UNIT I - HEALTH CARE PROCESS

Pharmacists' Patient Care Process

The goal of high quality, cost-effective and accessible health care for patients is achieved
through team-based patient-centered care. Pharmacists are essential members of the health
care team.

The profession of pharmacy is continuing its evolution from a principal focus on medication
product distribution to expanded clinically-oriented patient care services. As a result of this
professional evolution, the importance of, and need for, a consistent process of care in the
delivery of patient care services have been increasingly recognized by the profession at
large.

Pharmacists have unique training and expertise in the appropriate use of medications and
provide a wide array of patient care services in many different practice settings. These
services reduce adverse drug events, improve patient safety, and optimise medication use
and health outcomes.

Pharmacists contribute to improving patients' health by providing patient care services as

authorized under their scope of practice and facilitated by collaborative practice agreements.

The foundation for the pharmacist's patient care process is embedded within the
pharmaceutical care model developed by Hepler and Strand in the 1990s. However, there is
variability in how this process is taught and practiced. To promote consistency across the
profession, national pharmacy associations used a consensus-based approach to articulate
the patient care process for pharmacists to use as a framework for delivering patient care in
any practice setting.

The pharmacists' patient care process described in this document was developed by
examining a number of key source documents on pharmaceutical care and medication
therapy management.

Patient care process components in each of these resources were catalogued and
compared to create the following process that encompasses
a contemporary and
comprehensive approach to patient-centered care that is delivered in collaboration with other
members of the health care team.

PHARMACISTS' PATIENT CARE PROCESS

Pharmacists use a patient-centered approach in collaboration with other providers on the
health care team to optimise patient Health and medication outcomes An Essential first step
is the establishment of a patient-pharmacist relationship that supports engagement and
effective communication with patients, families, and caregivers throughout the process. In
addition, at the core of the process, pharmacists continually collaborate, document, and
communicate with physicians, other pharmacists, and other health care professionals in the
provision of safe, effective, and coordinated care. This process is enhanced through the use
of interoperable information technology systems that facilitate efficient and effective
communication among all individuals involved in patient care. (Figure 1).
Pharmacists' Patient Care Process
Pharmacists use a patient-centered approach in collaboration with other providers on the
health care team to optimize patient health and medication outcomes.

Using principles of evidence-based practice, pharmacists:

A. Collect
The pharmacist assures the collection of necessary subjective and objective information
about the patient in order to understand the relevant medical/medication history and clinical
status of the patient.

Information may be gathered and verified from multiple sources including existing patient
records, the patient, and the health care professionals.

This process includes collecting:

• A current medication list and medication use history for prescription and nonprescription
medications, herbal products, and other dietary supplements
• Relevant health data that may include medical history, health and wellness information,
biometric test results, and physical assessment findings

• Patient lifestyle habits, preferences and beliefs, health and functional goals, and
socioeconomic factors that affect access to medications and other aspects of care

B. Assess
The pharmacist assesses the information collected and analyzes the clinical effects of the
patient's therapy in the context of the patient's overall health goals in order to identify and
prioritize problems and achieve optimal care. This process includes assessing:
• Each medication for appropriateness, effer veness, safety, and patient adherence

• Health and functional status, risk factors, health data, cultural factors, health literacy, and
access to medications or other aspects of care
• Immunization status and the need for preventive care and other health care services,
where appropriate.

C. Plan
The pharmacist develops an individualized patient-centered care plan, in ccollaboration with
other health care professionals and the patient or caregiver that is evidence-based and
cost-effective.

This process includes establishing a care plan that:

• Addresses medication-related problems and optimizes medication therapy
• Sets goals of therapy for achieving clinical outcomes in the context of the patient's overall
health care goals and access to care
• Engages the patient through education, empowerment, and self-management
• Supports care continuity, including follow-up and transitions of care as appropriate
D. Implement
The pharmacist implements the care plan in collaboration with other health care
professionals and the patient or caregiver.
• Addresses medication and heatheated problems and engages in preventive care.
strategies, including vaccine administration
• Initiates, modifies, discontinues, or administers medication therapy as authorized
• Provides education and self-management training to the patient or caregiver

• Contributes to coordination of care, including the referral or transition of the patient to

another health care professional
• Schedules follow-up care as needed to achieve goals of therapy

E. Follow-up: Monitor and Evaluate

The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the
plan in collaboration with other health care professionals and the patient or caregiver as
needed.
This process includes the continuous monitoring and evaluation of.
• Medication appropriateness, effectiveness, and safety and patient adherence through
available health data, biometric test results, and patient feedback

• Clinical endpoints that contribute to the patient's overall health

• Outcomes of care, including progress toward or the achievement of goals of therapy

UNIT II - DIMENSIONS OF HEALTH

Health is a state of complete physical, mental, and social well being and not merely an
absence of disease or infirmity. -W.H.O. (1948)
Wellness is much more than merely physical health, exercise or nutrition. It is the full
integration of states of physical, mental, and spiritual well-being. The model used by our
campus includes social, emotional, spiritual, environmental, occupational, intellectual and
physical wellness. Each of these seven dimensions act and interact in a way that contributes
to our own quality of life.
"Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity." According to this definition, wellness has a direct influence
on your overall health, which is essential if you are trying to live a better life.

The term wellness can refer to a variety of conditions within the body. While many people
associate their wellness to their physical health it can also be used to describe your
environmental,

Dimensions of Health:

1. Physical Health:

Practising healthy eating habits, being physically active, feeling well, resistance to disease,
taking care of our bodies, and our ability to heal.
Example: Adding more fruits and vegetables to your diet, cutting back on processed foods,
exercising regularly or getting enough sleep.
Physical Wellness is the ability to maintain a healthy quality of life that allows us to get
through our daily activities without undue fatigue or physical stress. The ability to recognize
that our behaviours have a significant impact on our wellness and adopting healthful habits
(routine checkups, a balanced diet, exercise, etc.) while avoiding destructive habits (tobacco,
drugs, alcohol, etc.) will lead to optimal Physical Wellness.
Physical wellness can refer to any of the aspects that are needed to keep your body in top
condition. Consuming a healthy diet and getting an adequate amount of exercise to build
cardiovascular health, endurance or flexibility are essential to this goal.
You are responsible for your health care which means treating minor conditions and
consulting a professional to manage more serious conditions. On the path to good physical
health, you should:
1. Monitor warning signs so you understand when your body is not getting the nutrition
it needs or establishing an unhealthy state.
2. Keep on top of your physical health which helps to improve determination,
self-control and self-esteem.
3. Get a sufficient amount of sleep, avoid harmful substances like tobacco products,
and get annual physical exams.
4. Know the ideal health numbers for conditions such as weight, cholesterol, blood
pressure or blood sugar and develop a regular exercise routine.

2. Emotional Health:
Ability of yourself, and one lay of your rerationely. Example ding wife dealy of
haung high seliefc a atd self-esties, engaging in emotionally healthy relationships, or
Emotional Wellness is the ability to understand ourselves and cope with the challenge's life
can bring. The ability to acknowledge and share feelings of anger. fear, sadness or stress:
hope, love, joy and happiness in a productive manner contributes to our Emotional Wellness
This is one of the important dimensions of health. Emotional wellness focuses on ensuring
that you are attentive to your feelings, thoughts and behaviour.
This includes both positive and negative reactions, though overall you should:
1. Seek an optimistic approach to life, enjoying life in spite of occasional
disappointment.
2. Adjust to change and express your emotions appropriately.
3. Express your feelings freely while managing your feelings, allowing yourself to cope
with stress in a way that is healthy.

Those working toward a path of emotional wellness will work to:

-Keep a positive attitude.

-Learn to manage their conditions.
-Maintain a balance in life by setting their priorities.
-Seek support for expressing their emotions appropriately.
-Remain aware of their thoughts and feelings.

3.Intellectual Health:
Ability to think clearly and critically, problem solving abilities, learning abilities, and
knowledge learned throughout life.
Example: Reading books, taking classes, learning a new language or trade, or working on
an art project.

Intellectual Wellness is the ability to open our minds to new ideas and experiences that can
be applied to personal decisions, group interaction and community betterment. The desire to
learn new concepts, improve skills and seek challenges in pursuit of lifelong learning
contributes to our Intellectual Wellness.
Finding a way to engage in creative and stimulating activities that allow you to share your
gifts and expand your knowledge is essential to your overall health.

Those that have high intellectual wellness:

1. Engage in the exploration and their understanding of new ideas.
2. Cherish stimulation and mental growth.
3. Get involved in cultural and intellectual activities.
This will allow you to find a path to explore your creativity, problem solving skills and ways to
learn more about your personal interests and the world around you. Keeping up with current
events and finding new ideas to strike your intellectual curiosity will allow you to continue to
grow over time.

4. Spiritual Health:
Feeling inward unity and peace with life, working towards a purpose, striving towards
meaning, seeking answers to life's questions.
Spiritual Wellness is the ability to establish peace and harmony in our lives. The ability to
develop congruency between values and actions and to realize a common purpose that
binds creation together contributes to our Spiritual Wellness.
Spiritual wellness involves discovering a set of beliefs and values that brings purpose to your
life. While different groups and individuals have a variety of beliefs regarding spiritualism but
the general search for meaning for our existence is considered essential to creating harmony
with yourself and others, regardless of the path to spirituality you choose to follow.
It is considered healthier to find your own path to the meaning of life that allows you to be
tolerant of the beliefs of others and live a life that is consistent with your beliefs.

On the path to a healthy spiritual life, you should:

1. Apply your values to your actions and decisions.
2. Make time to relax each day.
3. Accept the views of others.
4. Make time for prayer or meditation.

5. Social Health:
Interactions with others, developing healthy relationships/friendships, adopting to social
situations, social bonds and support. Example: Keeping in touch with friends, joining a club,
participating in a community event or meeting new people.
Social Wellness is the ability to relate to and connect with other people in our world. Our
ability to establish and maintain positive relationships with family, friends and co-workers
contributes to our Social Wellness.
Social wellness refers to your ability to interact with people, respect yourself and others,
develop meaningful relationships and devela? quality communication skills. This allows you
to establish a support system of family and friends. This is another one of the important
Those with high social wellness believe that it is important to:
- Live in harmony with the environment and others.
-Consider the common welfare of the community over their own.

Those on the path to healthy social wellness will work to:

- Develop interdependent healthy relationships while developing healthy
behavior.
-Create a balance between their community and the environment.

6. Occupational Wellness
Is the ability to get personal fulfillment from our jobs or our chosen career fields while still
maintaining balance in our lives. Our desire to contribute in our careers to make a positive
impact on the organizations we work in and to society as a whole lead to Occupational
Wellness.
The ability to find peace between your leisure time and work time while managing stress
from your relationships with coworkers effectively is essential to occupational health. Your
work takes up a great deal of your time, so it is important to find something that you love to
do and gives you a sense of purpose.

To achieve occupational wellness, it is important to:

= Feel as though you enjoy your work most days.
= Feel like you can talk openly with your employer and coworkers.
= Have a manageable workload.

7. Environmental Health:
Being more earth friendly, recycling, appreciation of nature and the environment, enjoying
the outdoors. Example: Riding your bike to work, walking places instead of driving, hiking,
traveling, enjoying outdoor sports or activities, or being involved in community clean up.
the quality of our environment, be it our homes, our communities or our planet contributes to
our Environmental Wellness.
More dimensions of health? Yes. The environment can have a significant impact on our
feelings about overall health.

For developing environmental wellness, you should:

- Live in harmony with your environment.
-Take action to protect this environment from harm.
-Minimize behavior that could impact your environment while protecting yourself from
environmental hazalds.
-Realize the effects of your daily habits on the world around you.
-Live a life that is accountable to your short-and long-term environmental needs.
-Bring awareness of the Earth's limits and resources to others.

UNIT III - STAGES OF HUMAN LIFE

12 LIFE STAGES
DIFFERENT NEEDS FOR THE DIFFERENT STAGES OF OUR LIVES

The Life Cycle

The life cycle begins with infancy and develops into childhood. At approximately 20 years of
age, we celebrate adulthood and conclude our lives as senior citizens. These four basic
stages can be broken up into hundreds more, all equally important to the development of our
"self."
Thomas Armstrong, executive director of the American Institute for Learning and Human
Development, teaches the 12 stages of life: h
1. Pre-Birth
2. Birth
3. Infancy
4. Early Childhood
5. Middle Childhood
6. Late Childhood
7. Adolescence
8. Early Adulthood
9. Midlife
10. Mature Adulthood
11. Late Adulthood
12. Death

During each of these stages, we have different needs, goals and experiences, but they all
contribute equally to the human life evcle.
1. Prebirth: Potential - The child who has not yet been born could become anything - a
Michael Angelo, a Shakespeare, a Martin Luther King - and thus holds for all of humanity the
principle of what we all may yet become in our lives.
2. Birth: Hope - When a child is born, it instills in its parents and other caregivers a sense of
optimism; a sense that this new life may bring something new and special into the world
Hence, the newborn represents the sense of hope that we all nourish inside of ourselves to
make the world a better place.
3. Infancy (Ages 0-3): Vitality - The infant is a vibrant and seemingly unlimited source of
energy. Babies thus represent the inner dynamo of humanity, ever fueling the fires of the
human life cycle with new channels of psychic power.
* Defining relationships, observing their surroundings and developing motor control are some
of the basic skills learned as a baby. Dependent on caregivers, infancy brings a series of
new developments at a fast pace.

CHILDHOOD
In this stage of life, we define the inner subjective self and develop technical and social skills
that we employ later in our adult lives. Children are creative and willing to imagine and
pretend. From their caregivers they need the ability to explore. This can be achieved by
allowing children to try new activities, like after-school sports, learning an instrument or
summer camp
4. Early Childhood (Ages 3-6): Playfulness - When young children play, they recreate the
world anew. They take what is and combine it with the what is possible to fashion events that
have never been seen before in the history of the world. As such, they embody the principle
of innovation and transformation that underlies every single creative act that has occurred in
the course of civilization.
5. Middle Childhood (Ages 6-8): Imagination - In middle childhood, the sense of an inner
subjective self develops for the first time, and this self is alive with images taken in from the
outer world, and brought up from the depths of the unconscious. This imagination serves as
a source of creative inspiration in later life for artists, writers, scientists, and anyone else who
finds their days are nights enriched for having nurtured a deep inner life.
6. Late Childhood (Ages 9-11) Ingenuity - Older children have acquired a wide range of
social and technical skills that enable them to come up with marvelous strategies and
inventive solutions for dealing with the increasing pressures that society places on them This
principle of ingenuity lives on in that part of ourselves that ever seeks new ways to solve
practical problems and cope with everyday responsibilities..
7. Adolescence (Ages 12-20): Passion - The biological event of puberty unleashes a
powerful set of changes in the adolescent body that reflect themselves in a teenager's

ADULTHOOD
This is a period in life when you begin accumulating responsibilities. It is the beginning of the
need to make our mark on the world. Great growth is experienced in adulthood as families
are created and identities are formed through success at home and in the workplace.
In adulthood, one might experience:
-New desires and life goals (different from goals in previous stages of life)
-A change in health = Growth in family
-Greater spiritual understanding
-Withdrawal from society/reality (midlife crisis)

8. Early Adulthood (Ages 20-35): Enterprise - It takes enterprise for young adults to
accomplish their many responsibilities, including finding a home and mate, establishing a
family or circle of friends, and/or getting a good job. This principle of enterprise thus serves
us at any stage of life when we need to go out into the world and make our mark.
9. Midlife (Ages 35-50) Contemplation - After many years in young adulthood of following
society’s script for creating a life, people in middle life often take a break from worldly
responsibilities to reflect upon the deeper meaning of their lives, the better to forge ahead
with new understanding. This element of contemplation represents an important resource
that we can all draw upon to deepen and enrich our lives at any age.

ELDER
As we age into senior citizens, we gain a heightened sense that the last stage of life is
approaching. For many this is a time to slow down and reflect. Aging adults need to feel
important and should remain in good company with activities that keep them engaged.
10. Mature Adulthood (Ages 50-80): Benevolence - Those in mature adulthood have
raised families, established themselves in their work life, and become contributors to the
betterment of society through volunteerism, mentorships, and other forms of philanthropy.
All of humanity benefits from their benevolence. Moreover, we all can learn from their
example to give more of ourselves to others.

11. Late Adulthood (Age 80+): Wisdom - Those with long lives have acquired a rich'
repository of experiences that they can use to help guide others. Elders thus represent the
source of wisdom that exists in each of us, helping us to avoid the mistakes of the past while
reaping the benefits of life's lessons.

12. Death & Dying: Life - Those in our lives who are dying, or who have died, teach us
about the value of living. They remind us not to take our lives for granted, but to live each
moment of life to its fullest, and to remember that our own small lives form of a part of a
greater whole.