FAR153/2 COMMUNICATION SKILLS IN PHARMACY PRACTICE

2014/2015
I)
Describe the PAR technique in patient counseling at the Out-Patient pharmacy. (25m)
PAR is a technique used in effective communication
P - being prepared. This is prior to counseling and means being alert for
- potential barriers to communication,
- possible compliance problems,
- the need for privacy,
- or the likelihood that increased counseling time will be required
We need to know
- the prescription of the patient
- the patient profile
- the personal knowledge of the patient. Speak to his/her level
- the state of the pharmacy and the people who are waiting. We need to emphatize.
- Our own mental state-be mentally ready.
A - assess the situation
- Look and listen for clues to barriers
- Look for verbal clues, and listen for nonverbal.
- You may use certain phrases to draw out further clues from the patient
- Start the assessment from the moment of identification and keep looking and listening
throughout the conversation
R - respond to the needs and barriers
- Reflect to the patient your understanding of the content of their words and the feelings they
express
- Acknowledge their concerns as being genuine
- Clarify any doubts or uncertainties towards their medicine
- Focus on helping them remove their barriers
- Speak to encourage them, not to instill guilt
- Dos encourage them to ask questions, empathize and respond
- Donts fake listening, talk down to them, or use unclear terms

II)

(A) Define non-verbal communication and describe the characteristics of non-verbal

communication. (10m)

Non-verbal communication is a system of symbolic behaviours that includes all forms of

communication except words. It is messages transmitted by vocal means that do not involve
language.
There are 4 characteristics of non-verbal communication:
- Subconscious Non-verbal communication is often sent and received on a subconscious
level. We are usually not aware of the messages we send non-verbally.
-

Contextual Non-verbal communication depends on the situation in which is occurs.

Ambiguous The meaning is open to interpretation and often confusing.

Cultural Non-verbal communication has a distinct cultural nature.

(B) What are the functions of non-verbal communication? Give examples for each function.
(15m).
There are 7 functions of non-verbal communication:
1. Repeating / Reinforce
- The use of non-verbal behaviour to say what you are saying in words.
- Emblems the non-verbal behaviours that we use to display what we mean
- Example: head nods at the same time as someone saying yes
2. Substituting
- The use of non-verbal behaviours to say things rather than words
- We often answer questions others ask by responding non-verbally rather than verbally
- Example: nodding your head to answer a question rather than saying yes
3. Complementing
- The use of non-verbal behaviours to strengthen what is being said with words
- Illustrators non-verbal behaviours that support what is being said verbally
- Example: A friend says Im sorry and at the same time makes a sincerely sad face.
4. Accenting
- The way we emphasize certain words in order to clarify what we mean.
- Example: NO! or No????
5. Regulating
- Non-verbal behaviours that control the flow of the conversation, and tell us when it is our
turn to talk, or when the other person is finished talking.
- Example: While telling a story to a friend, one may pause to allow room for comments
6. Contradicting

When people are saying one thing yet their non0verbal behaviour is telling us something
completely different.
Example: A friend says, Im sorry while smiling

7. Listening
- A physical and psychological process that involves acquiring, assigning meaning and
responding to symbolic messages from others
- The primary reason for listening is to acquire oral messages from others.
- Active listening is a form of therapeutic listening which focuses fully on the patient in order
to accurately see the world as they see it.

III)
List out the common barriers and how to overcome the barriers in the interpersonal communication.
(25m)
Common barriers:
1. Unclear process
- The receiver and sender may not share the same language, slang, jargon, vocabulary,
symbols.
2. Chain of command
- There may be too many layers that a message passes through between sender and
receiver
3. Large size of an organization, geographic distance
- Large numbers of receivers require good message sending methods
4. Personal limitations
- Physical and mental disabilities, and differences in intelligence and education may interfere
with mutual understanding
5. Human nature
- Peoples egos, prejudices and traditions can get in the way
6. Conflicting feelings, goals, opinions
- If people feel on opposite sides of an issue they may not share
7. Power
- The idea that knowledge is power can lead to information hoarding

8. Noise

Physical / External noise noise that occurs outside of the sender and receiver.
Physiological noise noise of a biological nature
Psychological / Internal noise noise comprised of a communicators biases, prejudices
and feelings toward a person and message
Semantic noise noise that comes from our attributing different meanings to words.

Ways to overcome:
1. Use feedback ask a set of questions about a message to determine whether it was
understood as intended
2. Simplify language tailor the language to the audience for whom the message is intended
3. Listen actively listen for full meaning (listen to understand)
4. Constrain emotions stop communicating until composure has been restored
5. Emphasize non-verbal cues ensure that actions align with words

IV)

State the prime question and discuss how it can be used to identify patients drug related
problems.(DRPs) (25m)
1. What did the doctor tell you this medication was for?
Done to review whether the patient understands the purpose of the medicine
Expanding the question- include its use. What is it used for? What symptoms does it
help with?
2. How did your doctor tell you to take the medication?
Verifies the
Drug administration
Dosage and frequency
Compatibility with food and other drugs
Proper technique of administration
Time of administration- some drugs have very strict dosing schedules
Storage
Actions when a dose is missed

3. What did the doctor tell you to expect?

Verifies beneficial effects and outcome expected by the patient
The potential side effects
Action to be taken, unexpected outcome to occur
Through questioning, determines the patients symptoms
As well as what progress is considered successful to the patient
4. Final verification.
Asking the patient to play back Listening to their response
Correct any misinterpretation
Reemphasize important points
Add any missing information
Prevents misuse of drug
V)
i) A nurse called the medical ward to DMC to get information on amphotericin B administration. Using
different questions, obtain information from the nurse.(10m)
A continuum of questions will be asked, narrowing down from open-ended to closed-ended
questions. It should lead the conversation in the desired direction
Highly open ended questions
- Asked to obtain more information from the nurse.
- Will use the terms- who, what, how, when, describe
- Example: Can you tell me what is this drug being used for?
Moderately open ended questions
- May I know what did the doctor tell you to do with the drug?
Moderately closed ended questions
- Will be used to obtain specific, detailed information.
- Limits the possible answers
- From the list of dosage forms, which did the doctor tell you to use?
Highly closed questions
- Is amphotericin B to be given orally or parenterally?
Totally closed
- Did the doctor tell you to inject the drug?
Sensitive questions
- This is a very common concern among nurses. The wrong method of administration happens
from time to time.
Reflective questions

Demonstrates that you are listening.

Provides feedback
Example: It seems that you are not too sure on the amount of the dose to be administered.
May I reconfirm with you?

ii) You are required to do a presentation on a new drug called sitagliptin to the medical officer. What are
the preparation do you need to make during the presentation? [15m]
Before the presentation,
- Understand the audience- the medical officer- and his perspective.
- Research thoroughly on the subject and be the expert.
- Document all your sources to convince the audience.
- Write out the speech, and prepare the slide show.
- Rehearse the presentation repeatedly until you are bored.
- Rehearse the presentation with someone else in a dress rehearsal.
- Modify the presentation after getting feedback
- Prepare yourself- imagine you standing in front of the medical officer presenting flawlessly.
During the presentation
- Introduce the presentation, paying attention to your physical, non-verbal demeanor.
- Present the material. Maintain eye contact to prevent stage fright.
- Build a story and keep it relevant.
- Keep it short and sweet.
- Use readable fonts
- Simplify your graphics
After the presentation
- Open the floor for question-and-answer session.
- Maintain control over the flow of the session.
- Repeat the question when you get it, so the audience can hear it as well.
- Take a few moments to think before answering.
- Exit the stage, thanking everyone for their attention
- Mention if you will be available for further consultation
The three Es
- Enthusiasm
- Energy
- Excitement

2013/2014
V.
Discuss the systemic approach for answering a drug information request. (A medical helper
calling from the ward asking about Amoxicilin dosage) (15m)
1. Secure requestor demographics
The requestors profession should indicate educational experience and knowledge base
Therefore, the individual receiving the query can use this information to determine the
appropriate mannerism (in terms of educational level) to formulate and deliver the
response.
In this case (referring question), medical helper should have a broad knowledge base
about medical, so we can tell him/her more about and professionally, the Amoxicilin
dosage.
2. Determine a method for delivery of the response
Gather information from the requestor that will allow you to reply to the request.
Example of information: the requestors address, phone number, pager number and fax
number.
3. Obtain background information
Aids in clarifying the question and is a critical step in the process.
The question may not be stated concisely or the requestor may not know how to ask the
question
To formulate an acceptable response, both the caller and researcher must have a clear
understanding of the ultimate question
Example: What is the dose of amoxicillin indication, age etc.
4. Determine and categorize the ultimate question
Completely understanding the scope or the true question also aids in developing a
realistic estimate of the time required to compose a response
Example of question classifications: ADR, availability, dose, drug compatibility/stability,
drug interaction, drug therapy, identification, pharmacy practice, pharmacology
5. Develop strategy and conduct search
Select and prioritize resources based on the probability of locating the desired
information
Conduct a systemic search
Be familiar with the 3 types of information sources in the literature hierarchy
Begin with the established knowledge located within the tertiary literature due to the
condensed, easy-to-use format of the information presented. Then progress through the
secondary response to primary literature.

6. Perform evaluation, analysis and synthesis

Confirm the information with other references to assure the consistency between
various resources

7. Formulate and provide response

Restate the question and any pertinent background information
This allow the requestor to be informed of the question and focused on the impending
resources
A brief review of the search strategy and references reviewed may be included in the
response as a confirmation to the comprehensive search conducted
Compose the response at the requestors comprehension level
8. Conduct follow up and documentation
Method of documentation:
Paper form
Log book
Computer database
Reasons of documentation:
Justification of pharmacists professional value to the institution
Future references for repetitive drug information requests
Protective measure against legal liability
Method of follow up
Mail survey
Phone call
Written communication
Reasons of follow up
Provide the requestor with additional information that supports or changes a prior
recommendation, e.g.: recent publications or guidelines
Obtain feedback concerning the quality of the service.

2012/2013
IV. (A) List out 5 elements of the non-verbal communication. Discuss each element. (10m)
The elements of the non-verbal communications:

1. Proxemics (distance)
Different cultures have different comfort levels of distance
As children grow old and becomes less dependent on parents, they require more space
Men tend to take up more space than woman
Edward T. Halls 4 levels of distance:
Intimate: 0-18 inch
Personal: 18 inch-4 feet
Social: 4-10 feet
Public: 10 feet to infinity
A good rule of thumb is to stand an arms length away from the patient.
2. Haptics (touch)
The power of touch:
Studies found that strangers that were touched were more likely to return change
left in a phone booth
Food servers who used touch received larger tips
Students who were slightly touched by clerk while checking out library books
evaluated the library much more favorably than those who were not touched.
3. Chronemics (time)
Studied found that people who arrive 15 minutes late are considered dynamic, but much
less competent, composed and sociable than those that arrive on time.
4. Kinesics (behavior)
Facial expressions:
The face is capable of conveying 250,000 expression
Smiling increases sociability, likeability and attraction
Eye contact:
People are more likely to comply when more eye contact is used
Eye contact conveys a sense of sincerity
Eye contact establishes a connection between persons
Body language:
Mirroring building rapport with others by mimicking their non-verbal cues
People like those who are similar or equal to them
Posture e.g. sitting bend forward shows more attentive listening
Muscle tone and tension
Gestures
The movement of part of body
Can be seen as subtle or not so subtle cues
Use to take place of words, or help us to increase understanding of what is being
said
Gait movement of limbs

 Physical appearance
More attractive people are judged to be happier, more intelligent, friendlier,
stronger and kinder, and are thought to have better personalities, better jobs, and
greater marital competence.
Attractive people get more dates, higher grades, higher tips and lighter court
sentences than unattractive people
5. Artifacts (dress, belongings, etc)
Material objects as an extension of oneself
Clothing has the power to influence
Fragrance and odor
Several studies show that fancy suits, uniform and high-status clothing are realted to
higher rates of compliance.
6. Vocalic (paralanguage)
Use of voice to communicate includes elements such as pitch, rate, pauses, volume,
tone of voice, silences, laughs, screams, sighs, etc.
Studies have found that people who talk louder, faster and more fluently are more
persuasive
Deep voices are often viewed as more credible
Powerless style of communication lowers perceptions of credibility.
Emphasis on certain words will convey importance and enhance recell
Using a soft, calm and even tone suggests support and comfort
Slowing down parts of our speech conveys importance and patients will tend to recall
that part of the message
7. Environment
What we surround ourselves with
Example: the way we decorate our house tells others a lot about us.

(B) Explain the questioning skills

Good questioning is one of the most widely used social skills. It can be an asset to the
pharmacist to get essential information from the patient in order to respond to his enquires and also
need when dealing with other health professional, staff training, implementation of procedures,
ordering and supplying goods
Type of questions:

1. Open ended questions

It allows people to respond in their own way, to provide more detailed information and
elaboration on their complain or enquiry
2. Closed ended questions
Encourage the respondent to become involved in the interchange and enable answers
to be provided with relative ease.
Permits answers which are short, factual or which are selected from a limited number of
options
Types:
The selection question (forced choice question) e.g. do you want dissolvable
or non-dissolvable tablets?
The yes/no question e.g. has there been any bleeding?
The identification question, which requires the respondent to provide
considered response containing information e.g. can you tell me the medication
you are currently taking?
3. Leading questions
Lead the respondent towards an expected response
4. Probing questions
Designed to explore responses and elicit further information
Particularly useful in exploring the patients medical history, may take the form of, what
do you mean exactly by stomach ache?
Pausing is a techniques linked to probing, which can be used before (to draw the
respondents attention in preparation of the beginning of an interaction) and after
questioning (suggests to the respondent that further information is required).
5. Recall questions
Which are lower order cognitive questions, involve simple recall of information and
testing of memorized information
Essential in diagnosis of illness
6. Process questions
Higher order cognitive questions, e.g. opinion, justification, analysis of information
Why do you think this medicine is making you feel ill?
(C) Explain listening skills
Listening is the process of understanding. True listening involves both the eyes and ears.
Listening skills:
1.
2.
3.
4.

Sit up
Look interested
Lean forward
Listen

5. Act interested
6. Nod your head to show that you are
tuned in
7. Track the speaker with your eyes
Barriers to effective listening:

 Consider topic uninteresting

Criticize the speaker instead of the
message
Concentrating on detail, not main
ideas

Avoid difficult listening situation

Tolerate or failing to adjust to
distractions
Faking attention

Reflective Responses (10m)

The purpose- to resolve challenging situations that arise
What it does
1. It acknowledges the feelings and emotions of patients
2. It clarifies what the patient is saying
3. It focuses the situation on the patients problems
What to do.
1. Listen to what the patient is saying
2. Label or describe the patients feeling and content
3. Communicate back to the patient in feedback
It combines both active listening skills- paraphrasing content/words and empathizing responses
paraphrasing feelings.
Paraphrasing is reflecting back both the patients feelings and responses. However, it does mean to
agree or concur.
In emotional situations:
1. Acknowledge the feelings before proceeding
a. Eg: Sounds like you are
b. So you believe
c. It seems like
2. Limit responses to your level of understanding.
3. Dont expect to get it right on the first try
4. You do not have to hit the nail on the head
Primary goal of reflective responses in a pharmacy setting
- to calm the patient down
- so he/she will be receptive and attentive to the counseling process.
- It removes the emotional barrier.

RIM - Technique for Compliance counseling.

R - Recognize
Using objective and subjective evidence, the pharmacist can determine if the patient may have an
existing compliance problem.
Objective Evidence
prescription

patient profile
refill record

Subjective Evidence
patient respond during counseling
use reflective responses
I Identify
Determine the causes of noncompliance with supportive probing questions, empathic responses, and
other universal statements.
Knowledge deficit
Practical impediments
Attitudinal barriers
M - Manage
Develop partnerships with patients.
1.

Knowledge deficit
verbal /written information & verifying patients understanding

2. Practical Impediments
providing corrective actions individualized for the problems
3. Attitudinal barriers
empathetic response, open-ended questions & universal
Statements