will also
allow them to more openly and freely discuss their problems
Achieve a more increased and more accurate understanding of their situation
Discuss alternatives where necessaryMake decisions about next steps along with
specific actions to be taken Make adjustments so that the best results can be
obtained
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EmpathyGood for developing a therapeutic
relationship Lets the patient know that they are not alone
– that they are not “crazy” for what they are feeling
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
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ReassuranceIts an attempt to make the patient feel better
or more confident
Good: may be exactly what the patient needs to hear – but make sure they ask for it
Downside: runs the risk of appearing to minimize the patient’s feelings
Remember each patient is unique and their feelings are unique
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Probing or QuestioningAn attempt to gather more information
Good: many times more information is required to make a good assessment or draw an appropriate conclusion for the patient
Downside: we are getting away from the patient’s feelings – not always helpful
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AdvisingTrying to help the patient solve a problem –
you have to remember what your realm of expertise is
Good: very useful when you are the expert
Downside: not so good when the patient is the expert – asking you questions about decisions in their own life
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Generalizing or ComparingAn attempt to state what is generally true
Good: may be exactly what the patient wants to hear
Downside: once again – may give the appearance that the patient’s feelings are being minimized – are you getting to their unique feelings
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AssertivenessA response in which there is mutual respect
between the patient and the pharmacist
Good: no subjective or judgemental responses, allows for differing viewpoints to be awknowledged
Downside: sometimes people just want to vent or let loose – the patient is not looking for a reasonable response
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AggressivenessThis response does not respect the other
person’s viewpoint
Good: there is no positive here – there may be a temporary feeling of satisfaction – but not good for the therapeutic relationship
Downside: if one of the parties are angry, this will allow for the situation to escalate
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NonassertivenessIn this situation, you fail to respect yourself
Good: The other party may get what he or she wants
Downside: sets up a potential future situation where you will be taken advantage of
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JudgingCommunication where you are telling the
patient that they are wrong
Good: never good
Downside: Not acknowledging the patient’s feelings, may be demeaning
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ScenarioPatient:
“Oh sir, (holding up a bottle). I just went out to my car and counted my pills and you shorted me 5 pills again.”
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”
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ScenarioTechnician: I am so tired of Mr. Jones
complaining. He never has a kind word and I can’t stand being around him.
Pharmacist: You obviously don’t know how to handle Mr. Jones. Don’t take things so personally. You’re overreacting
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Questions?