1. Difficult Conversations
NHS Grampian Network of Community Pharmacist Training Day
14th November 2018
Dr Claire McCullough
ST5 Palliative Medicine
Clinical Lecturer (Scholarship)

2. Aim
Explore approaches to ‘difficult conversations’ faced in community pharmacy

3. Objectives Describe the 3 circle model of communication
List key communication skills
Describe model for reflective practice
Discuss ‘difficult conversations’ faced in community pharmacy
Just in case box
Distressed
Bereavement
Evaluate impact on well being when working with loss, grief + bereavement

6. Consider a conversation…

7. What makes conversations difficult?

8. The Three Circle Model Soothing System Drive System Threat System
Connection Focused
Content, Connected,
Kindness, Safety
Soothing
Drive System
Incentive Focused
Wanting, Pursuing, Achieving
Activating
Threat System
Threat Focused
Protective, Defensive,
Safety –Seeking
Activating/Inhibiting
Emotional responses are strong.
Those associated with threat are FEAR + ANGER

9. Key Communication Skills
Soothing System
Active Listening
Reflection
Clarification
Using Silence
Empathising
Educated guesses
Summarising
Drive + Soothing System
Agenda setting
Time setting
Information sharing
Negotiating

10. Reflective Practice Experience + Reflection = Learning
How do you think the other person might have felt?
Any communication skills you used well?
Any communication skills you would like to improve?

11. Scenarios | Small Group Work

12. Just in case box Friday afternoon John metastatic colorectal cancer
Son comes into pharmacy to collect a regular repeat prescription for him
There is also a prescription for a ‘just in case box’
What are your concerns?
How would you proceed?

13. Distressed relative
June has come to collect a prescription for her partner, Paul.
They had an appointment earlier this week and were informed that his condition is now terminal.
She is clearly upset and starts crying
What are your concerns?
How would you proceed?

14. Bereavement
Samira’s father died last week, but you are not aware. She has been collecting his medicines for many weeks now.
She has come to the pharmacy to return his remaining medications.
‘I’ve just come to hand in dad’s medications’.
What are your concerns?
How do you respond?

15. Bereavement | Strategies
‘What most people want is for those around them to listen to and acknowledge their loss.’
Macmillan cancer support + National Bereavement Alliance
Acknowledge the person’s loss + offer sympathy
Mirror words and phrases used
Think about your own needs

16. Video | NHS Education Scotland
mins

17. Working with loss, grief + bereavement

18. Care of Self Physical, emotional, social and spiritual health
Recognising signs of stress
Work – Life Balance
Recognising bad habits
Always working late/starting early
Not taking regular breaks
Not taking annual leave
Worrying about work when not at work

19. Well being at work What kinds of support do you get at work?
What does your team do to support one another?
What are the things outside of work that help you feel healthy and well?
What kinds of support work well for you?

20. Questions?

21. Objectives Describe the 3 circle model of communication
List key communication skills
Describe model for reflective practice
Discuss ‘difficult conversations’ faced in community pharmacy
Just in case box
Distressed
Bereavement
Evaluate impact on well being when working with loss, grief + bereavement

22. References Support Around Death | http://www.sad.scot.nhs.uk
Turas Learn | Palliative + End of Life Care: Enriching + Improving Experience Framework
experience/palliative-and-end-of-life-care-enriching-and-improving-experience
Gibb’s Reflective Cycle