PATIENT ASSESSMENT, DRUG INFORMATION, LITERATURE EVALUATION,

COMMUNICATION SKILLS (PCL 562)

COMMUNICATION SKILLS
What is communication
Communication (from Latin commūnicāre, meaning "to share" is the activity of conveying
information through the exchange of ideas, feelings, intentions, attitudes, expectations,
perceptions or commands, as by speech, gestures, writings, behaviour and possibly by other
means such as electromagnetic, chemical or physical phenomena. It is the meaningful exchange
of information between two or more participants (machines, organisms or their parts).
The communication process is not complete until the receiver understands the meaning of the
message sent and gives a feedback. Communication and collaboration are essential for patient
care and to achieve the outcomes that a team sets out to accomplish.
There are three integral elements of communication, i.e. Sender, Message and Receiver.
Effective communication is a skill. It involves exchanging ideas, thoughts, opinions, knowledge,
and data so that the message is received and understood clearly. It means having an ability to
listen attentively and to convey information efficiently with sensitivity to patient confidentiality,
respect, and empathy. When effective communication takes place, both the sender and receiver
feel satisfied. Developing and using this skill plays a key role in keeping patients safe.
Effective communication includes ensuring both verbal and written communication is timely,
effective, and clear.
Media for Communication
Communication is carried out using a broad spectrum of media, the means through which the
message is encoded for transmission to the receiver.
The medium used in conveying a message must be appropriate for the purpose it is intended e.g.
use of text message to inform client of the death of a loved one will be inappropriate. The
medium used must also retain the integrity of the message from when it is sent, to when it is
received. The medium used must also be matched to the audience size e.g. in small groups verbal
communication with(out) the use of amplifiers will be appropriate, while for large groups, mass
media will be deployed.
In the Pharmacy, it is one-to-one interpersonal communication that is the most commonly used
method and this does not require amplifiers but can be enhanced when tone, voice quality, and
other media aids like pictograms etc are used
Elements of the Communication Process
Every message must be appropriately matched. And requires certain properties to ensure it is not
muddled or lost in translation.
The following acronym MSCREF describes the basic elements of the communication process
1. M- Message should be clear, concise and straight to the point. It is important that there are no
exaggerations if unintended or if it will distort the message or elicit an adverse reaction in the
receiver. Tone is very important especially since messages are often interpreted messages based
on the tonality.
2. S- Sender of the message must be in the appropriate frame of mind to encode the message
aright, and attempt to eliminate obstacles to the appropriate message being sent to the
appropriate recipient.
3. C- Channel is same as medium, i.e. the medium through which message reaches the receiver.
Channel must be effective and culturally acceptable to the target. The sender must be able to use
the medium appropriately i.e. encode the message appropriately for it to be relayed to and
decoded by the receiver.
4. R- Receiver is the final recipient. The receiver must be appropriately tooled to decode and
interpret the message i.e. must be able to process the message, leading to understanding and
appreciation of the intended message.
5. E- Effect or reactions to the message received by the recipient. Effects may be appropriate,
timely and effective. A good message will elicit the appropriate response without any bias
leading to the expected action.
6. F- Feedback originates from the recipient of the message. This may include seeking
clarification or (if the message is clear enough) verbalizing receipt. Feedback is important in
helping the sender know if the message was received as intended.

Types of Communication

Intra-Personal Communication
a. This is talking within oneself.
b. It is the thought going on within a person.
c. Takes place before any other form.
d. Before you talk to any type of audience or take any action, you must think about it.
e. It follows therefore, that conflict within oneself can negatively influence communication with
others .

Interpersonal Communication
Interpersonal communication is the face-to-face verbal and nonverbal exchange of information,
ideas or feelings between individuals or groups.
Types of Interpersonal Communication:
a. Verbal Communication: This is the exchange of ideas through spoken or written expression
(word).
b. Non-verbal Communication: This involves the expression of ideas, thoughts or feelings
without the spoken or written word. This is generally expressed in the form of body language
that includes gestures and facial expressions.
c. Both verbal and non-verbal form the basis of interpersonal communication
Non-Verbal Communication (NVC)
NVC are forms of communication other than verbal messages. The body language and manner in
which something is said (vocals) are important components.
Non-linguistic NVC comprise of four main elements:
a. Body contact
b. Interpersonal space
c. Appearance
Appearance is an often-disregarded part of communication skill. First impressions are very
important - they can be about attitude as well as dress. Visual impact is at least as important as
verbal impact. People will very quickly make assumptions based on your personal appearance,
including your facial expressions, the clothes you wear, how well-groomed you are and your
body language.

i) Clothes and appearance

Perhaps the most obvious element of personal appearance, and certainly the easiest one to
change, is what you wear and how you look. Nobody is likely to be able to tell you exactly what
is appropriate attire in any given situation. There will, however, be plenty of people to tell either
you or someone else if you get it wrong.
You should also ensure that you are appropriately groomed.. It does, however, mean that you
should be clean, your clothes should be clean and ironed, and that your hair should be tidy.

Nobody expects you to be packaged into something you are not. However, your appearan is a
reflection of your own self-esteem. You should aim to present yourself to your best possible
advantage. Whilst you might be casually dressed when working within your organisation, a more
formal approach may well be preferable when representing your organisation at an external
meeting. Good grooming and a tidy appearance is always preferable, whether casually or more
formally dressed. It presents a much more professional appearance.
It also suggests that you think that you are relatively important: that you matter. This is important
if you wish to be taken seriously. Nobody is going to respect someone who does not look like
they respect themselves.

a. Physical Non-verbal Communication or body movement

This is the sum total of the physically observable. For instance, hand gestures, body language, facial
expressions, the tone of one’s voice, posture, stance, touch, gaze, and others. Several researchers
have revealed that physical nonverbal communication constitutes about 55% of our daily
communications.
This is the sum total of the physically observable. For instance, hand gestures, body language, facial
expressions, the tone of one’s voice, posture, stance, touch, gaze, and others. These are subtle
signals that are picked up as part of our biological wiring.

b. Aesthetic Communication
Art is an important means of communication. Through the paintings or other forms of art, an artist
can covey the strongest messages. Several times in the history of the world, art has been used as an
effective form of nonverbal communication.
Body Language
Understanding body language is one of the most important aspects of personal presentation. The
image conveyed by the physical self should support and enhance what is being communicated
verbally. If the visual image differs widely from the spoken message, it is often the non-verbal
account that is believed.
a. The way you sit and stand, your gestures and mannerisms and your facial expressions will say
far more about you and how you are feeling at any given time than the words you are
using. When individuals are nervous or uneasy, their behavioural 'bad habits' become more
pronounced.

b. Awareness of your body language, of how you behave under pressure, what signals you are
unconsciously giving, how nerves and stress affect you physically, can help you understand how
you 'come across' to others. It can also explain how the wrong impression is sometimes given
and how confusion can occur.

c. Body language can also be used as a mask to convey contrary feelings. How often have you
nodded firmly when you did not understand a word, smiled when your instinct was to scowl, or
clapped enthusiastically at the end of a talk that nearly put you to sleep? In these cases you were
not being hypocritical, but using body language positively as the mechanism of good manners.

d. Our gestures are part of our personalities, a part of how we express ourselves. Hand and arm
movements can add emphasis, aid explanation and convey enthusiasm. They only become a
negative signal when repeated so often that they become irritating to the observer. Listeners can
become so side-tracked by the sight of someone constantly playing with their hair, tapping on the
table with a pen, etc., that they no longer listen to the spoken word. These negative signals can
break down the communication process.

Positive body language includes

a. Maintaining eye contact with the person you are talking to

b. Smiling (if needed especially as greeting or at the end of a conversation

c. Sitting up in a chair, leaning forward slightly (showing you are listening)

d. Nodding in agreement

e. looking interested

f. Presenting a calm behavior

Negative body language includes:

a. Not looking at a person when the person is speaking

b. Tapping a foot, finger

c. Rocking backward and forward

d. Scratching

e. Continually clearing your throat

f. Fiddling hair, ear lobes, jewelries etc

g. Yawing h. repeatedly looking at watch or wall clock

d. Visual Communication
This is communication through visual aids like pictures, graphs, objects, drawings, placards,
presentations, and illustrations, etc. Visual Communication is a crucial part of today’s methods of
conveying important information. It is used in presentations, televisions, etc.
3. Written Communication
The use of written words to convey messages. Written communication happens through email,
memos, texts, posts, etc. While written communication helps you share your thoughts well,
sometimes it does not fully convey the emotion that you are trying to share.

A mode is the means of communicating, i.e. the medium through which communication is
processed. There are three modes of communication: Interpretive Communication, Interpersonal
Communication and Presentational Communication.
Different Modes of communication
1.Interpretative Communication
2.Presentational Communication
3. Interpersonal Communication
4.Verbal Communication
5.Non-Verbal Communication

1.Interpretative Communication
Also referred to as “one-way communication”, in this mode, the information conveyed by the
sender is interpreted by the receiver in its original form. The target has to understand the
message in both written and spoken form keeping various aspects in mind. For example, in a
class, the learners may not understand every word said by the teacher but are expected to
understand the main crux of the topic.

2. Interpersonal Communication
Interpersonal communication is the process by which people exchange information through
verbal and nonverbal messages. It is an unmediated mode of communication that occurs when
we interact and attempt to mutually influence each other, simultaneously, in order to manage
relationships. Although interpersonal communication can encompass oral, written, and non-
verbal forms of communication, the term is usually applied to spoken communication that takes
place between two or more individuals on a personal or face-to-face level. Examples of
Interpersonal Communication include: Personal Interview, Telephonic Conversations, Interactive
Sessions, Debates, E-mails, Text Messages
3. Presentational Communication
Presentational Communication is another type of one-way communication, which facilitates
interpretation by members of another group where no direct opportunity for the active
negotiation of meaning between members of the two groups exists. With this mode of
communication, a person is speaking to an audience that can be rehearsed, pre-prepared, or
scripted.
4. Linguistical or Alphabetic Communication
As one of the popular modes of communication, Linguistical or Alphabetic Communication
mainly refers to written or spoken communication where the sender conveys their message
through writing on paper or through speaking.
Examples: Text messages, audio messages, emails, speech, notes and lists, etc.

5. Gestural Communication
Gestural Communication has its quintessential emphasis on body language and physical
movements to communicate messages. Sign Language is the best example of the gestural mode
of communication as those who can’t talk or hear are able to communicate best through their
gestures and have their own set of unique languages to converse. While this mode of
communication is mainly combined with spatial, aural or linguistic ones, it can also be used
individually given that both the sender and receiver have common points of reference and
meanings to have an understandable communication.

6. Aural Communication
As the name suggests, oral communication uses audio mode to convey messages whether it is
through sounds or spoken audio. The speaker’s voice and pronunciation need to be clear and
precise with no background noise.
Example: Radio, audio messages, music, recordings, songs, audiobook.

7. Visual Communication
Visual Communication can be simply termed non-verbal communication as it comprises visual
messages from the sender to the receiver. It is one of the oldest modes of communication when
the ancient people didn’t know a language to communicate with, it is through pictures, drawings
and symbols that they were able to talk and converse with each other.
Examples: Pictures, Videos, Charts, Graphs, Symbols

8. Multimodal Communication
Multimodal Communication can be simply referred to as communication through varied modes
such as verbal, written, gestures, etc. There are different modes of multimodal communication

Essential skills for effective communication

a. Listening skills
b. Questioning skills
c. Participatory skills
d. Explaining skills

What is a question?
It is a request for information. The purpose is to:
1.Obtain specific information
2.Diagnose specific difficulties
3.Open interactions (e.g. 'Hello, how may I help you?')
4.Assess knowledge and understanding
5.Help create enlightenment
6.Maintain control of interactions
7.Encourage full participation
8.Show interest and concern (e.g. 'How are you today, sir?')
9. Ascertain attitudes, opinions and feelings (e.g. 'How do you feel about...').

LISTENING AND RESPONSE

LISTENING
Listening is a skill of critical significance in all aspects of our lives, from maintaining our
personal relationships, to getting our jobs done, to taking notes in class, to figuring out which bus
to take to the airport. Regardless of how we’re engaged with listening, it’s important to
understand that listening involves more than just hearing the words that are directed at us.
Listening is an active process by which we make sense of, assess, and respond to what we hear.
The listening process involves five stages:
a. receiving,
b. understanding,
c. evaluating,
d. remembering,
e. responding.
An effective listener must hear and identify the speech sounds directed toward them, understand
the message of those sounds, critically evaluate or assess that message, remember what’s been
said, and respond (either verbally or nonverbally) to information they’ve received.

Active Listening
Active listening is a particular communication technique that requires the listener to provide
feedback on what he or she hears to the speaker, by way of restating or paraphrasing what they
have heard in their own words. The goal of this repetition is to confirm what the listener has
heard and to confirm the understanding of both parties. The ability to actively listen
demonstrates sincerity, and that nothing is being assumed or taken for granted. Active listening is
most often used to improve personal relationships, reduce misunderstanding and conflicts,
strengthen cooperation, and foster understanding.
Active listening can also involve paying attention to the speaker’s behavior and body language.
Having the ability to interpret a person’s body language lets the listener develop a more accurate
understanding of the speaker’s message.
a. The Receiving Stage
The first stage of the listening process is the receiving stage, which involves hearing and
attending.
Hearing is the physiological process of registering sound waves as they hit the eardrum. As
obvious as it may seem, in order to effectively gather information through listening, we must
first be able to physically hear what we’re listening to. The clearer the sound, the easier the
listening process becomes.
Paired with hearing, attending is the other half of the receiving stage in the listening process.
Attending is the process of accurately identifying and interpreting particular sounds we hear as
words. The sounds we hear have no meaning until we give them their meaning in context.
Listening is an active process that constructs meaning from both verbal and nonverbal messages.
The Challenges of Reception
Listeners are often bombarded with a variety of auditory stimuli all at once, so they must
differentiate which of those stimuli are speech sounds and which are not. Effective listening
involves being able to focus on speech sounds while disregarding other noise.

b. The Understanding Stage

The second stage in the listening process is the understanding stage. Understanding or
comprehension occurs when both the speaker and audience share an experience of meaning, and
constitutes the first step in the listening process. This is the stage during which the audience
determines the context and meanings of the words they hear. Determining the context and
meaning of individual words, as well as assigning meaning in language, is essential to
understanding sentences, and, thus, both are essential to understanding a speaker’s message.
Once the listener understands the speaker’s main point, they can begin to sort out the rest of the
information they are hearing and decide where it belongs in their mental outline. For example, a
political candidate listens to her opponent’s arguments to understand what policy decisions that
opponent supports.
Understanding what we hear is a huge part of our everyday lives, particularly in terms of
gathering basic information. In the office, people listen to their superiors for instructions about
what they are to do. But without understanding what we hear, none of this everyday listening
would relay any practical information to us.
One tactic for better understanding a speaker’s meaning is to ask questions. Asking questions
allows the listener to fill in any holes he or she may have in the mental reconstruction of the
speaker’s message.

c. The Evaluating Stage

This stage of the listening process is the one during which the listener assesses the information
they received, both qualitatively and quantitatively. Evaluating allows the listener to form an
opinion of what they heard and, if necessary, to begin developing a response.

During the evaluating stage, the listener determines whether or not the information they heard
and understood from the speaker is well constructed or disorganized, biased or unbiased, true or
false, significant or insignificant. They also ascertain how and why the speaker has come up with
and conveyed the message that they delivered. This process may involve considerations of a
speaker’s personal or professional motivations and goals. For example, a listener may determine
that a co-worker’s vehement condemnation of another for jamming the copier is factually
correct, but may also understand that the co-worker’s child is sick and that may be putting them
on edge. A voter who listens to and understands the points made in a political candidate’s stump
speech can decide whether those points were convincing enough to earn their vote.
The evaluating stage occurs most effectively once the listener fully understands what the speaker
is trying to say. While we can, and sometimes do, form opinions of information and ideas that we
don’t fully understand—or even that we misunderstand—doing so is not often ideal in the long
run. Having a clear understanding of a speaker’s message allows a listener to evaluate that
message without getting bogged down in ambiguities or spending unnecessary time and energy
addressing points that may be tangential or otherwise non-essential.

d. The Remembering Stage

In the listening process, the remembering stage occurs as the audience categorizes and retains the
information they’ve gathered from the speaker for future access. The result—memory—allows
the person to record information about people, objects, and events for later recall. This process
happens both during and after the speaker’s delivery.
Memory is essential throughout the listening process. We depend on our memory to fill in the
blanks when we’re listening and to let us place what we’re hearing at the moment in the context
of what we’ve heard before.
Remembering previous information is critical to moving forward. Similarly, making associations
to past remembered information can help a listener understand what she is currently hearing in a
wider context. In listening to a lecture about the symptoms of depression, for example, a listener
might make a connection to the description of a character in a novel that she read years before.
Using information immediately after receiving it enhances information retention and lessens the
forgetting curve or the rate at which we no longer retain information in our memory. Conversely,
retention is lessened when we engage in mindless listening, and little effort is made to
understand a speaker’s message.

e. The Responding Stage

The responding stage is the stage of the listening process wherein the listener provides verbal
and/or nonverbal reactions based on short- or long-term memory. Following the remembering
stage, a listener can respond to what they hear either verbally or non-verbally. Nonverbal signals
can include gestures such as nodding, making eye contact, tapping a pen, fidgeting, scratching or
cocking their head, smiling, rolling their eyes, grimacing, or any other body language. These
kinds of responses can be displayed purposefully or involuntarily. Responding verbally might
involve asking a question, requesting additional information, redirecting or changing the focus of
a conversation, cutting off a speaker, or repeating what a speaker has said back to her in order to
verify that the received message matches the intended message.
Nonverbal responses like nodding or eye contact allow the listener to communicate their level of
interest without interrupting the speaker, thereby preserving the speaker/listener roles. When a
listener responds verbally to what they hear and remember—for example, with a question or a
comment—the speaker/listener roles are reversed, at least momentarily.
Responding adds action to the listening process, which would otherwise be an outwardly passive
process. Oftentimes, the speaker looks for verbal and nonverbal responses from the listener to
determine if and how their message is being understood and/or considered. Based on the
listener’s responses, the speaker can choose to either adjust or continue with the delivery of her
message.
It is important to use communication skills that convey correct information to patients for
effective pharmacists actions in promotion of health, responding to symptoms and management
of diseases.

PHARMACISTS ACTIONS AND COMMUNICATION WITH PATIENTS

1. Ensuring safe and correct use of medicines
2. Responding to symptoms
3. Discussing patient health-related and social problems that impact on health status
4. Empowering individuals to be active in health promotion and preservation.

PATIENT INTERVIEW
It the primary way of obtaining

MOST IMPORTANT SKILLS AND QUESTIONING TECHNIQUES REQUIRED IN

ORDER TO CONDUCT COMPREHENSIVE PATIENT INTERVIEWINCLUDE
1. Active listening
2. Understanding perception of individual
3. Empathy
4. Rapport building
5. Questioning and listening
i) Open ended questions
ii) Close ended questions
iii) Leading questions
iv)Silence
v) ‘Why’ question
6. Responding and explaining.
7. Non-verbal communication cues and body language

1. Active listening
Listening is the first communication skill to be mastered specifically, active listening. Whereas
listening is a passive process, active listening is a dynamic process which includes hearing what
is being said, as well as processing and interpreting the words spoken (or not spoken) to
understand the complete message delivered. External and internal factors can interfere or disrupt
can

2. Understanding perception of individual

Through the communication process, anticipate different perceptions according to the
individual’s needs (e.g. social problem associated with occurrence of acne may impact
differently on individuals).

3. Empathy
This is the intellectual identification with or vicarious experiencing of feelings, thoughts or
attitudes of others. When you express empathy, it allows your patient feel as though you
understand their unique experiences.
Sympathy: Feeling sorry for the patient
4. Rapport building
First impression matters a lot and it will weigh on the rest of the patients interview and also
affect relationship with the patient. Building a good rapport sets the tone for the interview and
allows the patient to feel comfortable, making the communication more open and honest.
Rapport building:
a. Convey friendliness and warmth
b. Express genuine interest and concern
c. Refer to previous encounters when relevant
d. Provide reassurance
e. Preserve confidentiality

5. Questioning and listening skills

a. Use effective questions by adopting open questions to obtain information that is necessary.
b.Ask only one question at a time.
c. Structure the flow of questions to follow a logical pattern.
d. Use probing questions to follow up patient’s response. Patients may not be aware that certain
information must be known by the pharmacist to suggest appropriate line of action.
f. Encourage patient participation by pausing both after asking a question and after the initial
response.
g. Practise active listening.

i) Open-ended question: Questions that require patients to answer with more than a simple Yes
or No whereas closed ended questions generally limit the patients response to either Yes or No.
Use of close-ended questions should be specific to the information you want to collect.

ii) Leading questions: Questions that suggest a particular answer. These questions lead the
patient to provide a response the patient believes to the answer the interviewer wants to hear.
Leading questions should be avoided when an accurate answer is required.

iii) Silence: Silence is very significant in interactions with patients. It allows the patient to reflect
on the question and provide a thoughtful and accurate response. Silence may also indicate that
the patient has not understood the question. In general, silence should be long enough to provide
the patient a chance to gather their thoughts but not too long to make them feel uncomfortable.

iv). Why question: Why questions should be avoided when interviewing patients. With the
Why questions, patients may feel the need to defend themselves but with the “What” method, the
patient is given the opportunity to reflect on reasons without feeling as though they are being
judged.

6. Responding and explaining skills

a. Place the most important points at the beginning of the communication session.
b. Emphasise key issues.
c. Give specific, concrete instructions.
d. Limit the information to the essentials to prevent cognitive overload.
e. Simplify complicated messages.
7. Non-verbal communication and body language
a. Close conversational distance
b. Direct eye contact
c. Direct body and facial orientation
d. Open, forward leaning posture
e. Smiling and using pleasant facial expressions
f. Voice intonation denoting interest and appropriate speech speed.

The issue of reliability

Reliability of information obtained from patient during interview must be assessed. Factors that
can affect reliability includes: psychiatric conditions, impaired cognitive function, inadequate
memory recall, lack of understanding of the question being asked. To address potential
unreliability, it is important to cross-reference information from a variety of sources.

Barriers to communication
a. Environmental factors such as lack of privacy, lack of space in the pharmacy
b. Time available for pharmacist to dedicate to the patient for listening
c. Patient characteristics such as speech defect, inability to communicate.

Dont’s in communicating with patients

• Don’t ask ‘why’ questions
• Don’t use ‘should’ and ‘ought’
• Don’t blame the patient
• Don’t automatically compare the patient’s experience with your own
• Don’t invalidate the patient’s feelings.

Pharmacist skills needed in communication

In addition to a sound knowledge of drugs and the ability to adopt a comparative approach
between possibilities of treatment, the pharmacist also needs the ability to:
a. explain information clearly and in terms that are understandable to patients of different
backgrounds
b. pose the right questions to patients without putting them off
c. listen to the patient.
d. Counselling in the community pharmacy setting This should be an integral part during
dispensing of medicines.
e. Pharmacists should be visible and accessible for patients to request advice.
Well-informed patients are more likely to use their medications correctly.
h. The intervention of the pharmacist in the provision of advice on medicines improves medicine
safety