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Communication in Care Settings

Overview

This unit discusses the importance of communication in care settings and how to effectively communicate with others by taking into account their individual needs and preferences and removing any barriers that may be preventing effective communication.

The subject of confidentiality is also examined in detail in this unit.

Contents

Study Guide

1.1 Identify different reasons why people communicate

Communication is the process by which individuals send and receive information between one another. Unless somebody is completely isolated from everybody else, it is an essential part of daily life.

But what motivates people to communicate with one another? Why do we do it?

There are several reasons:

  • To express a need. e.g. a drink or to go to the toilet
  • To give an instruction. e.g. asking somebody to wash up or explaining how to work the telly
  • Social interaction. e.g. chit-chat with a stranger in a queue or a cuppa with friends is a way to de-stress and socialise
  • To share information. e.g. a car salesman telling a potential buyer about a car’s specification or a child telling their parents what they did at school today
  • To ask questions. e.g. “how are you feeling?” or “please can you pass me the gin?”
  • To offer reassurance, compassion or empathy. e.g. “I know how you feel” or “we will get through this together”
  • To express feelings and emotions. e.g. “I love going shopping!” or “I hate you!”
  • To build and maintain relationships. e.g. meeting a person for the first time or asking a partner how their day has been

1.2 Explain how effective communication affects all aspects of your own work

Effective communication is essential in day-to-day life but perhaps more so for those that work in the health and social care sector as we frequently have to interact with individuals who have different communicative requirements.

Effective communication means making sure we are understood and that we understand the person we are communicating with. This often means adapting our methods of communication in a way that benefits the other party and ensures that there is clarity and mutual understanding.

As a carer or support worker, you will have to connect and interact with lots of different people of a varying levels and abilities. Some individuals may have physical disabilities that affect their communication (e.g. deafness.), which may mean that you need to use gestures or visual aids to communicate. Some may have learning disabilities, which may require you to talk at a slower pace and give them more time to comprehend.

But it’s not just the individuals that you support that you need to communicate well with. There will also be your colleagues, managers, other professionals and people that are important to the individual you support such as their family. This is by no means an exhaustive list – but it does show that effective communication is vital in many aspects of your work.

In addition, reading and writing is a method of communication that you will use quite a lot. Like speaking and listening, it is important that nothing is misunderstood through written media. This means your writing should be clear and legible as well as professional and objective.

1.3 Explain why it is important to observe an individual’s reactions when communicating with them

There is an oft-misunderstood quote by Professor Albert Mehrabian:

It is suggested that the combined effect of simultaneous verbal, vocal and facial attitude communications is a weighted sum of their independent effects — with the coefficients of .07, .38, and .55, respectively.

Mehrabian and Ferris (1967)

Don’t worry if it doesn’t make sense to you – it’s difficult to read and out of context, however you have probably heard the ‘layman’ version of it before:

Only 7% of communication is verbal; voice tone accounts for 38% and body language 55%

Although Mehrabian’s studies were only to do with communication that involved feelings or attitudes (so they are not really applicable to all communications) we can take from this that we should not concentrate only on the words that are being spoken during a conversation.

By observing an individual’s reactions whilst communicating, we can infer a lot of useful information.

For example, if an individual seems nervous or angry during a conversation it could mean that they do not like or agree with what you are saying. It may also mean that they just in a bad mood generally or perhaps they are too hot. By observing this you are able to ask them what is wrong or if they don’t understand. You could turn down the heat or ask if it would be better to reschedule the conversation for another day.

If an individual says they understand but has a confused facial expression, you could ask them to repeat back what you have just said in their own words to clarify their comprehension.

By perceiving an individual’s visual cues during conversation, you will have lots of opportunities to ensure that the communication is clear and prevent misunderstandings.

2.1 Find out an individual’s communication and language needs, wishes and preferences

In order to communicate effectively with an individual it is paramount to identify and understand their language needs, wishes and preferences. By doing so, you are much better equipped to have a meaningful conversation with them.

You can do this in several ways.

The most obvious is to ask the people that are close to the individual such as family, relations and friends. These people know the individual best and can offer valuable insights into how best to communicate with them.

I have worked with an individual that refuses to talk to anyone that sits in a particular chair – fortunately his father warned me of this but had I not been informed, I would have had no idea why I was being ignored – or even if I was being heard!

Dan Dutton, DUTTONCARE

As well as their family, other professionals that are involved in the individual’s care should be able to offer guidance on their communication requirements and preferences. Your co-workers and line manager are the obvious choice but you may also be able to glean useful information from other professionals such as their social worker, psychologist, GP, community nurse etc. Some of these may have been associated with the individual for a long time and know them well.

As a carer, you should be privy to an individual’s personal care and support plan. The quality of these documents varies between service providers (and even between services under the same provider), however there will ideally be a section on communicating with the individual, which will specify how best to approach communication and any particular nuances that individual has.

Although it is always better to do a little research about an individual before communication, it is not always possible. We often find ourselves in the situation where we are chatting to an individual we have never met and know nothing about them. (well, I do anyway!).

When this happens, you simply have to wing it and use trial and error to discover what works and what doesn’t. In addition, providing that you are able to communicate on some level, you could ask the individual about how to converse with them best.

You will also find that many individuals are happy to provide you with information about their communication needs – for example, somebody who is hard of hearing will probably have no qualms about asking you to speak up a bit!

2.2 Demonstrate communication methods that meet an individual’s needs, wishes and preferences

For this criteria, you will need to demonstrate to your tutor or assessor that you are able to communicate with an individual in a way that fulfills their communication requirements. To do this, they will probably want to observe you communicating with one of your clients.

Here is a real-life example of a conversation between a support worker (SW) and their client (C) with a moderate learning disability. For context, the support worker, assessor and client are sat in the client’s lounge.

SW: It’s Friday so we need to change your bedding and give your bedroom a quick tidy today. Would you like to do that now or later?

C: Later

After 1 minute…

C: Let’s do it now

SW: Okay. Is it okay if my assessor comes up, too, to observe me?

C: Yes

Client, support worker and assessor go upstairs

SW: Would you like to polish or change the bedding?

C: Bedding

SW: Remember when you weren’t able to change the bedding on your own? Now you’re brilliant at it!

C: Thank you (smiles)

SW: Is it okay if tidy up your CD’s on your shelf whilst you’re doing that?

C: Yes

Client and support worker do their jobs then go back to the lounge.

Real conversation between support worker and client

After your observation, your assessor will want to talk to you about the way you communicated with the individual.

The support worker in the example above could say that they identified the need to talk slowly and use short sentences with just two or three keywords from the individual’s care plan.

They might also add that the question of cleaning the bedroom now or later was deliberately worded that way as it ensures that the task is completed. When compared to the question “would you like to clean your bedroom?“, you can see that the client has the easy option of replying “No”. This could also be documented in the care plan as a way of promoting choice whilst ensuring the client is able to keep their home clean and tidy – of course, the client is still within their rights to say ‘No’ to doing the task both now and later, but for this particular client that rarely happened.

The support worker offered further choice to the client by asking if they wanted to change the bedding or do the polishing (with the support worker doing the other). This helps to promote the individual’s self-esteem.

Similarly, by praising the client about their bedding-changing skills, the support worker helped to make them feel valued, again promoting self-esteem. And asking the client for permission before touching their CDs demonstrates respect.

2.3 Show how and when to seek advice about communication

If you are unable to communicate effectively with a particular individual and one or both of you are unable to understand one another, it will be necessary to seek advice from others.

This may be due to incorrectly identifying the communication needs, not having the relevant skills or training to communicate with them or simply a clash of personalities.

The first person you should approach is your manager and you should ask them for guidance on how to communicate better.

They may advise that you need to do some general training in communication skills or something more specific to the individual you are struggling to communicate with. For example, if an individual communicates primarily using Makaton, they should ensure you are put on a relevant beginner training course.

Other people you can approach for advice could be co-workers, family and friends of the individual and local health and social care professionals – a speech and language therapist can offer valuable insights into what may be going wrong.

3.1 Identify barriers to communication

A barrier to communication is anything that prevents the messages between individuals from being received and/or understood. By being able to identify these barriers, we can take measures to eliminate them or at least minimize their impact.

Language barriers are perhaps the most obvious impediment to successful communication. If two people do not speak the same language then it will be very difficult to communicate. Although, in the UK, English is the primary language, there are also minority languages in common usage such as Welsh and Polish. According to the 2011 census:

In the 2011 Census, 92.3 per cent of people (49.8 million) aged three and over in England and Wales reported English as their main language (English or Welsh in Wales).

The remaining 7.7 per cent of the population (4.2 million) had a main language other than English.

Polish was the most common language after English with 546,000 people (1.0 per cent of the population) reporting it as their main language.

After Polish the next most common main languages were from South Asia, Panjabi (273,000 people) and Urdu (269,000) each with 0.5 per cent and Bengali (with Sylheti and Chatgaya, 221,000) and Gujarati (213,000) each with 0.4 per cent. This was followed by Arabic (159,000) and French (147,000) each with 0.3 per cent.

Office for National Statistics (ONS)

Dialects and accents can also be barriers to communication as some people have difficulty understanding English that has a geographic twang.

Similarly, if you use technical jargon or slang that is not familiar to the individual then they may have difficulty understanding what you mean.

Some individuals may not understand complex sentences that contain a large number of keywords. Their cognition may also be slower, so may not be able to process information if somebody speaks too fast or does not give them enough time for it to sink in.

Additionally, some people may only be able to communicate with sign language, Makaton or other communication methods that rely on gestures.

You should always do your best to ensure the location is as comfortable as possible and meets the needs of individuals or environmental barriers could make communication difficult. If somebody doesn’t feel comfortable in their environment they will be less likely to be open and want to communicate.

This could include factors such as:

  • Temperature (is it too hot or too cold?)
  • Lighting (is it too dark or too bright?)
  • Seating (is it comfortable or uncomfortable? will you have to stand?)
  • Noise (are there too many external noises or are they too loud?)
  • Time (are you or the individual(s) pressed for time?
  • Space (do you each have your own personal space? are you close enough to hear one another?
  • Distractions (is the TV on? are there other people chatting in earshot?)

Emotional or psychological barriers to communication are when the subject matter is taboo or sensitive to the individual. This could include subjects such as sex, religion, politics etc. Or perhaps the individual is in a heightened state of emotion such as anger. Differences in perspective, viewpoint or opinion can also be a blocking point in communication – it is very difficult to make somebody with deeply-ingrained beliefs see things differently.

Cultural barriers can also prevent effective communication because cultural traditions and upbringing affect the way individuals think and behave. For example, in some cultures eye contact is considered impolite whilst in others not making eye contact is considered rude.

If communicating non-verbally, there may be physical barriers that prevent visual aids from being seen. For example, if an individual relies on lip reading to receive messages, if they cannot see your face they wouldn’t be able to understand you – in fact, they probably wouldn’t even realise you are speaking!

Lack of or poor communication skills can be a major stumbling block to communication. If somebody cannot read, for example, communication via written media would be impossible for them.

Finally, if an individual has a lack of interest in what you are saying or is unable to hold their attention for long, communication can be very difficult. For example, an individual that has no understanding of their finances may not have any interest in you supporting them to pay their gas bill.

3.2 Demonstrate how to reduce barriers to communication in different ways

Now that you have learned about some of the barriers to communication, we shall now look at ways to eliminate or reduce them to maximise effective communication from both sides.

The table below lists the types of communication barriers and methods that could be used to reduce them:

BarrierMethod
LanguageUtilise a translator or interpreter
Learn the language
Accents, dialect, wordingSpeak clearly
Speak slowly
Give the individual time to absorb the information
Use simple wording and sentence structure
EnvironmentalEnsure the setting is comfortable for the individual
Reduce distractions as much as possible
EmotionalMake the individual feel comfortable
Do not try too hard to push them to talk about things they don’t want to
Show compassion, empathy and understanding
Be non-judgmental
Give the individual time to calm down and return to baseline emotions before initiating communication
CulturalResearch the individual’s culture and traditions beforehand (speak to family, friends, colleagues, professionals etc., Internet research)
Respect the individual’s cultural beliefs
PhysicalRemove any physical barriers
Ensure the individual can see you clearly (e.g. for sign language, lip-reading etc.)

This is by no means an exhaustive list. In your job role, you will be required to be innovative in breaking down any barriers that hinder communication. Once you have identified a barrier to communication, reflect on it, use your imagination and think outside the box to try to find inventive ways to remove it.

I once worked with an individual that would have regular home visits from their community nurse. Unfortunately, the individual would just sit watching the TV during their meetings and ignore her.

Any request to turn off the TV and engage in conversation were also ignored.

As we couldn’t remove the distraction from the individual, we instead attempted to remove the individual from the distraction. We worked with the community nurse to arrange the meetings at her offices instead of having home visits.

From the first meeting at the new venue, the individual showed interest, attention and engagement.

Dan Dutton, DUTTONCARE

3.3 Demonstrate ways to check that communication has been understood

A large part of effective communication is ensuring that the information that you have given the individual and the information that they have given you are understood correctly.

It is usually not enough to simply ask somebody if the understand. Nine times out of ten they will say ‘yes’ even if they don’t. This can be for a variety of reasons; they may think they understand but in reality do not, they may understand some parts but not others or they may simply just be affirming because they want to end the conversation.

It is good practice to exercise active listening during communication. This is where you make a conscious effort to understand and comprehend exactly what is being said to you by being mindful of not only the words that they are using but also by observing their body language and facial expressions. You should also ensure that you give the speaker your full attention.

To prevent misunderstandings, you should provide feedback to the individual at regular intervals by paraphrasing what they have said to you and repeating it back to them. You should also encourage the individual to do the same for you.

It is also prudent to record a summary of the conversation along with any actions yourself or the individual are to take next. This cements the key points of the communication and gives all parties the opportunity to check their understanding and speak up if there is something written down that they don’t agree with.

3.4 Identify sources of information, support and services to enable more effective communication

No matter how good we think we are at communicating, there is always room for improvement. Therefore, it is important to be able to identify sources of information, support and services that can increase the efficacy of your communication skills.

During regular supervision with your manager, you can both collaborate to identify how you might improve your communication. Your manager may be able to offer advice and guidance on what you can do – this could be through regular practice and experience or formal training.

You could conduct you own research guidance on communications with individuals with specific conditions. The MENCAP website has a lot of useful information about communicating with people that have learning disabilities and the RNIB produces several publications that have advice about communicating with people that are visually impaired.

There is also software available that can make communication easier, such as speech-to-text converters for those that have hearing disabilities or text-to-speech converters for those that are visually impaired.

Talking to people that have had a lot of contact with an individual can be useful to discover information about communication that is particular to that person. This could include family, friends and health and social care professionals.

With a little research and by talking with the right people, you should be able to find out a lot of information that can help you to communicate more effectively.

4.1 Explain the term ‘confidentiality’

Confidentiality means respecting all individual’s personal data and protecting it by ensuring that it is only shared with others on a need-to-know basis or if there are extenuating circumstances.

It is an important legal and ethical obligation of the job role as everybody has a right to privacy.

4.2 Demonstrate confidentiality in day to day communication, in line with agreed ways of working

Confidentiality is a big part of daily practice in health and social care and there will be ample opportunities to demonstrate this to your assessor. You should also be aware of your organisations agreed ways of working for confidentiality, which should be documented in relevant policies and procedures.

When discussing confidential information, you should always be mindful of your surroundings and who is within earshot. For example, you shouldn’t talk about a specific individual’s care with a colleague if there are other clients or members of the general public in close proximity. If you are talking outside, you should be aware that there may be neighbours on the other side of the fence that may overhear you.

Personal information is also often written down, whether it be in care plans, financial letters or even on a label on their medication. Care should be taken to ensure that they are not kept in a place that someone without authorisation may see them. Records and documents should be stored securely in line with your organisation’s policy. Similarly, digital records should also be protected by passwords so that only the relevant people can view them. And if they are no longer required, they should be disposed of correctly, ideally by shredding them.

You should also ensure that you do not talk about, complain or gossip about individuals that you work with outside of the work environment. This is also a breach of confidentiality and could lead to disciplinary action.

4.3 Describe situations where information normally considered to be confidential might need to be passed on

Whilst we should always respect an individual’s right to privacy, there are circumstances where personal information may need to be shared with others.

As a care worker, you may need to share information with your manager or the rest of the team to ensure that the individual receives the correct and highest quality care. In most cases, an individual or their next-of-kin will have signed a document to say that they consent to this type of information sharing.

If, for example, an individual tells you something that may be injurious or fatal to themselves or others, you should pass this information on to try to prevent it. This information may need to be shared with your manager, social services or even the police.

This includes suspicions of abuse, which may need to be reported to the local safeguarding team.

Orders from a court or other judicial service can also override confidentiality.

4.4 Explain how and when to seek advice about confidentiality

If you are ever unsure about an issue concerning confidentiality, you should speak with your manager for advice and guidance. They will (hopefully) have the knowledge and experience to help, or if they don’t, will be able to find out for you.

You may be asked by individuals if they can talk to you in confidence or to promise not to tell anybody. In these cases it is best to explain that you can’t make that promise as, depending on what they say, you may be required by law or duty of care to pass the information on.

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