PP Pharmacology & Pharmacy 2157-9423 Scientific Research Publishing 10.4236/pp.2023.145011 PP-124989 Articles Chemistry&Materials Science Medicine&Healthcare Investigation of Patients’ Mood on Their Distance from the Pharmacist during Medication Instruction Saori Gocho 1 * Yukina Miyagi 2 Naoko Yamaguchi 2 Chika Nakayama 3 Yuka Miyachi 4 Shoshiro Okada 2 Taeyuki Oshima 4 Department of Pharmacy, Nagoya Ekisaikai Hospital, Nakagawa, Nagoya, Aichi, Japan Department of Pharmacy, Gifu University of Medical Science, Kani, Gifu, Japan Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan College of Pharmacy, Kinjo Gakuin University, Moriyama, Nagoya, Aichi, Japan 19 05 2023 14 05 145 155 27, March 2023 16, May 2023 19, May 2023 © Copyright 2014 by authors and Scientific Research Publishing Inc. 2014 This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Background: Pharmacists must adjust their distance from patients to facilitate communication during interviews and gain their trust. The distance between the patients and the pharmacists varies depending on many factors, such as gender, posture and the patients’ mood. Only a few of these papers have actually measured and validated distance with patients. In this study, we validated our method of assessing mood and measuring distance before beginning a survey with patients. Methods: We measured comfortable interpersonal distance among men and women using an ecological scenario, in which a pharmacist approaches the subject, and the subject is asked to stop the pharmacist at the distance he/she feel comfortable with. Five pharmacists and 33 subjects participated in the study. The Japanese version of the Brief Mood Questionnaire Checklists (BMC-J) was used to quantify the subject’s mood for the day, and then the distance from the pharmacist that the subjects considered comfortable was measured at the bedside. The relationship between the mood and distance obtained was examined. Results: The comfortable distance of subjects was influenced by gender, posture, and mood. The shortest distance was 94.7 ± 11.1 cm (mean ± SD), for the male subjects versus the female pharmacists in the sitting position. The distance of male subjects shorted when they had positive emotions and lengthened when they were worried. Female subjects maintained a long distance from both male and female pharmacists when they had positive emotions and a short distance when they were worried. Conclusion: Findings show that the distance changes depending on the subjects’ mood at the time of measurement. It was found that the present measurement method can be used to determine the psychological state of the patient and measure the comfort distance at that time, and can be used as a simple method to examine these relationships. Therefore, it is also considered a practical method for the next step, which is a clinical study on patients.

Non-Verbal Communication Personal Space Interpersonal Distance Mood Pharmacist 1. Introduction

Patients need to understand drug therapy and receive practical information from pharmacists to ensure the proper use of pharmaceuticals. This information is based on pharmacological evidence, and pharmacists constantly monitor patients’ status, including confirmation of their level of understanding, adherence, therapeutic effects, and side effects. Therefore, pharmacists must improve their information-gathering skills, management skills, communication skills, and basic clinical knowledge [1] . This study focused on communication skills. There are two types of communication: verbal and nonverbal. Verbal communication entails transmitting information using spoken language, whereas nonverbal communication uses expressions, eyes, posture, and physical movements [2] . During face-to-face conversations, detailed information can be conveyed through verbal and nonverbal communication [3] [4] . Regarding nonverbal communication, we focused on personal space (PS), which includes interpersonal distance. PS is the immediate area surrounding individuals where most of their interactions with others occur [5] . PS varies among people and is used to facilitate interpersonal relationships [6] . Recently, there has been an increased interest in PS in the medical field. Dr. Kashiwagi highlighted the importance of considering the patient’s comfort distance, that is, a daily-changing distance [7] .

However, although there have been several reports on patients’ comfort PS measurement studies, only a few studies have considered the patients’ daily physical and psychological situation. Futami et al. reported no relationship between anxiety characteristics and distance [8] .

We have been investigating methods of measuring mood and comfort distance to find a relationship between mood and this daily-changing distance. Our final goal is to conduct experiments on patients in a clinical setting; thus, we have devised a measurement method that emphasizes not being a burden on the patients. No other study has quantified the patient’s mood at the time and actually measured the distance the patient feels comfortable, which is thought to provide new insights.

 2. Methods 2.1. Pharmacists and Subjects

A study was set up with two male pharmacists (41 - 42 years), three female pharmacists (22 - 40 years), 16 male subjects (48.7 ± 13.9 years), and 17 female subjects (60.9 ± 12.7 years). The subjects were volunteers involved in university education who understood the purpose of and consented to take part in this study.

 2.2. Subjects’ Mood Surveys

A questionnaire was developed for this study, which comprised the three following items: 1) The subject’s attributes (gender and age). 2) The Japanese version of the Brief Mood Questionnaire Checklists (BMC-J) (Figure 1) [9] [10] was used to evaluate the subjects’ mood (psychological state). 3) Free description items to describe the subjects’ physical condition at the time of measurement.

The BMC-J assessed the subjects’ mood at that time. The mood ratings comprised lists of four positive emotions (happy, joyful, pleased, and enjoyment or fun) and five negative emotions (depressed/blue, unhappy, frustrated, angry/hostile, and worried/anxious). The nine emotions were scored on a 7-point Likert scale ranging from 0 (not at all) to 6 (strongly). The following abbreviations were used to denote the nine sentiments of the BMC-J: happy (HAP), joyful (JOY), pleased (PLZ), enjoyment/fun (ENJ), depressed/blue (DEP), unhappy (UHA), frustrated (FRU), angry/hostile (ANG), and worried/anxious (WOR).

 2.3. Measurement of Comfort Distance

Comfort distance was measured by having the pharmacist’s approach or move away from the subjects and asking the subjects to indicate the distance they felt appropriate for conversation at the bedside.

The following unifications were made in this study: The comfort angle of the subjects and pharmacists was 45˚, we measured the distance on an extension line of 45˚ diagonally from front to back (Figure 2). The angle was set at 45˚ because our preliminary study showed the comfort angle was 45˚ and Futami et al. reported similar methods [8] . Other biases, such as intimidation due to eyes height, were avoided by matching the pharmacists’ eyes height to the subjects. Furthermore, the room size and bed placement were standardized.

Pharmacists approached the subjects by closing half the steps from a distance extended from the subjects, and the distance was measured at the point where the subjects signaled that it was just right. The distance from the pharmacist’s chin to the subject’s chin was measured using a laser rangefinder (Zamo II, Bosch). Similarly, the distance was measured from the point where the pharmacist was too close by taking half the steps away to the subjects to the point where the subjects signaled “just right”. The comfort distance is defined as the average of both the approaching distances.

Subjects were measured for distance in both sitting and supine posture patterns. The order of distance measurements was recorded, starting with the pharmacists of the same gender as the subjects they were sitting. Second, measurements were performed in the supine position. Third, pharmacists of the opposite gender as the subjects in the sitting position were measured. Finally, measurements were taken in the supine position. Mood was assessed only once before the measurements.

 2.4. Analysis Method

IBM SPSS Statistics for Windows ver.27 (IBM Corp.) was used for the analysis. The comfort distance was divided by position and gender, and the mean and standard deviation were calculated for each. The results of the Shapiro-Wilk-Test, p < 0.05, prompted a nonparametric test. The Mann-Whitney U test was used to compare the two groups. The correlation between each mood and comfort distance was calculated using Spearman’s rank correlation. In addition, the median for each mood was calculated. To more clearly assess differences by mood, after excluding the median from each subject’s data, two groups for each mood were formed, in which the group with a score greater than the median was labeled as the “high group,” while the group with a score lower than the median was labeled as the “low group.” Subsequently, we compared the comfort distance between the two groups. This study is an exploratory study.

 3. Results 3.1. Relationship between the Comfort Distance and the Posture of the Subjects

The results of the comfort distances for each gender of pharmacists and for the two postures of the subjects (sitting and supine) were showed in Table 1. The shortest distance was 94.7 ± 11.1 cm for the male subjects versus the female pharmacists in the sitting position. The longest distance was 124.2 ± 20.7 cm for the supine female subjects versus the male pharmacists. No difference was observed for male subjects when the distance was compared based on their posture. Moreover, no difference was observed when the distance was compared based on the pharmacist’s gender. Conversely, the distance from male pharmacists to the sitting position of female subjects was significantly longer than that from female pharmacists (p < 0.05). The same result was observed in the supine position (p < 0.01). The distance from male pharmacists to female subjects was significantly longer in the supine position than in the sitting position (p < 0.05).

3.2. Correlation between Each Emotion and Comfort Distance

The correlations between the results of BMC-J and comfort distance are listed in Table 2 and Table 3. For the sitting position of male subjects, there was a significant negative correlation between male pharmacists and UHA (r = −0.586, p < 0.05), FRU (r = −0.561, p < 0.05), and ANG (r = −0.625, p < 0.01) and a significant positive correlation between female pharmacists and DEP (r = 0.571, p < 0.05). For the supine position of male subjects, a significantly negative correlation was observed between female pharmacists and PLZ (r = −0.558, p < 0.05), and a significantly positive correlation was observed between female pharmacists and DEP (r = 0.635, p < 0.01), FRU (r = 0.561, p < 0.05), and WOR (r = 0.514, p < 0.05). Furthermore, for the sitting position of female subjects, significant positive correlations between male pharmacists and ENJ (r = 0.537, p < 0.05) and between female pharmacists and all positive emotions, HAP (r = 0.486, p < 0.05), JOY (r = 0.637, p < 0.01), PLZ (r = 0.615, p < 0.01), and ENJ (r = 0.713, p < 0.01), were observed. For the supine position of female subjects, a significant positive correlation between male pharmacists and ENJ (r = 0.499, p < 0.05), and between female pharmacists and ENJ (r = 0.570, p < 0.05) was observed.

References Kodama, T. (2013) Japan Pharmaceutical Association, Pharmacist Vision. https://www.nichiyaku.or.jp/assets/pdf/vision.pdf Arita E. ,et al. (2006)Basic Attitudes When Communicating—Integration of Verbal and Non-Verbal Communication Dispensing and Information 12, 66-68. Merabian A. ,et al. (1968)Communication without Words Psychological Today 2, 53-55. Takagi, S. (2005) The Role of Facial Expressions and Body Movements in Communication. Bulletin of the Graduate School of Letters, Arts and Sciences, 1, 25-36. Sommer R. ,et al. (1959)Studies in Personal Space Sociometry 22, 247-260. Little, K.B. (1965) Personal Space. Journal of Experimental Social Psychology, 1, 237-247. https://doi.org/10.1016/0022-1031(65)90028-4 Kashiwagi, T. (2008) Living with Death: From the Field of Life and End-of-Life Care. Japan Christian Church Publishing House, 33. Futami A. ,et al. (2014)A Study of Nurse Standing Position at the Bedside Considering the Patient’s Personal Space Japanese Journal of Nursing Art and Science 13, 211-218. David, L.T. and Ed, D. (1990) Memory Accuracy in the Recall of Emotions. Journal of Personality and Social Psychology, 59, 291-297. https://doi.org/10.1037/0022-3514.59.2.291 Tanaka K. ,et al. (2008)An Examination of the Reliability and Validity of the Japanese Version of the Brief, Momentary Mood Checklists (BMC-J) Collection of Papers from Osaka University of Economics 58, 271-275. Hall, E.T. (1966) The Hidden Dimension. Japanese Translation by Hidaka, T. and Sato, N. (1970) Misuzu Shobo, Tokyo. Aono, A. (2003) Gender Differences in Interpersonal Distance: From the View Point of Oppression Hypothesis. The Japanese Journal of Experimental Social Psychology, 42, 201-218. https://doi.org/10.2130/jjesp.42.201 Heshka, S. and Nelson, Y. (1972) Interpersonal Speaking Distance as a Function of Age, Sex, and Relationship. Sociometry, 35, 491-498. https://doi.org/10.2307/2786529 Biggio, M., Bisio, A., Bruno, V., Garbarini, F. and Bove, M. (2022) Wearing a Mask Shapes Interpersonal Space during COVID-19 Pandemic. Brain Sciences, 12, Article 682. https://doi.org/10.3390/brainsci12050682 Cartaud, A., Quesque, F. and Coello, Y. (2020) Wearing a Face Mask against Covid-19 Results in a Reduction of Social Distancing. PLOS One, 15, e0243023. https://doi.org/10.1371/journal.pone.0243023 Kühne, K., Fischer, M.H. and Jeglinski-Mende, M.A. (2022) During the COVID-19 Pandemic Participants Prefer Settings with a Face Mask, No Interaction and at a Closer Distance. Scientific Reports, 12, Article No. 12777. https://doi.org/10.1038/s41598-022-16730-1 Iachini, T., Frassinett, F., Ruotolo, F., Sbordone, F.L., Ferrara, A., Ariol, M. and Ruggiero, G. (2021) Social Distance during the COVID-19 Pandemic Reflects Perceived Rather than Actual Risk. International Journal of Environmental Research and Public Health, 18, Article 5504.https://doi.org/10.3390/ijerph18115504 Givon-Benjio, N. and Okon-Singer, H. (2020) Biased Estimations of Interpersonal Distance in Non-Clinical Social Anxiety. Journal of Anxiety Disorders, 69, Article ID: 102171. https://doi.org/10.1016/j.janxdis.2019.102171 Givon-Benjio, N., Oren-Yagoda, R., Aderka, I.M. and Okon-Singer, H. (2020) Biased Distance Estimation in Social Anxiety Disorder: A New Avenue for Understanding Avoidance Behavior. Depression and Anxiety, 37, 1243-1252. https://doi.org/10.1002/da.23086 Perry, A., Rubinsten, O., Peled, L. and Shamay-Tsoory, S.G. (2013) Don’t Stand So Close to Me: A Behavioral and ERP Study of Preferred Interpersonal Distance. Neuroimage, 83, 761-769. https://doi.org/10.1016/j.neuroimage.2013.07.042 Wieser, M.J., Pauli, P., Grosseibl, M., Molzow, I. and Mühlberger, A. (2010) Virtual Social Interactions in Social Anxiety—The Impact of Sex, Gaze, and Interpersonal Distance. Cyberpsychology, Behavior, and Social Networking, 13, 547-554. https://doi.org/10.1089/cyber.2009.0432 Blondis, M.N. and Jackson, B.E. (1977) Nonverbal Communication with Patients: Back to the Human Touch. Japanese Translation by Niki, H. and Iwamoto, S. (1979) John Wiley & Sons Inc., New York.