Principle and Element of Inrerpersonal Communication

Communication skills

Second year
Lec.3&4

Principles and Elements of Interpersonal Communication

The interpersonal communication model reveals that you must recognize that this type of communication is more than merely speaking to others, offering a printed prescription label, or affixing an auxiliary label to a prescription. You must make sure that the messages you transmit to others are received accurately.

Case Study 2.1.

Mr. .Ali, a 59-year-old man with moderate hypertension, enters your pharmacy. He comes to pick up a new prescriptionan antibiotic for a urinary tract infection. The doctor called in a new prescription for me, and can I also have a refill of my heart medication?

Components of the Interpersonal Communication Model

focus on one-to one interpersonal communication that occurs in pharmacy practice, in which the interaction occur between two individuals .
This specific form of communication (interpersonal communication) is best described as a process in which messages are generated and transmitted by one person and subsequently received and translated by another.

A practical model of this process is shown in Figure 2.1. The model includes five important elements:
sender,
message,
receiver,
feedback,
barriers.

Figure 2-1 The interpersonal communication

1.The Sender
In the interpersonal communication process, the sender transmits a message to another person. In the example described above, the initial sender of a message
was Mr. Ali : The doctor called in a new prescription for me, and can I also have a refill of my heart medication?

2.The Message

In interpersonal communication, the message is the element that is transmitted from one person to another.
Messages can be thoughts, ideas, emotions, information,
or other factors and can be transmitted both verbally (by talking) and nonverbally (by using facial expressions, hand gestures, and so on).

3.The Receiver

The receiver (you in the above example) receives the message from the sender (Mr. Ali). As the receiver, you decode the message and assign a particular meaning to it, which may or may not be Mr. Ali intended meaning. In receiving and translating the message, you probably considered both the verbal and nonverbal components of the message.

4.Feedback

Feedback is the process whereby receivers communicate back to senders their understanding of the senders message.
In most situations, receivers respond to them with their own verbal and nonverbal messages.
In the feedback loop, the initial receiver becomes the sender of feedback, and the initial sender becomes the receiver of feedback, as noted in the model.
Feedback can be simple, such as merely nodding your head, or more complex, such as repeating a set of complicated instructions to make sure that you interpreted them correctly.


In any interpersonal communication situation, individuals at any point in time are simultaneously sending and receiving messages.

The communication is transactional and the interaction includes both verbal and nonverbal messages.

5.Barriers

Interpersonal communication is usually affected by a number of interferences or barriers. These barriers affect the accuracy of the communication exchange.

Personal Responsibilities in the Communication Model

As a sender, you are responsible for ensuring that the message is transmitted
in the clearest form,
in terminology understood by the other person, and
in an environment conducive to clear transmission.
To check whether the message was received as intended, you need to ask for feedback from the receiver and clarify any misunderstandings.

. As a receiver, you have the responsibility

of listening to what is being transmitted by the sender.
To ensure accurate communication, you should provide feedback to the sender by describing what you understood the message to be.
However, practice has found that without appropriate feedback, misunderstandings occur, these misunderstandings might result in harm to the patient.
Research has found that when pharmacists communicate effectively with patients, patient outcomes improve


Words&Their Context

In general, individuals assign meaning to verbal and nonverbal messages based on their past experiences and previous definitions of these verbal and nonverbal elements.
The most common example of this is evident in different languages and dialects of the world. Different words mean different things to different people based on the definitions learned.
Example , let us assume that you wish to inform Mr. Ali that his urinary tract antibiotic will be more effective if taken with sufficient fluid to guarantee adequate urinary output.
, This medication should be taken with plenty of fluids. The message is received and decoded into words and symbols in the mind of Mr. Ali
Another important factor is that people assign meanings based on the context that they perceive the sender is using.
The following actual situation illustrates this point.
Case 2.2
A 9-month-old baby is admitted to the hospital with a severe infection. The pharmacist spoke with the mother upon admission and learned that about 1 week ago her son had developed a minor bacterial infection and received an antibiotic, which she gave him for 4 days until the infection appeared to be cleared up. When asked why she stopped the antibiotic, the mother stated that she was just following the directions on the prescription label: Take one-half teaspoonful three times a day for infection until all gone. The mother stated that she gave the medication until the infection was all gone. Unfortunately, the intended message was that the antibiotic should be given until the liquid was all gone (which would have been about 14 dayslong enough to treat the bacterial infection).

Congruence between verbal &non-verbal messages

The meaning of the message may be somewhat unclear if the receiver senses incongruence between the verbal and nonverbal messages. That is, the meaning of a verbal message is not consistent with the meaning of a nonverbal message.
. To avoid this incongruence,
as a sender, you must be aware of the nonverbal messages as well as the verbal messages.
As a receiver, you must point out to the sender that you are receiving two different messages.
Examples of Incongruent Messages
people base their interpretation of verbal and nonverbal messages on a variety of factors.
1.their definitions and perceptions of the words, symbols,
2.and nonverbal elements used by the sender.


Preventing Misunderstanding

In the previous situation involving the babys antibiotic prescription, the label read, Take one-half teaspoonful three times a day for infection until all gone.
Unfortunately, the mother interpreted the message incorrectly. In this situation, the meaning could be clarified relatively easily by rearranging the position of the last two prepositional phrases (. . . three times a day until all medication is finished for infection) or rearranging the wording
(. . . until the medication is all gone).
To improve the communication process, we must remember that people assign meanings to messages based on their background, values, and experiences.
Typically, we can anticipate patients feelings and their understanding about the use of drugs. Thus, a person placed on a medication for the first time has a different perception than a person who has taken the medication for several years; a person of a different gender, age, or race may have experiences different from ours.

A key to preventing misunderstanding is anticipating how other people may translate your message. It may be helpful to determine their experience with drugs in general and with a particular drug specifically.

Using Feedback to Check The Meanig of The Message

Using a feedback to check the meaning of the message) may alleviate some communication misunderstandings.
As senders of messages, we should ask others to share their interpretation of the message. In the example of the antibiotic, the original pharmacist should have asked the mother in a nonthreatening manner, When you get home, how long are you going to give the medication to your son? Thus, her initial perception could have been corrected, and the problem could have been avoided.

case study 2.3

A patient being seen in an anticoagulation clinic mentioned to the pharmacist that he had developed several bruises on his hands and legs. The pharmacist immediately checked the patients computer records and found a recent INR value of 6,which was well above his targeted 23 range. The pharmacist asked whether the patient had changed his diet, lifestyle, or drug regimen. The patient said no, but that he was given another medication during his last clinic visit. The pharmacist
then went back to the profile and noticed that the patient had been receiving 4 mg daily Coumadin for some time, but his dose was reduced to 3 mg during the last visit to adjust his INR. The pharmacist suspected what the issue might be and asked the patient, Did you stop taking the 4 mg tablet? The patient replied, No, nobody told me to, so I have been following instructions and taking both tablets!!
Thus, he was taking 7 mg per day rather than the intended 3 mg.
Unfortunately, relying on our intuition is not as effective as obtaining explicit feedback to measure understanding.
. It is particularly important for pharmacists to provide feedback by summarizing the information they have received from patients in the course of interviews conducted or assessments made related to their drug therapy.


Importance of Perception in Communication

Perception is important in the process of interpersonal communication because we tend to interpret messages based on our perception of
1) what we believe the message says and
2) the individual sending the message.
We need to recognize how fragile the communication process is during professional communication and to value the use of feedback to enhance our ability to verify the true meaning of messages.
the receivers perception of the words, symbols, and nonverbal elements used by the sender influences how the receiver interprets the meaning.

Case study 2.4,

A patient returned to the pharmacy complaining of side effects apparently caused by his medication. The patients records indicated he was given 30 nitroglycerin patches. Both the pharmacist and the physician told him to apply one daily. The patient opened his shirt to reveal 27 nitroglycerin patches firmly adhered to his chest!!

In case study 2.4, the patient perceived the phrase apply one daily to be absolute, so he applied one each day (but did not perceive the implied message that he should remove one). He followed his perception of the instructions.
Unfortunately, no one asked him how he was going to use the patches (in other words, did not ask for feedback on his perception of the instructions).
If the pharmacist had verified the patients understanding, the patient would have been avoid the resulting embarrassment and possible side effects.

case study 2.5.

A young woman suffering from vaginal candidiasis was given the usual 15 nystatin vaginal tablets and was told by the pharmacist to use one tablet daily for two weeks. She returned to the pharmacy after two weeks in severe discomfort with a complaint that those nystatin tablets taste terrible!

In case study 2.5, the patient assigned the wrong meaning to the word use and used the medication by wrong way --taking them orally.
People of different backgrounds, values, and experiences may assign meanings to messages that are different from those intended by the sender.
One skill that minimizes perceptual differences is to use terms and concepts that are familiar to the patient. It is very easy for patients to misunderstand when you use medical terminology or language that is overly abstract, such as drink a lot of fluid. What does a lot mean to the patient? A glass? A cup? Broad, nonspecific directions do not really help patients understand what you want to communicate.
Another example might be, instead of asking patients whether they
hurt a lot, you should ask them, describe your pain on a scale of zero to 10 with
zero being no pain and 10 being the worst pain imaginable.


Perception of Individuals
Our perception of the message is also influenced by our perception of the individual sending the message .
. We respond using our perception of that individual as our reference point because we tend to be influenced by a persons cultural background, status, gender, or age.
The following statements illustrate this point:
People who are mentally ill do not comply with their medication regimens.
Elderly people cant hear well and always talk too much.
People who talk slow are lazy.
Women with red hair have a temper.
People who are overweight are jolly.

. We need to evaluate when our perception of the sender is incorrect or when our assumptions might be interfering with our ability to communicate with others& to check our assumptions before proceeding. Does the elderly person really have a hearing deficiency? Does the person who talks slowly have a learning disability?
. Patient perceptions are influenced by their past experiences with pharmacists, physicians, and other health care providers do not perceive us as professionals, they will not value the information we provide.

Sharing The Same Perceptions

One key to preventing misunderstanding is to try to understand and share the perceptions of other individuals).
Many times, using lay language, which is familiar to patients, rather than medical terminology, which is familiar only to health care professionals, can enhance understanding.
Determining the patients past experience with medications or with the particular drugs prescribed may also be helpful.

Using Feedback To Verify Perceptions

The best technique to alleviate harmful misperceptions is using feedback to verify the perceived meaning of a message.
As senders of messages, we should ask others to share their interpretations of the message. In the above nitroglycerin example, the pharmacist should have asked the patient in a nonthreatening manner how he was going to use the patches.
The receiver can also alleviate some misunderstanding by offering feedback to the sender. After receiving the message, receivers should summarize the key elements of the message.