Final

Question 1

What are the five steps of complete and effective communication?

Answer 1

• Send message (must be clear and tailored to audience)
• Receive
• Confirm receipt/interpretation
• React purposefully (prompts, reactions, changes)
• Feedback
• Continuous cycle of communication

Question 2

What does divergence refer to when evaluating a patient’s information?

Answer 2

• Does their message match their non-verbals?

Question 3

What is empathy?

Answer 3

• The ability to understand and communicate your understanding of the feelings of another
• Prompts and summaries recognize what patient is saying
• Empathy recognizes what patient is feeling

Question 4

What are the important aspects of empathetic responding?

Answer 4

• Recognize and identify the patient’s feelings
• Communicate understanding of feeling (non-verbal and verbal)
• Check for accuracy

Question 5

What is the medication experience?

Answer 5

• Patient’s personal approach to use of medicines - why they believe/feel a certain way about therapy
• Sum of all events in a patient’s life involving drug therapy
• Construct we help create in partnership with patient
• It is the subjective experience of taking medications every day

Question 6

What are important aspects to consider when trying to learn about the patient’s medication experience?

Answer 6

• Be attentive to general attitude towards medications, preferences, concerns, understanding, cultural and ethical beliefs
• Often gather this information indirectly from patient interview

Question 7

What are the four types of medication experience?

Answer 7

• Meaningful encounter: Sense of losing control, sign of getting older, causes questioning, meeting with stigma
• Bodily effects: Pharmacological effects vs. side-effects, weigh benefits and risks, trade-offs
• Unremitting nature: Unremitting nature of chronic medications is a burden
• Exerting control: Patients learn meaning of medication, question it, realize effects and continuous nature, experiment with becoming managers of their own treatment regimens

Question 8

What is reflection?

Answer 8

• Process of reviewing experience of practice in order to describe, analyze, evaluate, and therefore inform learning about practice
• Occurs before, during, and after situations with purpose of developing greater understanding of self and situation so future situation encounters are informed from previous encounters

Question 9

Why bother reflecting?

Answer 9

• Learn from thinking about what we do, not actually doing
• Helps increase diagnostic accuracy, decrease errors
• Can be hard to articulate professional knowledge and professional practice is not understood in terms of skills along

Question 10

How do we reflect?

Answer 10

• What? (describe situation - achievements, consequences, responses, feelings, problems)
• So what? (discuss what was learnt - in terms of self, relationships, models, attitudes, cultures, actions, thoughts, understanding, improvements)
• Now what? (identify what needs to be done to improve future outcomes, develop learning)

Question 11

What is the cycle of the patient care process?

Answer 11

• Patient assessment (open interaction, develop relationship; continuously gather and evaluate information; is therapy safe, effective, indicated, manageable)
• Develop a care plan (goals of therapy, alternatives, recommendation, monitor, follow-up)
• Implement the care plan
• Follow-up/monitoring plan
• All processes involve continuous communication and documentation

Question 12

What information should you gather when creating a database?

Answer 12

• Demographics
• Reason for assessment
• History of present illness
• Past medical history
• Medication history
• Family history
• Functional history (e.g., ADLs)
• Social history
• Review of systems
• Physical exam, vitals, investigations/diagnostics
• Lab findings

Question 13

What are the components of the medication history?

Answer 13

• Allergies
• Adverse effects
• Current medications
• Past medications
• Non-prescription meds
• Other meds and immunizations
• Medication experience
• Medication adherence
• Other medication considerations (e.g., cost, etc.)

Question 14

What are the differences between closed, open, and fully open questions?

Answer 14

• Closed = Verify/clarify information (e.g., will you…? have you…?) (yes/no answers)
• Open = Open up topics (Wh questions, own words with some re-direction)
• Fully open = Invite conversation (Tell me…/Describe…) (Few limitations)

Question 15

What are the purposes of prompts and summaries?

Answer 15

• Recognize what patient is saying

- Patient feels heard

Question 16

What are the three prime questions?

Answer 16

1. Purpose = What did the doctor tell you this medication was for?
2. Directions = How did the doctor tell you to take this medication?
3. Monitoring = What did the doctor tell you to expect from this medication?

Question 17

What is signposting? What are transitions?

Answer 17

• Signposting = Helps patient know what to expect in next interaction
• Transitions = Indicate to patient that you are changing topics

Question 18

What are the four questions to evaluate therapy?

Answer 18

• Indicated?
• Effective?
• Safe?
• Manageable?

Question 19

What are three perspectives to consider when evaluating medication therapy?

Answer 19

• Are the needs of the individual met?
• Is there treatment for all conditions?
• Are the medications appropriate?

Question 20

What are the four vital behaviours?

Answer 20

1. Engage patient behind prescription
2. Chat about medications
3. Check medications for person
4. Chart course forward together (patient-specific information, encourage follow-up)

Question 21

How do you engage the person behind the precription?

Answer 21

• Greet warmly
• Identify self and purpose (NOD)
• Listen and recognize patient’s perspective (active listening)
• Pause and give permission
• Small talk to connect
• Empathy
• Agenda setting (address patient concerns)

Question 22

How should you chat about medications with patient (VB #2)?

Answer 22

• Gather other medications, medical conditions, allergies
• Identify medical indication
• Explore medication taking, benefits, risks
• Acknowledge patient cues
• Use flexible and systematic approach (signposting, TED invitation questions (tell, explain, describe), 3 prime and open Qs, watch for patient cues, conversational transitions)

Question 23

What are the refill prime questions?

Answer 23

1. How do you know this medication is working for you?
2. How do you fit this into your day?
3. What is different since you started the medication? OR How do you feel the medication is working for you?

Question 24

How do you engage in vital behaviour #3, checking the medications?

Answer 24

• Evaluate appropriateness of medications
• Three perspectives (individual, disease, medication)
• Evaluate therapy given current health and life context
• Ask yourself is medication is indicated (i.e., do they have conditions), effective (i.e., does this medication treat this condition), safe, and manageable

Question 25

What is a focused medication history?

Answer 25

• Focus on one main issue/presenting medical issue

- Not exhaustive history, but sufficient

Question 26

What do you need to know to determine the appropriateness of therapy?

Answer 26

• Medical conditions
• Diagnosis
• Lifestyle
• Allergies
• Taken drug before
• Age, weight
• Insurance
• Other conditions, medications

Question 27

Regarding medication of interest, along with asking three prime questions, what else should you explore with regards to the patient?

Answer 27

• Explore their reason for taking the medication

- How did it happen? How is pain? What else have you tried? Have you used it before?

Question 28

What is non-assertive/passive communication? What are the two aspects/types?

Answer 28

• Allow others to cross boundaries
• Withrdaw: Leave situation, ignore issue, change subject, build false hope
• Accommodate: Back down and satisfy other person’s demands
• Can sometimes use this, but shouldn’t be primary style

Question 29

What is aggressive communication? What are the two aspects/types?

Answer 29

• Intimidate: Trade insults, threats, demands
• Dominate: Force ideas on person without discussing their concerns
• Show disrespect, escalates, conflict, fails to inform and gain cooperation

Question 30

What is assertive communication? What are the two aspects/types?

Answer 30

• Acknowledge: Verbalize concerns
• Problem-solve: Identify options/solutions, use problem-solving process
• Use “I” statements
• Generally recommended because it defuses situation, shows respect for self and others, protects you and patient from unsafe situations, and most of all, demonstrates professionalism

Question 31

What are the components of a documentation note?

Answer 31

• List date and prescription number
• Briefly describe: Data, assessment, plan
• Sign/provide initials

Question 32

What should be included in the data section of a documentation note?

Answer 32

• Patient concerns, goals, preferences
• Relevant subjective and objective data about patient
• Includes orders, labs, vitals, patient concerns/statements, etc.
• Red flags (so you know it was addressed)

Question 33

What is a positive aspect of social media in health care?

Answer 33

• Can essentially peer pressure people into engaging in healthy behaviours

Question 34

When posting on social media, what is something to consider?

Answer 34

• Posts should be visually appealing and simple
• Around grade 6 level
• Use positive language (i.e., show benefits and not risks of behaviours)

Question 35

What is health literacy?

Answer 35

• Degree to which individuals have capacity to obtain, process, and understand basic health information and services to make appropriate health decisions
• Ability to access, understand, and act on information for health
• Very context specific

Question 36

What are the different levels of health literacy?

Answer 36

• Level 1: Very poor. May not be able to determine medication doses
• Level 2: Can only deal with simple, clear material for uncomplicated tasks
• Level 3: Can cope with demands of every day life
• Leve 4 and 5: Strong skills

Question 37

What percentage of Canadians have low health literacy?

Answer 37

60% (assuming level 3 is minimum required)

Question 38

How should health literacy be dealt with on a case-by-case basis?

Answer 38

• It is not obvious therefore understanding and clarity should be checked with EVERYONE
• Referred to as “Universal Precautions”

Question 39

What are some indications of low health literacy?

Answer 39

• “I forgot my glasses”
• Lots of papers in purse
• Poor follow-up/lack of follow-through with appointments, etc.
• Few and very basic Qs
• Can’t explain concerns, how to take meds.

Question 40

What are some challenges individuals with low health literacy face?

Answer 40

• Increasingly complex health system (greater self-care requirements, increased meds. for chronic conditions, formulary and manufacturer challenges, medication recognition)
• Most patient instructions are written (low literacy patients have trouble understanding)
• Verbal instructions are often complex, delivered too fast, easy to forget

Question 41

What are some strategies to improve communication with patients with low health literacy?

Answer 41

1. Explain clearly and in plain language (slow pace, no jargon, no vague terms)
2. Focus on the key messages and repeat them (limit info to 1-3 key points, develop short explanations for conditions and side-effects, discuss specific behaviours and not general aspects, review information at end)
3. Use teach back technique and check understanding (clarify info as needed and re-assess understanding)
4. Effectively solicit questions (“What questions do you have for me?”)
5. Use patient-friendly educational materials to enhance interaction (appropriate content, plain language, layout, illustrations)
6. Communicate numbers effectively (speak in terms of odds, not percentages, use more than one method, visual aids, standard vocabulary that is consistent (i.e., keep same denominator), avoid relative risk figures alone, frame risk in same direction - good or bad, avoid complex forms)

Question 42

What are the odds for very common, common, uncommon, and rare?

Answer 42

• Very common = 1 in 10
• Common = 1 in 10 to 1 in 100
• Uncommon = 1 in 100 to 1 in 1000
• Rare = 1 in 1000 to 1 in 10,000