World Health Organization (WHO)- "health is a state of complete emotional, mental, physical, and social well-being and not just the absence of disease or infirmity"
Health
"layman defined" reaction to perceived alteration in health physical and social meaning
Illness
"professional defined" diagnosis as basis of medical practice and therapy
Disease
view to help professionals understand why and under what conditions people take preventative health actions (behaviors)
Health Belief Model
1. peoples psychological readiness for action
2. degree to which a certain course of action has a beneficial effect on improving health
3. motivating signs (seriousness, vulnerability)
communication attending behaviors (4)
1. eye contact
2. attentive body language
3. vocal qualities
4. verbal tracking
3 results of good attending behaviors
1. encourages patient to talk
2. demonstrates you're interested, that you care
3. establishes rapport
professional borrows the patient's feelings to fully understand them but always are aware of own separateness
empathy
professional loses separate identity and takes in patient's feelings or circumstances
sympathy
6 barriers to communication
1. interrupting
2. belittling
3. moralizing
4. lack of privacy
5. impairments
6. time contraints
2 types of questions
1. open-ended - how and could
2. closed-ended - why (avoid)
3 reasons to practice good questions
1. brings out specifics about patient
2. effectively diagnoses a patient's concerns
3. guides the manner in which a client talks about an issue: what, how, why, could
context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
what
leads to facts
context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
how
leads to feelings or process (good choice)
context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
why
leads to reasons (not a good choice, makes patients defensive)
context: 3 reasons to practice good questions: guides the manner in which a client talks about an issue
could
considered maximally open (aka the best)
3 components of listening accurately
1. encouraging
2. paraphrasing
3. summarizing
4 reasons to practice good listening
1. communicates interest/caring
2. clarifies for the patient what s/he said
3. checks your accuracy
4. communicates to the patient that they have been heard
7 ways Yalom (Curative Group Factors) to make people feel good about a group
1. impart information
2. instill hope
3. universality, altruism
4. correct family group problems
5. socialization, interpersonal growth
6. cohesion, catharsis (talk about concerns)
7. imitative behavior
"glue" to make group
cohesiveness
value group holds for members and member investment
enhances commitment
care of and care from group favors cohesion
4 factors favoring cohesiveness
1. group tasks are within member expertise
2. leader point out group accomplishments
3. leader models empathy and gives feedback
4. leader allows group tension at some point to reach goals
"what" group does or discusses
group content
"how" group works"
group process
3 phases of a group
1. initiating
2. working
3. termination
context: 3 phases of a group
initiating
anxiety is felt
need acceptance and trust
establish group goals, power and control, testing
context: 3 phases of a group
working
work on group goals
out of conflict and agreement come
sharing
emotional growth
context: 3 phases of a group
termination
summarize feelings about goals and accomplishments
you will miss group members
ideal size of working group
6-10 is best for effective work
create subgroup if gets too large
can't attain group goals if too small
7 characteristics of an effective group
1. goals clear and collaborative
2. open goal directed feelings communicated
3. power equally shared
4. controversy is healthy
5. balance tasks and maintain it
6. diversity encouraged
7. effective IPR
what is a leader
person who facilitates all phases of group development
Group: behaviors expected of group members, people know how class graded, know expected dress, behaviors
Group specific: risk taking, humor, anger
List Maslow's Hierarchy of Human needs according to which must be met first (bottom of pyramid): love and belonging, self-actualizing, safety and security, physiologic, self-esteem
physiologic < safety and security < love and belonging < self-esteem < self-actualizing
must meet basic needs before higher needs
Hans Selye Stress Response for "General Adaptation Syndrome"
Alarm: adrenal cortex, defense
leads to:
1) resistance and recovery OR
2) exhaustion: toxic substance or stress overwhelms defenses
8 stages of Erik Erikson
1. infancy (0-1 year)
2. toddler (1-3 year)
3. preschool (4-5 year)
4. school age (6-12 year)
5. adolescence (13-20 year)
6. young adult (21-40 year)
7. middle years (41-64 year)
8. later adults (65 and older)
people usually master one stage before next and sometimes move fast or regress
context: Erikson's 8 stages of man
trust vs mistrust
infancy (0-1 year)
context: Erikson's 8 stages of man
autonomy vs shame and doubt
toddler (1-3 year)
context: Erikson's 8 stages of man
initiative vs guilt
preschool (4-5 year)
context: Erikson's 8 stages of man
industry vs inferiority
school age (6-12 year)
context: Erikson's 8 stages of man
identity vs role confusion
adolescence (13-20 year)
context: Erikson's 8 stages of man
intimacy vs isolation
young adult (21-40)
context: Erikson's 8 stages of man
generativity vs stagnation
middle years (41-64 year)
context: Erikson's 8 stages of man
integrity vs despair
later adults (65- up)
what is goal of coping skills
to develop more conscious coping skills to handle life issue
4 coping skills
1. talking
2. relaxing methods
3. exercise
4. balance work and play
goals of coping with crisis
help patient and family
strengthen support systems
develop coping skills
view crisis realistically to reduce stress and achieve psychosocial growth
*crisis can be a turning point
crisis
reaction to threat, illness
5 stages of crisis
1. shock
2. denial
3. distress
4. disequilibrium
5. stabilized
2 types of crisis
1. developmental
2. situational
ex: illness and resolving it can lead to personal growth for families and patients
mostly unconscious mental processes that lessen anxiety
defense mechanisms
7 types of defense mechanisms
1. denial
2. projection
3. repression
4. regression
5. displacement
6. reaction formation
7. rationalization
context: 7 defense mechanisms
failure to recognize threat event
denial
context: 7 defense mechanisms
attribute to others one's negative traits
projection
context: 7 defense mechanisms
dismissing anxiety producing thoughts from awareness
repression
context: 7 defense mechanisms
return to earlier pattern of behavior
regression
context: 7 defense mechanisms
redirect feelings about one person to another
displacement
context: 7 defense mechanisms
substitute opposite wishes for true wishes
reaction formation
context: 7 defense mechanisms
substitute socially acceptable reason for real reason
rationalization
defense mechanism vs coping skills
unconscious vs conscious
goal is to develop conscious coping skills
type of communication in family
open, clear, direct
not closed, confusing, indirect
4 types of family
1. family of origin
2. nuclear family
3. blended family
4. extended family
context: 4 types of family
family into which a person is born
family of origin
context: 4 types of family
new family created by 2 partners
nuclear family
context: 4 types of family
common people
blended family
context: 4 types of family
family network
extended family
8 problem responses to illness
1. anxiety
2. denial
3. demanding
4. controlling
5. manipulation
6. suspicious
7. anger
8. depression
context: 8 problem responses to illness
mild, moderate, severe panic
anxiety
RPh:
1. recognize anxiety, search for cause, show calm and care
2. teach stress reduction techniques
context: 8 problem responses to illness
minimizes fear and anxiety, avoid intolerable feelings which can be adaptive if it helps one initially get through trauma and maladaptive if it prevents acceptance of problem and need for treatment
denial (Don't Even kNow I Am Lying)
RPh:
1. gentle, indirect approach
2. comment on observed condition
context: 8 problem responses to illness
excessive need for dependency, "entitlement" attitude, fears abandonment
demanding
RPh:
1. set limits in caring supportive manner, anticipate care needs
context: 8 problem responses to illness
rigid, needs lots of control, thinks rather than feels, and are driven to achieve
controlling
RPh:
1. give control over schedule and treatment
2. provide detailed teaching
context: 8 problem responses to illness
flattery, self-pity for self-gain, lying, threaten to harm, and takes advantage, play one staff against other
manipulation
RPh:
1. confront behavior with clear limits
context: 8 problem responses to illness questions caregivers intentions, complains about care, feels vulnerable and fearful
suspicious
RPh:
1. recognize beliefs and feelings, but offer no challenge
context: 8 problem responses to illness
feelings of displeasure from injury, mistreatment, opposition, impulses to fight back
9 strategies for homeless care with major goal to have compliance
1. simplify dosage
2. secure place to store medications
3. provide suitable containers
4. communication with interdisciplinary team
5. disorganize lifestyle
6. written/verbal education and link (patient, caseworker, and RPh)
7. assess need for fluids, food and protection from the elements
8. homeless people need to feel productive and respected like all other people
9. new resources for programs
what types of people are homeless?
1. 1/3-1/2 are mentally ill
2. alcoholics and drug users
3. lost job and home
4. war veterans
5. run away kids and adolescence
6. victims of domestic violence, battered children
7. displaced families
2 types of social support/systems
1. formal system
2. informal system
context: 2 types of social support
hospital, clinics, health care professionals, community agencies, home care agencies, professional counselors/therapists
formal system
context: 2 types of social support
family members, friends, co-workers, neighbors, spiritual center
informal system
2 types of groups for support in health care
1. self-help
2. support groups
context: 2 types of groups for support in health care
controlled and directed by individual members ex: Alcohol Anonymous
self-help
3 goals of self-help groups of support in health care
1. self-reliance
2. hope
3. improved morale
context: 2 types of groups for support in health care
led by health care professionals
support group
4 goals of support groups for support in health care
1. new knowledge and skills
2. encouragement
3. feedback on behavior
4. normalization of the experience
5 common religions and beliefs
1. Christianity
2. Judaism
3. Islam (Muslim)
4. Buddhism
5. Hinduism
**individual variation family practice or individual; do not assume; ask
context: 5 common religions and beliefs
Christianity
Western
largest group
Roman Catholics: Holy Days, Sacraments, birth control and abortion prohibited
context: religious and spiritual needs
anything that pertains to a person's relationship with a non-material life force or higher power
spirituality
context: religious and spiritual needs
organized system of belief's about a higher power
religion
9 Roles of a pharmacist with religion
1. consider: is patient angry at God, feeling punished, or a victim because of illness
2. facilitate best care possible despite not understanding all patient's beliefs
3. do not make generalizations on religious beliefs based on one member of a religion because each person is an individual
"ask the patient"
4. not a clergy or counselor
5. examine your spiritual and religious beliefs
6. assess and respect spiritual needs and religious beliefs of patients
7. educate self on major religions
8. learn how patients views higher power
8 parts of cultural assessment
1. language and communication style
2. religious beliefs, needs, and practices
3. healing beliefs and practices
4. food practices
5. cultural identity and practices
6. illness-wellness behaviors
7. nutritional needs
8. role of family
3 barriers to communication and pharmaceutical care/ pharmacist barriers
1. not speaking the language
2. not understanding the culture or willing to modify health care to background
3. stereotyping: apply positive or negative labels to a group
9 pharmacist interventions/strategies to achieve
1. awareness and acceptance cultures different from yours
2. learn about cultures (classes, expand circle of friends, involve in cultural centers and events)
3. ask questions and pay attention
4. keep mind open, do not stereotype
5. carry a pocket translator
6. auxiliary labels
9. markings on measuring devices
10. learn common phrases
11. make person from another culture comfortable in your pharmacy
T/F cultural competence is important and lasts for a short time
false. lifelong
cultural competence
knowledge base and interpersonal skills that allow health care providers to understand, appreciate and work effectively with individuals from cultures that differ from their own
2 communication techniques
1. non-verbal
2. verbal
context: 2 communication techniques
cautious use of hand gestures, eye contact
non-verbal
context: 2 communication techniques
show patience, avoid slang, speak slowly not loudly
verbal
Islam
second largest religion in the world with an estimated 1.4 billion adherents
Declaration of belief in one God, Allah, and that Muhammad is the messenger of God
pray 5 times a day -- at dawn, noon, midafternoon, sunset, and nightfall. Prayer, salah
2 Dietary Issues for Muslim
1. fasting during Ramadan, the ninth month of the lunar Muslim calendar (it begins in October this year), from approximately an hour before sunrise until sunset, is compulsory for all healthy, adult Muslim
2. fasting encompasses total abstinence from food, drink (including water), smoking, and sexual relations
4 gender issues for Muslim
1. modesty is an important issue
2. patients typically prefer same-gender providers
3. don't shake hands or hug patients, unless patient initiates it
4. female patients may wear an opaque black cape, or abaya, over their clothing and a head scarf, or hijab
3 stages of pregnancy
1. first trimester
2. second trimester
3. third trimester
context: 3 stages of pregnancy
5 thoughts with first trimester
1. hard to accept pregnancy
2. pregnancy may be a surprise at "unplanned time"
3. thinks of self
4. pregnancy is a "condition"
5. may be taking medications not knowing pregnant
context: 3 stages of pregnancy
3 thoughts with second trimester
1. mom worries about effect of medications on baby
2. worry about baby as separate individual
3. mom also worries about food, fluids, and "am I doing all I can for baby"
context: 3 stages of pregnancy
3 thoughts with third trimester
1. increased anxiety about role changes and impending delivery
2. "baby comes first"
3. bottom line questions from mom "can the medication wait until after delivery and will it hurt my baby"
2. PP depression: 10-16% 4 weeks PP with history and lack of support, dec. estrogen
3. PP psychosis: rare, 0.1% -0.2% rapid developing 2-3 day up to 6 weeks (mood and behavioral changes, labile mood, delusions, hallucinations
3 roles of a pharmacist to intervene with PP issues
1. assess medication intake: what medications, how much, how long, tetratogenecity risk
2. support mom to feel she is doing all possible for baby
3. counsel about effects of medication on baby
name of a test to evaluate/screen potential PP depression
The Edinburgh Postnatal Depression Scale
5 communication tips for pharmacist to care for children
1. sit or kneel at child's level
2. share observations to level "I don't like shot either" not over focus on self
3. look what captures interest of child
4. avoid comments to make child self conscious "you are getting big"
5. normal tone of voice, do not talk down
How do kids take medication?
pediatrics
teaching major role such as not putting medications in favorite foods
ice may numb tongue to bad tastes
don't tell kids early before medication is given
need trust with child as child may feel anxious and fearful about medication
T/F match medications approaches with developmental age of child
true
5 stages of death and dying by Kubler Ross
1. denial or shock
2. anger
3. bargaining
4. depression
5. acceptance
who is the best judge of patient pain?
Patient
patient's rights:
1. to decide the duration and intensity of pain
2. to be informed of all possible methods of pain relief
3. to choose the pain control method
4. to choose to live with or without pain
how do we evaluate for pain what tests?
1. assess:
-pain rating scares
- subjective evaluation of pain
2. plan:
-non-pharmacological pain relief
-pharmacological pain relief
3. implement:
-teach (patient, family, and staff)
-schedule medication
4. evaluate:
-effectiveness of treatment
-notify prescriber for change
2 types of pain
1. chronic
2. acute
context: 2 types of pain
lasts less than 6 months, act as a warning signal to injury, has an identifiable cause
acute pain
context: 2 types of pain
lasts more than 6 months past injury, has no apparent useful purpose, may or may not have an identifiable cause, mild to moderate intensity
chronic pain
6 non-pharmacological interventions for pain
1. cutaneous stimulation
-heat/cold
-massage
-tens
2. distraction
3. relaxation
4. imagery
5. hypnosis
6. biofeedback
5 advantages for non-pharmacological interventions of pain
2. stigmas (mistaken as: completely helpless, can't hear, not intelligent, must have someone to help, can't work)
hearing:
1. psychosocial fears (frustration, embarrassment, helplessness, alienation and isolation), unable to hear and must find other types of communication
strategies to communication and serving with visual impaired person
visual:
-prescription delivery system
-take extra time to thoroughly explain prescription directions, interactions, etc. to patients, spouse, others
-patience, ask questions
-braille prescription and auxiliary labels
-pharmacy at front of store
-stock white canes
-discuss strategies to provide complete instructions to enhance compliance for ex- need for special services, work and family
-medical devices and boxes
strategies to communication and serving with hearing impaired person
hearing:
-awareness causes of hearing loss
-don't assume lack of education
-learn to communicate by: signing, body language, written word, dec. distraction
-check to see if patient understands
-don't call name over loud speaker or speak from another room
-stock pharmacy hearing aide batteries
-words normal tone and slower
-get patient's attention by a light touch
-ensure that patient has necessary devices needed, email refills
-use simple sentences, avoid shouting, or using slang
-if necessary write down the message
-don't cover your mouth when talking, eating, chewing gum, drinking
4 physical aspects of people with decreased mobility
1. hard to perform basic activities such as cooking, dishwashing, cleaning
2. going through doors and elevators, getting things out or cupboard or refrigerator
3. takes longer to get from point "A" to point "B"
4. hard to ask for help
6 psychosocial aspects/needs of people with decreased mobility
1. trust
2. self-esteem
3. control
4. loss
5. guilt
6. intimacy
7 major fears of patient dying with an illness
fears:
1. of the dying process and pain
2. of loss of control
3. of loss of loved ones
4. of reaction of loved ones to dying
5. of isolation
6. of unknown
7. that life will be meaningless
6 roles of a pharmacist in hospice care
1. provide pain relief
2. understand the symptoms and treatment
3. reassure patient about availability of treatment for symptoms
4. understand side effects of treatment
5. monitor patient's response to treatment
6. create patient-specific dosage forms
Patient's rights' about terminal illness
10 choices in the Bill of Last Rights
1. right to be in control
2. right to have a sense of purpose
3. right to reminisce
4. right to be comfortable
5. right to touch and be touched
6. right to laugh
7. right to be angry and sad
8. right to have a respected spirituality
9. right to hear the truth
10. right to be in denial
stigma
sign of shame, disgrace, rejection, disapproval, or being shunned
-emerges if people feel embarrassed to discuss behaviors perceived as different
-linked to all mental illnesses - strong if illness causes unusual and severe behaviors
-we fear what we don't understand
-stigma causes more destruction than illnesses
An important issue confronting the person with chronic mental illness and HIV includes ______ and need for __________.
stigma ; confidentiality
5 health promotion interventions that pharmacists can teach patients regarding forms of cancer (testicular, breast, and skin) assessment
1. teach signs
2. encourage skin observations by patient and significant other
3. RPh may be the first one patient asks about lesion
4. sun protection: screen products, clothes
5. encourage referrals
ABCDs of Melonoma
A: symmetry of lesions
B: borders, irregular
C: color, blue/black or variegated
D: diameter, >6mm
E: evolving
sores that do not heal, persistent lump or swelling
6 fears of cancer patients and coping issues
1. return of disease
2. pain
3. disfigurement/body image changes
4. concern over the future
5. loss of work role
6. dependency/ loss of relationships/alienation
7 factors to improve cardiac health
1. close friend or confidant
2. pets
3. follow spiritual and cultural practices
4. healthy lifestyle
5. some need SSRI-antidepressent (if depressed which is common early in disease like post-MI)
6. relaxation, meditation
7. support or therapy groups
8 common stressors for person with respiratory problems (COPD)
1. carry 6-9 pounds of oxygen canister makes person appear invalid
2. anxiety and panic from shortness of breath; frequent respiratory infections
3. multiple inhalers
4. need energy efficiency strategies
5. break tasks into parts with rest breaks
6. avoid lifting or reaching
7. avoid polluted environments: need ventilation and climate control
8. coughing and mucus can embarrass
5 common stressors for person with diabetes
1. syringes vs pumps; injecting oneself
2. diet and exercise; changes
3. teach hypo and hyper blood sugar; need for education about medication, exercise, etc.
4. disability due to complications; fear of secondary complications like amputations, blindness, renal disease
5. effects on family
8 overall psychological impacts with chronic diseases and cancer
1. think depression
2. anxiety
3. body image
4. feeling lack of control
5. fear of death/cancer
6. diabetes fear of amputation
7. renal disease
8. blindness
context: DSM-IV criteria for abuse and dependency
maladaptive pattern substance use leading to clinically significant impairment or distress: 1 or more following past 12 months: failure to fulfill work, school home role, engaging in hazardous conditions like driving under influence (DUI), legal problems, continued despite problems
drug abuse
context: DSM-IV criteria for abuse and dependency
maladaptive pattern substance use leading to clinically significant impairment or distress: 3 or more over 12 months "out of control" in use. tolerance - need for more to achieve effect. withdrawal syndrome for specific substance experienced if not available
drug dependence
T/F dependence is equal to addiction
false. physical dependence does not equal addiction
common test to evaluate substance abuse is CAGE
C: cut down on substance use
A: annoyed when people criticize your use
G: guilty about drinking
E: eye opener drink or drug
2-3 yes = dependence
3 defense mechanisms overused by persons with a substance abuse problem
1. denial = major defense
2. projection
3. rationalization
conclusion of albrecht and havinghurst on aging? activity of youth and middle years
-elderly with more activities are happiest
-not just any activity, but those they are engaged in during the younger and middle years or substitute
activities to replace ones you can no longer do
-society disengages from elders
T/F there is a decrease in alternative (complementary) integrative therapies used in the USA. because we have an increase in better drugs.
FALSE. there is an INCREASE in use.
30-50% of all patients receiving conventional medical treatment co-treat themselves with alternative products or services. They use it when conventional therapies have less-than-desireable results or/and have unpleasant side effects, no known conventional therapy exists, or conventional therapy lacks emotional and spiritual benefits
Most patients do not tell their physicians they are using herbs or other alternative therapies nor does the physician ask
