O: Open posture. A care worker should consider the type of posture that they use so that clients feel comfortable and valued. Crossed legs and crossed arms can be seen as a barrier and that the professional is not interested. However, an open posture can be a sign that the professional is interested and willing to interact.
L: The care worker should lean towards the service user to show that they are interested. Leaning back and away from the service user may show distance and disinterest.
E: Eye contact with a service user shows that the care worker is interested in what the service user has to say. The care worker should consider that direct eye contact is not acceptable in all cultures. In some cultures, such as Asian or African cultures, it can be seen as disrespectful and as being defiant.
R: The care worker should make sure that they are relaxed when working with the service user. The care worker should not be fidgety or become distracted too easily, as the service user may also become nervous. When staff is relaxed it shows that they are comfortable with the situation which can encourage the service user to also be relaxed.
Group Structures – Bruce Tuckman (1965) introduced four stages of group development which he felt was crucial in setting up healthy groups.
Group structures involve two types of groups; Primary group and Secondary group. A Primary group is made up of a group of people who know each other and when there is a ‘feeling of belonging’ shared in the group. This also applies to people who have the same point of view, meaning, purpose or reason on a specific argument. These people often share the same ideas, beliefs and norms. This type of group is also mainly within the family and/or close friends.
The Secondary Group is made up of those who have a lot in common and is usually formed outside of the household.
Tuckman argues that there are barriers which can be formed when interacting within a group. These include:
- Not all knowing what the aim or purpose of their role in the group actually is;
- A lack of trust, as the people are all unfamiliar to each other;
- Different personalities cause clashes;
- The leader of the group may have a lack of communication skills which can prevent the other members from not interacting positively.
Tuckman identifies different stages when new groups are formed. These stages are:
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Forming is the first stage in group formation. It all starts off with asking basic questions and getting to know each other. They talk about the purpose and the aims of the group formation and whether they are ready for it. As this is the start of the group formation, some participants may feel unsure or uncomfortable. A ‘leader’ then emerges within the group.
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Storming is the second stage, and mainly includes arguing about the purpose of each person being there, and whether the ‘leader’ is ‘good enough’ to keep them all working together, as well as if they can maintain their authority over the group. They avoid any personal issues from coming in their way in order to not get distracted. Agreements may be needed to allow an improvement on the communication in the group.
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Norming is the stage where the participants get to know each other and learn about their norms, values and behaviours. The group culture is then formed. They form stronger bonds and are now ready to work together to solve conflict. They also learn to appreciate each other’s skills and experiences and how best to support each other.
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Performing is when the group matures and start working effectively to reach their aims. There tends to be more focus and relationships are much more comfortable at this stage. A feeling of trust and supportiveness emerges in the group, and norms and values are easily shared with confidence. The group’s performance improves and is much more effective.
Maslow’s Hierarchy of needs - Communication is important in meeting the needs of both service users and the society. Every individual has needs that have to be met to satisfy them. Maslow (1943) introduced a hierarchy of human needs where he argued that human beings have specific needs met in order to move on to the next stage. The first stage of the hierarchy is the Physical Needs. These needs include food, water and shelter which are the basic needs every human being should receive. Communication is needed for assistance, hunger or pain.
The second stage is the Emotional and Physical Safety Needs, such as love, value and reassurement. A sense of absence of one of these needs may be achieved if there is a lack of communication.
The third stage of the hierarchy is the Belonging and Affection Needs and involves the sense of belonging and absence of isolation and loneliness. This need can be met by interacting with other people as this leads to affection and can lead to developing attachments with other people.
The fourth stage involves Self-Esteem Needs which are confidence and empowerment. A high or low self-esteem can be the result of people’s opinions and reactions that you receive from them. In order to have a high self-esteem, a supportive and encouraging form of communication should be developed.
The last stage, which is the fifth stage at the very top of the hierarchy, is known as the ‘Personal Growth Developing Full Potential’ also knows as the ‘Self-Actualisation’ need. Many people will not come this far as you would have to achieve all the previous needs. It involves the person feeling confident and aware of whom you are as an individual and know what your goals are and what you want to achieve. This type of personal growth often depends on the sharing and expanding of concepts and ideas and interaction with and within the society.
Maslow’s Hierarchy of Needs chart
http://www.union.umd.edu/GH/basic_needs.
M1: It is essential to promote effective communication and interpersonal interaction in health and social care settings, as inappropriate or ineffective communication can damage the professional relationship between the health and social Care professional and service user.
In order to communicate effectively, it is important for health and social care professionals to use theories of communication. Effective communication is important in meeting the needs of both service users and the society.
Egan (1986) stated the importance of leaning in his theory of the SOLER Principles. Maintaining a good posture promotes effective communication and shows interest. For example, it is important for the counsellor to lean while counselling with a client. It shows that they are determined to help and it reassures the client as it allows the client to feel comfortable in opening up.
Egan also stated that eye contact is essential as it shows interest. Therefore, health and social care professionals need to ensure that they use appropriate eye contact in order to engage with the client. If not, it will form a barrier between the health and social care professional and the client as it will show that the care worker is not interested or willing to help.
Tuckman’s theory (1965) of group formation shows that the second stage, storming, is important as the group becomes more focused on their goals. This can be very important when teaching. People, for example students, who are being instructed or advised by someone, may have to go through the different stages of Tuckman’s model.
Maslow’s Hierarchy (1943) shows us how important it is to have your needs met. For example, the third stage Belonging and Affection Needs shows that ineffective communication between two people who share a relationship may be the cause of having your affection needs not met. For example, if the two people do not interact with each other, it is most likely for them to stop having intimate feelings for each other. Therefore, interaction which is effective is essential in a close relationship in order to share information and emotions. It also gives a sense of belonging which avoids a sense of isolation.
Final conclusion
Within this piece of work I have explained the factors which can have an impact, whether positive or negative, on the communication used in health and social care settings. I have also explained the importance of communication in health and social care and have referred theories to the explanation.
There are many factors that may have influenced the communication and interpersonal interaction in the case studies of Meredith and Keith. Interpersonal interaction is the communication conducted between one person to another. It can involve touch and closeness in order to encourage comfort and reassurance. Listening skills can be increased in order to show value in the opinion of the others.
Meredith is a 74 year old woman who is from St. Lucia. She came to Britain in the 50s and did nurse training to eventually become a ward sister. She later suffered from a number of mini strokes and then incurred a stroke which left her with a paralysis on her left side and a speech impediment.
The influences which had a positive impact on Meredith’s communication were:
- She was familiar with the environment, because she trained to be a ward sister.
- Jo was interested in Meredith’s wellbeing
The influences which had a negative impact on Meredith’s communication were:
- The environment was noisy, busy and pressured. There was a lack of time and a lack of privacy in the ward;
- There was a lack of choice given to Meredith;
- She had a speech impediment, which had an impact on her communication;
- She was unable to express herself due to the stroke she suffered from;
- Her social worker never remembered to bring her pen and paper, so she could write down what she wanted to say;
- The social worker was being negative around her;
- The absence of her friends made her feel lonely and unsupported;
- She agreed to go into residential care due to the pressure from the staff in the hospital she was in.
Keith is a 35 year old man who has joined a local support group for people who suffer from stress in his nearby region. He was getting treated by his GP already for having a slightly raised blood pressure and insomnia. He was an only child and suffered from loneliness and isolation.
The influences which had a positive impact on Keith’s communication were:
- There were a lot of people who are in the same situation as him, which helped him to feel that he belonged and was not excluded;
- While communicating with the others in the group, the chairs were put in a circle to aid communication;
- There was a lot of empathy involved, because most people were suffering from the same thing;
- It gave him a lot of time – 8weeks – to talk about his problems;
- He learned to be more responsive towards other peoples’ feelings;
- The man who ran the group was positive and approachable which helped Keith to open up more.
The influences which had a negative impact on Keith’s communication were:
- There were a lot of people involved, which made Keith feel uncomfortable;
- The group took place in a hospital and this may have made Keith feel uncomfortable;
- At the end of the sessions, Keith felt angry and sad that the group was ending;
- They had to admit to their problems and come face to face with them, which may have been very hard.
- There are many methods that are used in health and social care environments to overcome barriers in communication. In Meredith’s case some strategies to help her with her communication are providing her with a pen and paper, due to her speech impediment, so she could express herself and write down what she needs or what her wishes are. The use of pictures or images can help her with telling others what she wants and using sheets with information on it that offer options can be easy for her as she can just point at what she wants, for example a menu.
- Advocacy can also be very helpful. An advocate is someone who speaks on behalf of the patient and represents their interests. Because Meredith suffers from a speech impediment and, therefore, has communication problems, it is not possible for her to communicate well with others. An advocate will be very useful in these situations. The advocate can try arguing Meredith’s case, so she can stay in the ward and avoid going into residential care.
- However, there are some issues related to advocacy that need to be taken in account. For example, misinterpretation can lead to many problems. If the advocate gets Meredith’s needs wrong then it can lead to her becoming frustrated and the advocate might end up just guessing what her needs are. There is also a matter of confidentiality and trust involved when using an advocate. Meredith might not want the advocate to know about her personal problems and her needs. This can prevent her from opening up and, may therefore, end up in not meeting her needs. A service user should be able to trust their advocate in order to be heard. An advocate should be independent to be able to argue for the service user’s rights without being influenced by staff.
- Another way of overcoming barriers to effective communication is to give the service user rights and choices. This is also linked with Keith. Everyone needs privacy and dignity. You can give them these rights by simply asking them about their needs and listen to what they have to say, which also shows that you respect them. Being in care can also lead to isolation and unsatisfaction. It is, therefore, helpful to talk to them when they are alone to make them feel more comfortable, reassured and welcome.
- Adapting their environment can also help. It can avoid making the service user feel disempowered and shows empathy. You can simply sit beside them or let them do daily things like bathing, walking and eating. Closing curtains to ensure privacy is also essential.
- A one-to-one is always helpful with patients such as Keith. Keith needs lots of verbal encouragement to show him support. It can help both Keith and the service provider with understanding each other and coming to agreements. When doing this, it is also important to use non-verbal communication such as good eye contact and good body language in order to show that you are interested and ready to help. Staying positive at all times is also important as it shows that you are approachable and supportive. An open posture is also important to show interest and a smile shows warmth.
- Referring a service user to a speech therapist or physiotherapist shows that you care about the condition of the service user. As a service provider it is essential to put effort in the work that you are doing in order to provide the best service.
- The use of care values is also helpful as it makes the service user feel much more valued.
- For this task, I had to participate in a group discussion and have a one to one conversation with someone. The topic of the group discussion was ‘Facebook and the advantages and disadvantages of social networking’. It was a small group of 5 people, which was a good thing as we all got to talk and give our opinions about social networking.
- The setting of the one to one was a quiet room. I had my one to one with a friend of mine, which made it easier for me to talk and express myself as I was comfortable with her. The one to one seemed more organised and planned as we both knew what to say and we managed to reflect on each other’s opinions.
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In our one to one conversation, we were seated opposite each other with a slight angle. This helped me to use eye contact effectively and this showed that I was listening. We were not seated too near or too far from each other as this would have created a barrier in the communication taking place. This was also important in order to see each other’s facial expressions. I had to make sure that my listening skills were strong as I had to be able to respond to her, otherwise the conversation would have been uninteresting and boring.
- The topic we discussed was ‘The effects of youth gang crime on the socialisation of young people in Britain today’. It was a topic which was easy to discuss as there is a lot of controversy about it these days.
- The setting where the group discussion took place was a quiet room and the seats were arranged in a circle. This makes it easier to communicate as you can have eye contact with everyone and you can see each other’s body language. The group was small and organised and included about 5 girls ranging between the ages of 16 to 19.
- We discussed the positives and the negatives about social networking websites and how it affects our lives, using mainly Facebook as an example. We mentioned some real life cases which came on the news that involved social networks and how it can make people aware of certain things happening around the world.
- We decided to discuss this topic as social networks are part of our lives nowadays and everyone uses them somehow. However, they can be dangerous, and putting personal information on the internet can lead to unexpected consequences, so we found it quite useful to have a talk about it and share our own opinions and experiences on social networking and how it can affect our daily lives.
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The communication skills I used while doing the group discussion were good eye contact in order to show that I was listening; good body language like leaning in, but not too close, to show that I was interested in what was being said; I listened well and spoke out loud to make sure everyone could hear me and I made sure I made sense when talking/responding. I also gesticulated at times when necessary to emphasise what I said. It was important to keep my tone and volume of voice constant to make sure everyone involved in the discussion could hear me. One of my weaknesses was that I didn’t talk a lot and I couldn’t carry on the conversation.
- Patients and service users usually need a range of specific needs to help them with their communication. Service users suffering from an impediment, disability or disease usually have a difficulty with communicating. This can prevent them from having their needs met. It is, therefore, essential to provide service users these specific communication needs to help improve their quality of life.
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For example, a patient who suffers from dysphasia may have difficulty in speaking, understanding, reading or writing. This can affect their relationships and personality, which then can turn into loneliness and isolation. Dysphasia can be caused by a stroke, a head injury or dementia. The easiest way to communicate with people suffering from dysphasia is by talking to them very slowly and calm and making sure the environment is not noisy. You can also use non-verbal communication and make use of images and pictures.
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Within care settings, special methods are used due to people who have disabilities. For example, deaf people or people who have a speech impediment may not be able to use verbal language so therefore need to use sign language. Blind people are unable to read, so therefore they use a special form of reading known as Braille. This is a system of small raised dots that represent the alphabet, punctuation and numbers. Also, the method of Makaton is used which is a communication system using simple hand signs. It is commonly used with children affected with Down’s syndrome and adults with communication difficulties and learning disabilities to help them develop their language skills.
- People suffering from deafness or a hearing impairment may need a hearing aid to help them listen and respond. However, turning your back to someone who uses a hearing aid can impact on the ability of hearing. This is because some people suffering from a hearing impairment use lip reading as a way of understanding what is being said.
- Dementia can decline the abilities of the brain. Many old people are diagnosed with this syndrome because the older you get the more likely you are to develop it. Dementia can affect the memory, the way of thinking, the way of using your language, your understanding and your way of judging. Dementia can also be the result of a stroke, which can leave a person with a speech impediment which the affects their communication.
- There are no cures for this condition and it can only deteriorate. Due to the changes in understanding and usage of language, a communication problem occurs. The best way to communicate with an individual who suffers from dementia is to use simple language. If the person has completely lost the ability of speech, the best way to communicate is to use sign language or the use of pictures and images.
For this task I have to investigate on an area in a health and social care context. I have opted for ‘Mental health problems’.
A mental health problem affects a person’s brain. It may impact on the way a person thinks, behaves and interacts with other people. The severity of a mental illness can vary and many people who are suffering from a mental illness may not look as though they are ill or as though there is something wrong with them, while others may appear agitated, confused and withdrawn.
There are many types of mental illnesses. Some of the most commonly diagnosed forms of mental illnesses are:
- Depression – Feeling unmotivated, hopeless and having a low self-esteem;
- Anxiety – Being worried and restless all the time;
- Panic Attacks – Having sudden, unexpected fits about intense terror;
- Obsessive Compulsive Disorder – Having no control over your thoughts and ideas (Obsession);
- Phobias – An unreasonable fear for a situation or object;
- Manic Depression (Bipolar Disorder) – A mood disorder which causes hyperactivity;
- Schizophrenia - Hearing voices and seeing things that other people cannot.
The Illness - Wellness Continuum is linked to the statement of health as an absence of illness and disease. This continuum measures a person’s level of wellness with a diagram in the form of an arrow. The process of measuring starts in the middle of the arrow, which is a neutral point that shows no illness or wellness. As it moves to the right, significations of high levels of wellness arise. On the other hand, moving to the left shows high levels of illness, diseases and premature deaths.
The Illness-Wellness Continuum is linked to mental health too. Everyone has times where they are physically ill or stressed, whether it is temporary or permanent.
The cause of mental illnesses is still not clear. It is argued whether it is caused by their life experiences or whether it’s determined by their genes inherited from their parents. It is possible that some people are more vulnerable to mental health issues, which could be triggered by stressful or traumatic events. Stress, a difficult family background and physical illnesses are also seen as a possible cause for a mental problem.
The best way to communicate with an individual who suffers from a mental illness is to take things slowly. A lot of patience is required when talking to a mentally ill person. Trust is also an important factor when interacting with an individual who suffers from a mental illness. Due to their condition you can never be sure of whether they are telling the truth or not. The patient can also suffer from the side effects of their medicines. For example, tranquillisers that can make you feel drowsy. Erratic behaviour and not being able to engage well due to getting distracted can also lead to a difficulty in communication.
When assessing a patient it is also important to know that they may not exhibit any sort of mental ill health behaviour in front of you. This can lead to an incorrect diagnosis which, at times, can lead to prescribing the wrong medication or providing the incorrect treatment. A care worker may also feel threatened by the behaviour of the patient. On the other hand, the patient may also feel threatened by the care worker or the setting. Both individuals may feel pressured by each other and the patient may feel pressured by the questions. Another factor which may influence the conversation is not being able to understand each other. A patient may be agitated and may speak loud or very fast and in a sharp tone of voice.
However, a nurse needs to stay calm and steady at all times or things may escalate.
I have chosen a case study to illustrate the difficulties of communicating with a person who suffers from a mental illness.
‘Simon Jackson is a man who is in his early twenties and who lives in the Natterbox Community Centre. He talks to himself constantly and shouts abusively at people who pass him by whenever he is drunk, which is quite often. Being among people scares him and he is usually seen outside drinking beer with street drinkers. He is also often seen talking to himself and muttering agitatedly at himself. Young parents find his presence threatening to their children as he was once seen shouting at a child in the community centre. He lives alone and talks to no one. He also usually stays inside his flat for weeks at a time and he is sometimes seen looking around in dustbins for food. It is obvious that Simon gets picked on by some of the young people in the local area as he has been seen with visible cuts and bruises as if he had been beaten up quite badly.’
Simon’s mental state is clearly not well. He needs to have his needs met in order for him to start behaving more normal. Talking to him in a mild tone of voice and listening to what he says is important in this situation. There always seems to be something wrong in order to make him agitated. To make sure he does not trouble other people it is important to know what his needs are and what he wants to satisfy him.
His loneliness can also be a problem which may trigger him into becoming “edgy” and scared around others. He is probably not used to being among people and he may feel unsafe. It is important that the care worker encourages Simon to go out and meet new people. This helps him with his communication and it can aid him in starting to get comfortable around people. However, there should be someone with him at all times to make sure he does not get aggravated. Meeting new people can also help him build up his confidence, self-esteem and trust.
There are many methods which can help a service user to overcome communication barriers when talking to a person suffering from a mental illness. These methods can be applied to both verbal and non-verbal communication.
When interacting with a patient who suffers from a mental illness, it is important to use good body language and facial expression in order to make the patient feel comfortable. Keeping the SOLER principles in mind is important for service providers to be able to communicate effectively. Sitting squarely and maintaining an open posture is important to show that you are interested. Also, leaning in and having eye contact with your patient is important to show that you are listening. As a service provider it is also essential to show that you are relaxed, as being tense and nervous can lead to fidgeting and this may convey a wrong message to the patient.
Another way to show that you are ready to help a patient is by simply listening to them. This can make them feel valued which then may lead to the patient trusting the service provider and opening up more.
Proximity and personal space is also important as the patient should not feel under pressure. Sitting too close to the patient can lead to discomfort and intimidation.
Because patients who suffer from mental illnesses may have problems with putting their thoughts into words, it would be considerable for the service provider to paraphrase, or clarify, what the patient says to you. Not only does that make it easier for you to understand but it also makes the patient feel more valued as they know they are being heard.
Empathy is always important when dealing with people who are suffering from an illness. By being compassionate and by agreeing to what the patient says you show that you are capable of sharing another person’s feelings and emotions.
There are ways to treat and show support to people who suffer from a mental illness:
- Discussing the situation with someone you trust, e.g. a family member or close friend can be very helpful;
- People with mental health problems need help and support to enable them to cope with their illness. There are many treatments, including medication, counselling, psychotherapy and self help;
- It is important that people with mental illnesses are told about the options available so they can decide which treatment suits them best;
- An important step in the recovery process is for the person to accept that they are ill and to want to get better. This can take time, and it is important for family and friends to be supportive;
- Many support groups and charities offer advice, confidential counselling and information about the types of treatment available and where to get help.
- For this task I am going to provide a realistic evaluation about the two interactions that I have undertaken previously.
- I believe that the communication skills I used in my two interactions were appropriate. I made sure I used as much eye contact and positive body language as possible in order to show that I was interested and actively listening. When I talked I used an appropriate and loud tone of voice and made sure my expressions were clear and understood by everyone. I also managed to stay calm and not interrupt others while they were talking. I communicated respect and showed that I was taking my other people’s views and expressions seriously. This also helped me to reflect my opinions to theirs and build up on my responses.
- I also used effective body language in order to show that I was ready to respond and that I was listening. A loud voice was also important to make sure my partner could hear me and I made sure I stuck to the SOLER principles. I sat squarely and maintained an open posture in order to convey a positive message to my partner. I leaned in towards the person and maintained eye contact, which was important in order to show that I was listening and interested. Although I felt nervous, I showed that I was relaxed. This brings a much more positive atmosphere in the room. This also applies to the group discussion.
- Although the setting during the group discussion and the one to one was a quiet room, we could hear noises coming from outside the room. This disrupted the conversation and distracted us at times. The noise acted as a barrier in our communication cycle.
- One of the factors which influenced my way of communicating was the fact that my partner was my friend. This made it easier for me to open up and speak about my views as I feel more comfortable with someone who I know well.
- During both interactions I used appropriate and formal language. This was important in order to show my understanding of the subject and this also encouraged others to use formal language while interacting. Using inappropriate or informal language can also act as a barrier as it can lead to misunderstanding or misinterpretation which could then lead to a different response.
- However, there are some communication skills I may have to improve on. For example, I managed to carry on one conversation but failed to talk after that. I also did not talk a lot due to my insecurity and this prevented me from expressing my thoughts and opinions.
- During my one to one interaction I was quite nervous and stammered at times. This may have been due to the pressure I felt as I was being watched and recorded. There was one time when I did not know how or what to respond which then resulted in an awkward silence. However, I did manage to break the silence and talk after that.
- I also could have improved on my questioning and my way of reflecting on what my partner was saying to me.
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Walsh, Mark. Advanced Vocational Health and Social Care. UK, Collins, 2000.
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Moonie, Neil. AS Level for OCR Health and Social Care. UK, Heinemann, 2005.
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Moonie, Neil. AS Level for AQA Health and Social Care. UK, Heinemann, 2005.