This unit is aimed at those who work in care settings or with children or young people in a wide range of settings: Promote communication in care settings Assignment, UCB, UK

Unit 303 Promote communication in care settings

Unit aim: This unit is aimed at those who work in care settings or with children or young people in a wide range of settings. The unit is about the central importance of communication in such settings, and ways to overcome barriers to meet individual needs and preferences in communication.

1 Understand why effective communication is important in the work setting

• Identify the different reasons people communicate

 People communicate in order to:

• establish, build and maintain relationships with others,
• to give and receive information and instructions,
• to understand and be understood,
• to share opinions and experiences
• share knowledge,
• share and express their feelings,
• share emotions,
• to give encouragement and show others they are valued.
• To give reassurance
• Make choices
• Ask questions
• Socialise
• passing on culture, beliefs, wisdom and memories
• Make plans
• Agree actions 

• Explain how communication affects relationships in the work setting

 In your job you need to communicate with people all the time. First there is the service user, also their family and friends, who are likely to be involved in their care. You will also have to communicate with colleagues and with other professionals such as the district nurse, doctors, pharmacist, social workers, occupational therapist etc. The way in which you communicate will be different depending on the person with whom you are communicating and the purpose of the communication. You will adopt a different approach with different people, to convey the same communication. Effective communication is especially important for example, with regards;

health and safety– required for good team working in moving and handling

with service users – to ensure their choices are being met

with your manager – to report any problems

In an emergency – to summons assistance

Communication is also about written items such as records, which must be clear, accurate, precise and easy to read. Records form the basis of information which can be shared within the team and may also be used as evidence in a court of law if necessary.

Communication also:

• Ensures people rights are being met
• Builds good relationships with your colleagues
• Helps you to resolve conflicts
• Share information
• Relieve stress
• Give feedback to others

If an individual’s communication needs were not met they would possibly:

• Feeling of isolation and disempowered.
• Resistance to complying with their care plan because they feel that they did not have a part in designing it.
• Deterioration in health/well-being because they do not feel that they need to follow the advice of the practitioner. They do not understand the consequences of not following the advice.
• Possibility of harm to themselves or others as they feel that they are not being supported or listened to.

 1.3 Explain ways to manage challenging situations

 In your work role you will face conflicts and challenging situations with colleagues, those you care for and others within the care team. Most people want to avoid conflict and potentially stressful situations – this is human nature. People often find it easier to avoid communicating something that they think is going to be controversial or bad, putting off the communication and letting the situation fester.

With those you care for, you may face challenging situations which have been brought on by various factors. It could be that they are in pain, it could be due to their condition, their medication or through substance misuse, they are bored or lonely, they cannot understand what is happening to them or are frustrated. If you are faced with a challenging situation always follow your workplace policies and procedures.

The best way to manage any challenging situation is to discuss what the issues are with the person and try to find a solution to the problem. Try not to get emotionally involved. Relax and listen carefully to the views, opinions and feelings of the other person. Always treat the person with respect and dignity and also try to understand their feelings of being upset or angry. Ask the individual questions and listen to their responses. You will need to use all your communication skills in this type of situation. Look at the individual’s body language, tone of voice and their reactions to what is being said. Remain calm and non-confrontational and try to avoid the situation becoming aggressive. Communication is easier when we are calm, take some deep breaths and try to maintain an air of calmness, others are more likely to remain calm if you do.  If it does appear to have the potential to escalate you should walk away and give the individual time to calm down

 Your manager will provide guidance, explain ways of working and support you to develop your knowledge and skills as you progress in your work.

 2 Be able to meet the communication and language needs, wishes and preferences of individuals

 2.1 Demonstrate how to establish the communication and language needs, wishes and preferences of individuals in order to maximise the quality of the interaction

It is important to find out the individual’s communication and language needs, wishes and preferences because they can be so varied. The way you communicate with someone can differ depending on things such as:

• A sensory impairment
• Their disabilities
• Their health
• Age
• Gender
• Their culture
• Their values and beliefs
• Their level of communication skills
• The nature of the communication
• Who you are communicating with
• If there are distractions
• Personal space
• The type of communication etc

The best way to establish the communication and language needs of an individual is first by asking them and also by observing them and their reactions when communicating with them. This would immediately allow you to establish their usual language, if they are visually or hearing impaired or if they have any learning disabilities.  Next you would check the care plan for any special requirements or aids which the individual needs. You could also consult with colleagues. If the individual is new to your place of work you would try communicating with the individual on a one to one to establish their needs, wishes and preferences. If this was not successful you could also ask the individual’s family, friends, doctor or other professionals who have worked with the individual, for advice. Any information regards the individuals would be noted in their communication notes so that others were aware of the appropriate methods to use.

 2.2 Describe the factors to consider when promoting effective communication

 There are many factors to consider when promoting effective communication.

• Does the individual have a specific communication problem
• Do they have the correct equipment to support them to communicate
• Are there any barriers to communication
• Do they understand what the communication is about
• Are there cultural differences which need to be taken into account
• Do they need extra support such as an advocate
• Are you a good listener
• Do you think about yours and the individual’s body language, tone of voice, gestures, posture, eye contact
• Ensure the individual understands what you are saying
• Allowing time to understand and respond
• Not using jargon

Effective communication is about both the giving and receiving of messages, promoting effective communication requires you to consider both the way you give a message and the way that you receive a message.

It’s important to remember what communication is about. When communication with individuals it is about being competent at establishing how that person communicates in order to understanding their needs and wishes, letting them know that you have heard and understood them, being honest and open about what you can and cannot do to meet their needs and wishes and on its most basic level, about getting on with people – ie treating them with respect as individuals and as equals.

 The individual’s communication needs must be reviewed and reassessed regularly in order to ensure ongoing effective communication.

 2.3 Demonstrate a range of communication methods and styles to meet individual needs

 Your assessor will carry out an observation of you in your practice. The first thing you should do is check the service users care plan for details of the communication methods which meet this particular individual’s communication needs. As a carer you should understand that only 7% of communication is done verbally. When listening to an individual, it is important to recognise other factors which make the listening effective. It is important to be aware of, body language, having good eye contact with the person you are speaking to, a positive facial expression, gesturing with your hands, pointing at objects, nodding of the head, body language should show you are interested in what is being said, not slumped in a bored position, a positive facial expression showing interest in what is being said.  allowing individual time to answer questions, checking understanding, speaking at the individuals level of understanding, ensuring the correct environment such as good lighting and seated comfortably, using open questions to encourage communication.

 When communicating with an individual who is hearing impaired or sight impaired it is important to lean in close when speaking to them and speaking a little louder. However you should never shout at them or encroach on their personal space.

You need to ensure you are using the correct language, not calling the individual “darling” but using their correct name. Take care with the tone in which you speak, sound interested not bored. Listening or giving quality time. It can be as simple as ensuring the person has their call ”bleep” to hand, without it they are unable to call for assistance.

Different methods of helping and supporting communication can also be through the use of pictures, signs, Makaton, Braille, Light Writers,

It is important to understand it can be inappropriate to use physical contact whilst communicating as many people are uncomfortable with this. Never use physical touch if it is unwelcome, if a person feels threatened or their personal space is invaded, when it is culturally unacceptable. It is important to realise the power of touch and the dangers of it being misinterpreted, especially if the individual has experienced physical or even sexual abuse.

Gerald Egan developed a theory of communication using an acronym in order to build the components of communication with others. This was outlined in his book called ‘The Skilled Helper’. The acronym he developed is: S O L E R SOLER is often used to guide health and social care workers when dealing with vulnerable individuals.

S – Sit attentively at an angle

It is important to sit attentively at an angle to the person who uses the service. This means that you can look at the person directly and shows that you are listening to the person seated beside you and that you are conveying interest.

O – Open posture

It is important for a practitioner to have an open posture. This means not sitting or standing with your arms folded across your chest as this can sometimes signal that you are defensive or that you are anxious. If a practitioner has an open posture the person may be more inclined to elaborate on their concerns.

L – Leaning forward

It important that practitioners lean forward towards the person using the service. This shows that you are interested in what the person is talking about. It is also possible that the person may be talking about personal issues and so may speak in a lower or quieter tone of voice. In addition you may want to convey a message in a lower or quieter tone of voice if you are seated in a public environment.

E – Eye contact

Eye contact is important as this demonstrates that practitioners are interested and focused on the message that the person using the service is conveying. You can also develop a sense of the person’s emotional state by making eye contact, therefore, enabling you to judge the extent to which the person may be experiencing difficulty.

R – Relaxed body language

It is important to have a relaxed body language as this conveys to the person using the service that you are not in a rush. This will enable the person to develop their responses to questions in their own time.

The benefits of using SOLER theory are:

Benefits to a person using the service.

• He/she will feel empowered to make decisions because they feel that they are being listened to.
• He/she will develop a close relationship with the practitioner and feel that they care, which will make him/her feel less vulnerable.
• He/she is more likely to have a speedy recovery from illness if they have a positive relationship with their carers and can identify any issues that they experience.
• He/she will feel more positive about asking for help if they feel that they will receive it in a non-judgemental and productive manner.

Benefits to a health and social care practitioner.

• He/she will understand the needs of the person using the service.
• He/she will effectively address the needs of the person using the service and review care plans more efficiently.
• He/she can ask the person using the service to elaborate on concerns that they may have, this may enable the practitioner and person using the service to develop a more meaningful relationship.

 2.4 Demonstrate how to respond to an individual’s reactions when communicating

 As a carer you will establish, developed and maintained a relationship with individuals. Over a period of time you are more likely to be able to anticipate and understand the potential reactions they may display when communicating with them.

It is important to observe an individual’s reactions when communicating with them because they may not always say what they mean. By using effective listening you can notice reactions. This may be when you ask an individual “How are you feeling today” and they reply “I feel fine” but from the expression on their face, the tone in their voice and body language, you will know they are saying more. You should respond to this by asking open questions to try to establish what the problem is. As a carer you need to be aware of these reactions and respond to them in the correct way.

Other reasons it is important to observe an individual’s reaction is:

• To ensure you understand them
• To ensure they understand you
• See changes which may affect their care needs
• Pick up non-verbal communication (expressions, body language, frustration, agitation, anger etc)
• You know if there is a barrier to communicating and can identify how to overcome it e.g. technological aids needed, sign language, change vocabulary, tone of voice etc
• See non-verbal responses eg. Eye contact, posture, physical gestures etc

 3 Be able to overcome barriers to communication

 3.1 Explain how people from different backgrounds may use and/ or interpret communication methods in different ways

 It is important to find out the individual’s communication and language needs, wishes and preferences because they can be so varied. The way you communicate with someone can differ depending on things such as:

• A sensory impairment
• Their disabilities
• Their health
• Their understanding
• Age
• Gender
• Their culture
• Their values and beliefs
• Their level of communication skills
• The nature of the communication
• Who you are communicating with
• Their health
• If there are distractions
• Their mood
• Personal space
• The type of communication etc

People from different backgrounds or cultures may interpret words or gestures differently. In modern language “sick” or “bad” can mean good or “fly” can mean amazing.

In Japan and also western cultures, such as North American and European cultures burping during a meal is considered bad manners while burping is not considered rude in certain parts of India, China and in Bahrain- A small island country located in the Middle East, just south of Kuwait. Burping after a meal can be a sign of appreciation and satiety. Italians are extremely expressive communicators. They tend to be wordy, eloquent, emotional, and demonstrative, often using facial and hand gestures to prove their point.

Your communication techniques should be flexible in order to respect people from different backgrounds and to meet various cultural needs. Remember and think about the following:

• It is an individual’s choice of how they wish to be addressed e.g. ‘Mr’, ‘Mrs’ or use of their first name. Always ask people what they would prefer to be called.
• Make sure the individual is comfortable with the way you are communicating with them e.g. Not sitting too close, touching them, using words they understand etc
• Respect an individual’s differences. Their background or culture may affect the way they speak regards their dialect or accent, the words they use and also their non-verbal communication.

 Always find out as much as you can about the individual and their background as this will support your communication with them.

 3.2 Identify barriers to effective communication

 There are many barriers to effective communication. Anything which blocks the meaning of a communication is a barrier. The first barriers to check out are those that you could be creating. You may think that you are doing everything possible to assist communication, but be sure that you are not making it difficult for people to understand what you say for instance using acronyms another person does not understand. Avoid professional jargon and terminology.

Physical barriers – these are due to the nature of the environment where you are trying to communicate. It could be there are distractions or noise, such as the TV on. An inappropriate temperature, making the room too hot or cold.  Is the room light enough?  Are you positioned so that you are close enough to be heard but not invading the individual’s personal space?

Physiological barriers – this could include hearing, sight difficulties, sensory impairment, health problems, and disabilities.

Psychological barriers – personal problems and worries can lead to lack of concentration, memory loss (dementia) or mental health difficulties. The confidence of the person.

Language difference including dialect or accent – this could be due to the choice of words use. Others linguistic abilities may differ from your own, leading to poor explanations and misunderstandings. Do they speak the same language as you? This could also be affected by the background and culture of individuals

Lack of subject knowledge – leading to poor explanations or answers to questions

Stereotyping – When an individual has a preconception about another individual, it makes it difficult for the individual not to view the other individual’s communication with prejudice

To minimise these barriers, speak clearly and slowly, explain carefully and check understanding. Give the individual time to ask questions and respond.

 3.3 Demonstrate ways to overcome barriers to communication

 Once the barrier has been identified it can be overcome. With physical barriers such as noise, try to eliminate or reduce noise levels by closing doors and windows, turn off TV’s or radios. Set the room temperature at an appropriate, comfortable level. With physiological barriers, ensure any equipment the individual needs to communicate is available and working correctly. Are their hearing aids switched on? Are the batteries working? Are their glasses available and clean? Is the individual concentrating or is their mind elsewhere? Try to get them to focus on what you are saying. Make sure you keep communication at the correct level for the individual you are communicating with. Don’t use long complicated words if they are unlikely to understand them. Use simple language, clear speech and appropriate pitch, tone and volume. Use active listening. There is a difference between listening and hearing. Make sure you know the subject which you wish to communicate about and prepare to be asked and be able to answer questions. Don’t make assumptions about an individual from their appearance. Just because a person is in a wheelchair it does not mean their ability to communicate is impaired!

It may be necessary for you to seek advice and support to help reduce any barriers. This could involve further training or the use of a translator, interpreter, signer or advocate.

 3.4 Demonstrate how to use strategies that can be used to clarify misunderstandings

 If an individual appears puzzled after a communication, check if they have understood by asking questions to clarify certain points. You could ask them to repeat back the important point or ask questions to confirm their understanding. If they still appear puzzled you can then repeat or rephrase the communication. If they appear to understand they will give you nonverbal signs of acknowledgement such as nodding, smiling etc. Always give the individual time to respond and do not rush any communication with them. To prevent misunderstandings always ensure you use the individuals preferred mean of communication by checking their care plan notes. In certain circumstances it may be wise to ask another carer to be present, especially if the conversation is likely to cause upset or distress or is of an important nature. In this way they are able to offer both you and the individual support. Active listening is important. There is a difference between listening and hearing. Active listening ensures the individual has understood the communication and not just heard it.

 3.5 Explain how to use communication skills to manage complex, sensitive, abusive or challenging situations and behaviours

 See the answer to question 1.3 which explains this in detail

If the communication you need to carry out is of a complexed or sensitive nature it is best to plan what you want to say beforehand. In this way you can give it some thought and plan the best time and place to have the discussion. By doing this you can think about how the other person may react and take this into account in the planning.

 3.6 Explain how to access extra support or services to enable individuals to communicate effectively

There are many different services available which can support and enable individuals to communicate. Support can come in various forms such as Human or Technical or symbolic.

Human support can come in the form of an interpreter or translator. This could be accessed either through my workplace manager, social services or even the police, who should all have a contact list of interpreters to hand. It is always best to use a professional rather than family member as the individual may wish to discuss issues which they do not want the rest of the family to know about.

Another form of human support could be a speech therapist. This would usually be accessed through the individual’s doctor, although in some areas individuals are able to refer themselves to the local speech and language service, if they feel they need help.

Technical aids come in many forms. If the individual is suffering with hearing difficulties, they should be referred to the doctor for a hearing test to establish if they would benefit from a hearing aid. If the individual is suffering with visual difficulties, they may need glasses. It may be that they already wear glasses but they need a new prescription, so they should be referred to the optician. Older people should have their eyes tested every year and younger people every two years. Other equipment which could be used are Light writers and speaking communication aids in the form of computer programmes and equipment. It is essential that an assessment is carried out before a communication aid is chosen so that an accurate picture of the individuals needs can be established. This can normally be accessed on a private basis through the internet. Other technical support can include, telephone amplifiers to aid the hard of hearing which are generally available through the telephone supply company. Symbolic aids can include, picture boards and books. Sign language, Makaton and Braille. Tutoring can be accessed via the Sense website. The local primary health care provider should be able to provide information to access any extra support requirements

Support can also be obtained from the following organisations:

Communication need                                      Support organisation

A person with dementia                                  Alzheimer’s Society

A person with a visual impairment                Royal National Institute for the Blind

A person with a hearing impairment             Royal National Institute for the Deaf

A person with a learning disability                Mencap

A person with cerebral palsy                          Scope

A person who has had a stroke                    Stroke Association

A person with mental health needs              MIND

A person who are deafblind, have               SENSE

sensory impairments or complex needs

Translation services: This service can help changing the written text from one language to another.

Interpreting services: This service can help with converting spoken language to another language.

Speech and language services: This service can support people who have had a stroke and have problems with their speech.

Advocacy services: This service can support people who are unable to speak up for themselves. This service tries to understand the needs, wishes and preferences of individuals, and will argue on their behalf.

 3.7 Explain the purposes and principles of independent advocacy

 Independent Advocacy is a way to help people have a stronger voice and to have as much control as possible over their own lives.

Independent Advocacy is:

• Standing alongside people who are marginalised in our society.
• Speaking on behalf of people who are unable to do so for themselves.
• Standing up for and sticking by a person or group and taking their side.
• Listening to someone and hearing their point of view.
• Helping people to feel valued.
• Understanding people’s situations and what may be stopping them from getting what they want or need.
• Offering the person support to tell other people what they want or need, or introducing them to others who may be able to help.
• Helping people to know and understand what choices they have and what the consequences of these choices might be.
• Enabling a person to have control over their life but taking up issues on their behalf if they want you to.
• A process of working towards natural justice

Independent Advocacy is not:

• Providing general advice.
• Making decisions for someone.
• Help filling in forms.
• Care and support work.
• Telling or advising someone what you think they should do.
• Solving all someone’s problems for them.
• Speaking for people when they are able to do it for themselves.
• Agreeing with everything a person says and doing anything a person asks you to do.

Independent Advocacy organisations are separate from organisations that provide other types of services. They provide ONLY advocacy.  This frees them from conflicts of interest.

The independent advocate is there to help individuals or groups get the information they need so they can make real choices about their circumstances. The independent advocate supports individuals or groups to put their choices and wishes across to others and may speak on behalf of an individual or group who are unable to do so for themselves.

The four over-riding principles of Independent Advocacy are:

• Independent Advocacy puts the people who use it first.
• Independent Advocacy is accountable.
• Independent Advocacy is as free as it can be from conflicts of interest.
• Independent Advocacy is accessible.

The main themes of advocacy are:

• Safeguarding people who are vulnerable and discriminated against or whom services find difficult to serve.
• Enabling people who need a stronger voice by helping them to express their own needs and make their own decisions.
• Enabling people to gain access to information, explore and understand their options, and to make their views and wishes known.
• Speaking on behalf of people who are unable to do so for themselves.

 3.8 Explain when to involve an advocate and how to access advocacy services

 Independent advocacy under the Care Act 2014

Local authorities must involve people in decisions made about them and their care and support. No matter how complex a person’s needs, local authorities are required to help people express their wishes and feelings, support them in weighing up their options, and assist them in making their own decisions.

The advocacy duty will apply from the point of first contact with the local authority and at any subsequent stage of the assessment, planning, care review, safeguarding enquiry or safeguarding adult review. If it appears to the authority that a person has care and support needs, then a judgement must be made as to whether that person has substantial difficulty in being involved and if there is not an appropriate individual to support them. An independent advocate must be appointed to support and represent the person for the purpose of assisting their involvement if these two conditions are met and if the individual is required to take part in one or more of the following processes described in the Care Act:

• a needs assessment
• a carer’s assessment
• the preparation of a care and support or support plan
• a review of a care and support or support plan
• a child’s needs assessment
• a child’s carer’s assessment
• a young carer’s assessment
• a safeguarding enquiry
• a safeguarding adult review
• an appeal against a local authority decision under Part 1 of the Care Act (subject to further consultation).

Your council has to provide an advocate if you don’t have family or friends to help and you have difficulty:

• understanding and remembering information
• communicating your views
• understanding the pros and cons of different options

A paid carer cannot act as an advocate for you. You could also access advocacy support by:

• Contact social services at your local council and ask about advocacy services.
• POhWER is a charity that helps people to be involved in decisions being made about their care. Call POhWER’s support centre on 0300 456 2370 for advice.
• SeAp Advocacy gives advocacy support. Call 0330 440 9000 for advice or text SEAP to 80800 and someone will get back to you.
• Contact the charity Age UK to see if they have advocates in your area. Contact Age UK online or call 0800 055 6112.

 4 Be able to apply principles and practices relating to confidentiality

 4.1 Explain the meaning of the term confidentiality

 Confidentiality relates to the duty to maintain confidence and thereby respect privacy. Confidentiality refers to personal and sensitive information whether written or spoken about a person. Privacy relates to personal information that a person would not wish others to know without prior authorization. Privacy relates to a person’s right to be free from the attention of others. Confidentiality is an important principle in health and social care because it functions to impose a boundary on the amount of personal information and data that can be disclosed without consent. Confidentiality arises where a person disclosing personal information reasonably expects his or her privacy to be protected, such as in a relationship of trust. The relationship between health and social care professionals and their patients/clients centres on trust, and trust is dependent on the patient/client being confident that personal information they disclose is treated confidentially.

The Skills for Care “Code of Conduct” for social care workers states you should “Respect people’s right to confidentiality” Guidance statements

As a Healthcare Support Worker or Adult Social Care Worker in England you must:

1. treat all information about people who use health and care services and their carers as confidential.
2. only discuss or disclose information about people who use health and care services and their carers in accordance with legislation and agreed ways of working.
3. always seek guidance from a senior member of staff regarding any information or issues that you are concerned about.
4. always discuss issues of disclosure with a senior member of staff.

You should advise individuals with information and clearly explain your agency policies about confidentiality to service users and carers as this will establish and maintain the trust and confidence of the service users. Information regards an individual is only given to others on a “need to know basis” and generally only with the individuals consent. In a social care setting it is expected that information is “confidential to the organisation” thus it is not acceptable to keep secrets from colleagues about the care of individuals using the service. Equally, it is not acceptable to share private and personal information about individuals using the service with those who do not work in the care setting, unless you have permission from the individual or care manager

 Information should only be used for the purpose for which it was obtained.

4.2 Demonstrate ways to maintain and promote confidentiality in day‐to‐day communication

 As a carer you maintain confidentiality by never discussing an individual with others in the care setting unless it is other staff involved in the individuals care. You ensure that any time you have to discuss an individual with another member of staff it is done in private so that it is not overheard by others. You maintain the security of an individual’s care plan and daily notes by ensuring they are always placed in a secure storage place after completion. When communicating information by letter, ensure it is clearly marked “Private and Confidential”. By email send the correspondence as an attachment marked “Private and Confidential” By fax, mark as “Confidential” and send it yourself and confirm recipient has received it. All computers should be password protected and these should be updated on a regular basis. Screens should never be left open with confidential information on them. Electronic data should be encrypted. During handover ensure it is conducted in a private room with the door closed. By telephone, ensure that you are speaking to the correct person and that you are in a private place, with door closed, so as not to be overheard.

 4.3 Describe the potential tension between maintaining an individual’s confidentiality and disclosing concerns

 Generally confidential information can only be disclosed if it is in the Individual’s best interests, for the protection of others, in the interest of public health, during an official or legal investigation such as a court or tribunal orders disclosure, or if there has been or there is a risk of a serious crime committed. Maintaining an individual’s confidentiality is important as it creates a bond and trust between you and them. Repeating information they have told you can be very damaging to your relationship with them. You should always be honest and if something they tell you needs to be passed on you should explain why this is necessary and to who you will be passing the information.

An example could be if someone confides in you that they are being abused you must disclose this to protect that person from further abuse. You must inform the individual that the information must be passed on and that it is your duty and responsibility to do this. (Code of practice and workplace policies and procedures) This may upset the individual and cause them to mistrust you but if discussed and dealt with in the correct way it can help them to understand why it is necessary and how it will help them and stop the abuse from continuing. You can explain and reassure them that you would only pass the information on to your workplace manager who you trust.

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