Finale: ‘To be a pilgrim’

As a hopeful graduate entering into the Pharmacy world, everything is exciting yet daunting to me. Four years of university education has provided me with fundamental knowledge to practise and this is indeed a strength worth highlighting in all healthcare professionals: we are experts in our fields and we are very good at providing information support to our patients. However, we are not as good as picking up cues in accommodating patients’ emotional needs in health. By studying Health Psychology I found the ‘human’ in me again, just as I was studying literature and arts in school. I found satisfaction in discovering a hidden strength of empathy in me and I felt empowered to have an extended knowledge of human behaviours. Working in a world of deprived resources (healthcare being one of the major fields) it is so easy to lose the patience to listen. Talking ‘patient-centred care’ is all very well but having the scientific evidence to support the benefits can reinforce the importance and responsibilities in seeing patients as people, not just a piece of case study. 

I’d like to liken the journey to become a pharmacist to a pilgrimage. It is indeed a long journey to embark on and daunting as it is I am equipped to face the working world. The journey itself is as important as the destination, as I am now able to have self-dialogues in order to think and reflect on the way.

Week 30: Part 2 Stress

Learning about stress was somewhat very timely for us during this stressful period of revision. The three models of stress all had their strengths and weaknesses in describing stress, as stress is down to one’s perceptions (another link to health perceptions!).

I feel as budding pharmacists we are taught in a way that pharmacological intervention is the first instinct in our consideration of potential treatments, partly influenced by the fast technologies we enjoy in the day and age when we want an instant ‘fix’ for everything. 

I was interested to look at in the current non-pharmacological interventions available to help with stress. I looked at the MOODJUICE self-help leaflet and compared to the two mediation apps Headspace and Smiling Mind. I wondered if we can corporate these into community pharmacy setting to other parts of promoting public health too. As more and more people are using devices and apps like Fitbit to monitor their physical fitness, there is a potential to apply this in terms of mental health as well. In fact Headspace also markets itself the ‘gym for your brain’. There is a good potential for raising awareness of looking after one’s mental health and there has already been some successes in similar apps like the Change4Life ‘Couch to 5K running’ app. Community pharmacies are local health advice hubs are in a good place to recommend these relatively low-cost non-pharmacological interventions. There is limited evidence in the overall efficacy of these apps but community pharmacies could still contribute by acting as hubs to run clinical trials on these apps.

Week 30: Part 1 Positive Psychology & Resilience

Positive psychology focuses on analysing the ‘goods’ of the human nature and what brings long-lasting satisfaction, which is a step forward from the perception of ‘pathogenic’ psychology of the public. Whilst many faiths and religions have tackled this question for thousands of years, positive psychology makes a scientific scope of the picture and surprising (or unsurprisingly), many of the findings echoed with religious teachings such as ‘love one another’ and ‘be a good Samaritan’.

We researched some of the positive psychology interventions: Letter of thanks, Random Acts of Kindness (RAK) and Mindfulness. We agreed as pharmacists that we do have a role to play in promoting mental wellbeing. However, some interventions are perhaps more appropriate to encourage whilst in a caring role than others. I have previously participated in a Mindfulness course in school and saw it was a good technique to help anxious people such as myself. I have seen leaflets of Mindfulness classes in my hometown and I would definitely consider putting these leaflets in my pharmacy when I manage one in the future. Letter of thanks and RAK might seem a little awkward to be reinforced by pharmacists and it is partly due to the cultural barriers. I think us Britons are more subtle than our siblings across the atlantics and this is something to be mindful of when we design local interventions to promote mental wellbeing in this country.

Week 29: Social support and Stigma

This week we looked at the evidence supporting the benefit of social support and there is an overwhelming amount of evidence to social support. Relating to the talk given by the Psychiatry Pharmacist from clinical unit, I have been reflecting upon the ‘bucket model of stress- vulnerability’ by Brabben and Turkington. They described the bucket as the mental health state of anyone with a baseline amount of vulnerability by genetic and developmental factors that could predispose the individual to a higher baseline. Stressors can be added (e.g. financial difficulties) and managed in order to reduce the level in the bucket. When the bucket overflows it signifies the person is having an acute mental crisis. Social support can definitely form a part of the management of the stressors.

I felt from my experience that healthcare professionals are very much focused on the informational support, but do we accommodate the emotional needs of the patient other than the pharmacological interventions? We should also provide esteem support. I witnessed the effect this has on Rachel the pharmacist in my summer placement. Having spoken to some of the patients they all said she was a ‘good’ pharmacist because she was always very cheerful, showed her genuine interests to patients and acted on them effectively. Patients were honest with her when they did not adhere to their medications e.g. a gentleman came in and enquired about a tablet cutter because his dexterity had been reduced recently. Rachel immediately acknowledged and emphasised with him, then ordered some tablet cutters for him in the afternoon delivery. I look up to her example and am hopeful that to become a pharmacist who always cares for my patients emotionally. Perhaps the best quote I remember from her was ‘Would you treat your patients as you treat your grandparents?’

 

Week 24: Designing behaviour change interventions

This week we looked into the five different strategies of health promotion and how behaviour science theories have been shown to have a positive impact in health interventions. Having the theory side under our belt, we began to follow the process of designing a behaviour change intervention. In the two hour workshop, I have learnt that I could draw parallel between designing a behaviour change intervention, making a lesson plan as a tutor, designing a marketing scheme for a new product etc. Their successes are all very much to the specificity of the target audience and behaviour, as well as identifying the change needed. This is a process of mapping the COM-B model into intervention and policies. 

Although some of us may argue that pharmacists are unlikely to design behaviour change interventions on their own, it is likely that the increasing involvement of pharmacists in primary care such as non-medical prescribers in GP surgeries and local Clinical Commissioning Groups (CCGs) or even in the six public health interventions per year imposed in the current Community Pharmacy Contractual Framework. I believe the actual evaluation process of considering all the factors that could contribute to a successful intervention is transferrable and applicable in many future roles of pharmacists in primary care. However I do believe a successful design and evaluation of a behaviour change intervention requires a multi-disciplinary approach, drawing expertise from clinicians of different specialities and pharmacists’ input in their expert of medicines can make them a valued member in the team. I am looking forward to applying this planning and evaluation approach in my future role as a community pharmacist.