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The Expression of Professionalism in the Pharmacy Industry

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There are several different definition of professionalism have been mentioned in Hammer’s paper. Those definitions by Beardsley, Merriam-Webster and Chalmers all focused on “attitudes” and “behaviours”. Professionalism of an occupant includes, demonstration of values of the profession through exhibiting attitude and behaviours, which might be regulated by members of the profession which was suggested in a literature[5]. These values might include; respect towards others, treat everyone equally, speaking in appropriate ways, etc. All these elements of professionalism have to be maintained by the professionals who are entitled to carry out the duties. The personnel are expected to put the clients’ best interests before anyone else’s personal interest from the organization. Every personnel should respect each other within the organization as well as others in the same field of professions while working together as a team.

However, the attitudes of individuals are difficult to regulate. Behviours of individuals could reflect the attitude; therefore the authorities can regulate the behaviours as an approximate impression of attitudes. This is how professionalism can be maintained as whole the professionals.

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Professionalism in pharmacy

As a first line healthcare profession having high expectation from the public, pharmacy needed to be trustworthy and respected by the public as well as by other healthcare professionals. Hammer has mentioned this is due to the public perception that pharmacists are here to promote health as well as improving health and the rising of concern about personal health has brought the public attention to healthcare professionals and even led to pharmacist sometimes being challenged as mentioned in Hibbert’s paper. Pharmacy, which is the most accessible healthcare profession to the public, has become the closest healthcare profession that public. To maintain the trust and respect, there are values, behaviours, beliefs, skills, attitudes and knowledge for pharmacists to be adhered to, and these aspects together make up professionalism in pharmacy. Hammer has addressed that is important in improving student professionalism.

Pharmacists should exhibit these aspects of professionalism continuously during their practices. These include, communication skills, pharmaceutical knowledge, respect patients, the public & other healthcare professionals, keeping confidentiality of patients’ records, treat every individual equally, being polite towards the public, patients and other healthcare professionals. These are only examples of what are considered to be important inputs from every pharmacist in the profession.

Pharmacy is in connection with many other healthcare professions as well as interacting with closely to the public. In order to fulfill their duties, pharmacists are very much depended on their communication skill that is equally crucial to their pharmacy related knowledge.

Communication in pharmacy

Pharmacists have a role to have interaction with the public (patients, customers in community pharmacies) and other health care professionals (dispensers, technicians, doctors, other specialists). These interactions often include communication skills regarding medical subjects that are related to pharmacy. Communication skills include listening attentively, explaining clearly, non-verbal body gestures and some more diverse skills highlighted in Hargie’s paper.

Communication in community pharmacy

The importance of “interpersonal communication skills” is stated in the beginning of McDonough’s paper [10], that effective skills of communication is crucial for community pharmacists to introduce patients the knowledge of medication use and through counseling, pharmacists can improve the compliance of patient. These together would maximize the effectiveness of the drug therapy.

In community settings, pharmacists has direct interaction with the public, not only to hand them the medications that they are prescribed for, but counseling them about the use of the medications and potential issues may arise related to the drugs are more important roles of pharmacists. Some pharmacies provide services where the pharmacists make simple diagnosis though consultations and supply the patients with over-the-counter medicine or certain prescription-only medications. During a consultation, communicating with the patient require confidentiality depending on the patients’ request if there is a need of using the consultation room. Fulfilling professionalism, the pharmacist should show full respect to the patient by listening carefully, which is a type of skill in communication. Applying sufficient knowledge as well as providing all the options, which would help along side and assist the patient to make a decision about the treatment options. Skills include, making good eye contact to show interest in the patient; using appropriate interviewing technique etc. There are more communication skills discussed further on in this research including some mapped out in Hargie’s.

Working as a team with the pharmacy health assistants, technicians and dispensers, communication skills are needed to ensure accurate, time-efficient services are delivered. These interactions, might include passing on unfinished work of one to another, such as a half dispensed prescription; referring a patient’s to the pharmacist for further counseling or decision on treatment etc. In a business and healthcare point of view, accuracy and time-efficiency are the common goals of community pharmacies. This is because as an accurate service gain confident and trust in the service of the pharmacy from the customers. Balance between accuracy and time-efficient is important, as suggested by Szeinbach’s tasks finished during a limited period of time in community pharmacies possibility of errors would increase. Therefore, in community pharmacies, the pharmacist as well as the staff is required to have accomplished communication ability.

Communication in hospital pharmacy

According to Guchelaar’s paper, pharmacists has the role to monitor the whole process of drug therapy “from prescribing from prescribing, drug choice, dispensing and preparation to the administration of drugs”[. This is to ensure patient safety.

Antibiotic prescribing is the area where doctors in hospitals need advised, since there are resistances emerging from certain microorganisms such as clostridium difficile. The morbidity rates of hospital-acquired infectious disease are high due to inappropriate prescribing of antibiotics. The problem mentioned Ramsay’s paper and Davey’s paper. One of the methods of prevention suggested by Davey was to restrict the prescribing unless having authorized by pharmacists. This indicates pharmacists would have a role to consult doctors regarding antibiotic prescribing.

Advising nurses in administrating medications into patients, warn them about side effects, pharmacists need to have communication skills that would bring across the messages clearly. That is to indirectly ensure patients’ safety as suggested in Anacleto’s paper that side effects, drug adverse effect could lead to harmful consequences. Pharmacists have direct contact with patients, for example, during a medicine reconciliation; the pharmacist collects information about the patient’s medications for completing a drug history and counseling about current medication of the patient. That helps to monitor the progress of the drug therapy and assessing the appropriateness of the medication use. The positive effect on counseling patient is been heavily studied according to De Young. These studies have found that patient adherence and educating about medication improved due to “time and attention” giving to patients by pharmacists. Pharmacists is required to communicate with the other hospital staff via the written communication in patient’s medical records, phones or face-to-face discussion avoid “medication errors” due to lack of communication. At the outpatient pharmacy, pharmacists have to make sure there is a notes regarding any changes in the medication therapy of the patient comparing to the therapy before the admission to the hospital. The note is for the local GP to follow-up with the patient once discharged from the hospital. This ensures compliance after the patient discharged from the hospital as suggested in Cochrane’paper.

Pharmacy is in connection with many other healthcare professions as well as interacting with closely to the public. In order to fulfill their duties, pharmacists are very much depended on their communication skill that is equally crucial to their pharmacy related knowledge. However, there are obstacles in many different forms and ways would distort or completely block communication. Some are mapped out in three categorized factors in Paluck’ s paper. These appear as barriers of communication in many aspects in daily lives. Identifying barriers and trying to avoid them would improve communication, which eventually lead to better services provided from healthcare professionals.

Barriers in communications in general

Hargie’s paper has shown that problems arise from communication in healthcare professions and especially in pharmacy need more practical researches to assess the skills in communication of pharmacist in community pharmacy. This leads to the focus of this research by identifying the barriers thus to improve the communication skills in current pharmacy students which are the future pharmacists.

In a general terminology, communication barriers are problems in any aspects related to communications. There are many diverse types of barriers involving different form of communication with more new communication technology has arise over the years, it is difficult to put them into a globalized categories mentioned in Button’s literature review. In this research, the focus is on barriers related to “interpersonal communication” as this is regarded as by McDonough an important aspect for pharmacist as well as pharmacist students to “master”.

Communication barriers in community pharmacy

Communication barriers in community pharmacy usually involved with the environment, pharmacists, patients, administration and time, which was mentioned in the book according to Chapter 4, in Beardsley’s book[20],

There are barriers in pharmacy practice that are easily noticeable and some might be easily missed. The way to overcome this is once a communication barrier is detected, a method should be established to avoid or at least minimize the problem in the future. This is part of the aim of this research, to explore what students think communication barriers are, because their ability to identify these barriers and to overcome these barrier will be crucial skills that will be needed in the future career in order to provide accomplished pharmacy services.

Communication barriers in hospital pharmacy

In hospital pharmacy, the problems could be resulted from communication errors due to many reasons. In general, the lack of communication between the doctors and the pharmacists or between nurses and pharmacist, could lead to variable information given to the same patient regarding the same subject (e.g. dose regimen). This could cause misunderstanding in the patient. As documented in Tice’s paper regarding antibiotic use[21]and Cochrane’s paper[17], a typical and serious of problem could occur in newly discharged patients. There could be not enough information given form the hospital doctors to the GP and the community pharmacist who are responsible for the patient’s medication after discharge. The changes in the drug therapy for the patient lead to miss doses or wrong strength given, if there is a misunderstanding or insufficient information passed through to the community pharmacy and GP. This can also be seen in elderly patients who stay in a residence home. The carers need sufficient details in the medication regimen of patients who are recently discharged. The communication between the hospital pharmacist and the residence home carers are needed to avoid any error occurring related to the medication therapy of the patient. [17]

Communication barriers sometimes do not purely occur naturally. There might be underlying factors affecting or causing the broken down of the communication, such as diversity in society.

Diversity

A definition of diversity in Merriam-Webster online dictionary[22] is “the condition of having or being composed of differing elements” and “the inclusion of different types of people”. In terms of human diversity, there are differences in every individuals and often and some would automatically relate this term to disability as reported in Molloy’s paper[23]. This might be due some attention is directed towards the disability population in our society. However, there are more types of diversity in the society, age, gender, sexuality and social class. Diversities are affecting everyone’s choices, attitude and other aspects in daily lives with or without ones noticing.

Sometimes, they are visible and easily noticeable. Sometimes they are not. Visible types of diversity are obvious. e.g. age; non-visible might require interaction with individual to be identified e.g. sexuality. The term “diversity” often associated with “equality” as literatures has documented [24, 25], to educate the public to treat people from different background equally. By identifying different types of diversity, the discrimination against certain population can be avoided. In this research, there are more types of diversity being identified by students.

Diversity in health care

In the profession of health care, the personnel are facing the general public, which include all types of population in diversity, especially, the population with medical conditions who receive treatment from the healthcare services. As population is becoming older suggested in Wise’s ‘Demography’[26], due to advance medical technology, people are living longer lives, there are a growing population with medical conditions, which require a more long-lasting healthcare services to contend with the public health. Age diversity is and will be one of the major diversity in society encountered by the healthcare professionals. Other diversity types are equally important to be identified, as the population of diversity will be larger in the future as commented in Haack’s paper[27]. The paper also stressed that pharmacist should consider different characteristics in different diversity types. Personnel diversity should also be taken into account. The health care personnel might have different personal views or cultural beliefs that would affect the decision-making or attitude towards certain individual which would affect the decision-making of drug therapist as mentioned in Haack’s paper[27]. However, to keep professionalism, the personnel need to follow the standardized procedures or regulations that is set by the authority and hinder their own beliefs. This is a very arguable subject that might depend on individual cases. A classic example is; some pharmacists, whose religion is against abortion, might be asked to supply emergency hormonal contraceptive medications. Straightly speaking, personnel should treat anyone with the same manner including patients, customers, other healthcare professional and colleagues as commented in both Assemi’s [28]and Brown’s paper[29] regarding the cultural diversity in the society.

How diversity leads to barriers in communication.

As mentioned above, diversity could affect one’s attitude. And this could lead to an effect in communication. In pharmacy as well as some health care professions, communication is a crucial skill enabling them to carry out their main duties. In community pharmacy, the pharmacists and their staff could encounter any type of patient diversity. The patient diversity would affect the staff and eventually the pharmacists’ attitude towards the case, which could lead to a contradiction to professionalism.

It is believed that identifying these communication barriers resulting from diversity, can improve pharmacy service. As mentioned before in chapter 4 of Beardsley’s book[20], once barriers are identified, methods can be derived to solve the problem. The communication can to an mutual agreement thus facilitate better pharmacy services provided.

Students and professionalism

Maintaining the high expectation of the general public about pharmacy, current pharmacy students will need to prepare for the future when there will even be more attention drawn towards professionalism in pharmacy in the later years along with the evolution of the society highlighted in the beginning of Hammer’s paper.

In schools and universities, there is certain amount of professionalism education provided to students. However, most of the knowledge would only be taught in theory. There might be a problem when applying the knowledge of professionalism into practice by the students who have none at all or very slight experience in working in pharmacies. It is not certain that whether or not the students could fully understand professionalism from theory taught in schools and university. It has been commented that in Thomas’ paper[30], there might be a difference between experiencing professionalism in practice and being taught in theory, so a continuous learning since university should be achieved by pharmacy students. This is a direction of where this research is being led.

In this research, students are asked to comments on different aspects of professionalism. From the comments, the understandings as well as experiences of students are being explored. As mentioned above, the population is becoming older, the future pharmacists are the current pharmacy students, who will be facing and providing health services to the general public, so the students’ awareness on professionalism is crucial to be assessed. ‘Student professionalism’ by Hammar has suggested that more skills is required from future pharmacy due to the lack of manpower in the professions and increased focus on patient safety. She has shown there is a urge in educating pharmacy students about profionlism. Another paper of hers has assessed “behavioral professionalism of pharmacy students”. These have shown that importance of developing professionalism in pharmacy. These literatures had looked into professionalism broadly. That leads to this research being more focus on specific attribute in professionalism viewed by students. The research was initiated by Hall’s research which was carried out to identify aspects in professionalism which are thought to be important to pharmacy students. The study was views of pharmacists and there were 24 attributes thought to be important. This research is a further research from Hall’s research[33] of professionalism in pharmacy with focus on specific attributes which are targeting to point of views in pharmacy students.

These lead to the aim and objectives of this research: –

Aim : To explore students’ understandings on communication related to diversity

Objectives :

Identifying the range of communication barriers.

Describing the relationship between diversity to communication barriers.

Map out methods of how students from 4years overcoming communication barrier realted to diversity

Compare communication barriers that students have identified from students of all 4 years.

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