Health and Social Care Communication. Examples from work with a service user with memory problems, and with new users of a playgroup.

Authors Avatar by stephh16 (student)

LO4 – Be able to communicate and interact effectively in a health and social care environment

OCR Nationals Cambridgeshire

Level 3 Unit 1

Certificate/Diploma

Health and Social Care

Developing effective communication in health and social care

The service user that I plan to have a one-to-one interaction will in Majella. I am going to be a care worker working at a local day centre. Majella attends this particular day centre three times a week; I am planning on having a one-to-one interaction with this service user for reminiscence therapy. Majella has very little memory and therefore this type of therapy would be the most appropriate in order for her to try and reconstruct her memory of the past. This, in return should help Majella to communicate more effectively with not only care workers, but also her family and other service users she may wish to communicate socially with.

The fact that Majella has very little memory means this type of therapy would be most appropriate for her. It can be very useful and helpful. Reminiscence will provide a way for Majella to interact socially and conversationally based on her long term memory. This means her long term memory is acting as a facilitator.

Reminiscence groups can be done easily and each topic is easy to plan and put into practise. I can get videos of old fields and old loved film stars may revive memories for Majella, for example.

When using reminiscing therapy with Majella I should remember that everyone reminisces and for elderly service users such as Majella, memories mean so much more. Reviving Majella’s memory and making her happy is a positive thing to do in therapy. Also, like all parts of our bodies, the brain needs to keep functioning to the optimum level it is capable of and reaching into Majella’s long term memory will make her feel happy and will provide a time of enjoyment for both Majella and I.

Majella having very little memory could lead to her feeling confused, vulnerable and less confident then other service users may be. However, memories from previous years will often remain in service users like Majella’s mind, and will be not only intact but also quite detailed; sometimes they just need to be recalled. By recalling these memories it can be quite therapeutic and enjoyable for Majella. Reminiscence therapy will allow the service user the opportunity to meet as a group or one-to-one interactions and share stories and exchange experiences they may have had. This is helping the service user to be more sociable and will aid them to recall that they have had a full and happy life, and that they should not let their memory affect this. By actively being involved in reminiscence therapy this can enhance Majella’s self-esteem and help her to make a valuable connection between her past memories and her current lifestyle. This type of therapy also has the potential to help resolve and make sense of events that she may have encountered in her past experience. Such things can bring lots of emotions for Majella and I should be prepared for this.

Reminiscence refers to the recollection of memories from the past, that will be familiar to service users and beneficial towards other such as Majella. It involved exchanging memories with other young and elderly service users, or with care workers passing on information, wisdom and important skills. It is a form of therapy which has been known to be extremely useful when helped aid service users with memory problems; it provides way for the service user to communicate effectively about things they do remember. Reminiscence therapies are used frequently within care settings, such as residential homes like the one Majella is attending. A variety of different mediums are able to assist the act of recalling and retaining information.

One strategy that can help service users such as Majella to recall information is visual. This can be by looking at past photos such as her wedding day – this could trigger happy memories for Majella, as she will remember what she felt like that day and how pleased she was. I could also look at objects that have autobiographical meaning with Majella and we could discuss the story behind them. This would give her a chance to tell me exactly what she can and cannot remember. We could also look at pictures of her friends and family and see if she can remember the time these pictures were taken and where. This may help her to recall the names of people that she would have otherwise forgotten. Even hair and make-up styles that were around when Majella was younger can help her recall information. She may remember having that hairstyle and then remember something she did when having that hairstyle that she may have forgotten before.

Music can also help service users like Majella recall information. I could put familiar tunes for the radio station and she may have a memory of something she was once doing when this song was played. Also, we could look at different CD’s off different genres and generations. The service user may remember liking one of the singers very much. These sorts of memories would have a positive effect on Majella because she will reminisce about her younger days.

Smelling and tasting certain things can also help recall information. This can be tasting different foods, perhaps ones she liked when she was younger or smelling the scents of candles. Many older service users like Majella have memories of happy events that are associated with smells. For example, the smell of the first perfume bottle the service user was ever given or bought.

Finally touching different objects can help Majella to recall certain information. For example, she may touch something and not know what it is but remember touching something like that before. I can also encourage her to feel the texture of something as this could have the same affect.

Reminiscence can be used in a group or a one-to-one interaction, it can usually be categorised into three main groups:

1. Simple reminiscence – the idea of this type of reminiscence is to reflect on past information in an enjoyable manner that will make the service user feel confident and happy

2. Evaluate reminiscence – this particular type of reminiscence can be more therapeutic and can be used to review a service users life or to prevent any conflict they are having in their life

3. Occasional reminiscence – this can be quite unpleasant as well as stressful for the service user and this could be called the offensive defensive reminiscence. It could be the cause or the result of a behavioural and emotional issue.

Reminiscence therapy can include a wide range of topics:

   1. Family and friends

   2. Loves and losses

   3. Achievements and disappointments

   4. Adjustment to life’s changes

   5. Social inclusions

In using reminiscent therapy with Majella, this may help me to assist her in better memory recall and it could also help to improve her quality of life. It can provide an enjoyable talking point between Majella and I, helping to improve communication resulting in Majella feeling listening to, and this will potentially increase her sense of self-worth.

Research from http://www.memoryboxnetwork.org/reminiscence-therapy/ shows that in Scotland alone there are an estimated 71,000 people with Dementia with the number expected to double in the next 25 years. It also shows that 64% of dementia sufferers live in their own home with others living in care homes. A review of recent studies carried out by IRISS the Institute for Research and Innovation in Social Services noted to key points:

      1. Reminiscence therapy is a valuable psychotherapeutic approach.

         1. Reminiscence therapy can improve the mood, cognitive ability and well-being of service users who have memory loss

         2. There is evidence to suggest that reminiscence work can improve the relation between care workers and service users

Memory is simply a service users and a care workers ability to encode, store, retain and recall information and past experiences within the human brain system. It is the total in which we all remember, and will give us the capability to learn and adapt from previous experiences within our lives, and to build relationships, it is potentially the ability to recall past events. It is known to be a storage of learnt and retained information from activities we may have done or experiences we may have had.

Memory has tried to be defined through models produced by psychological theorists. Memory has two systems according to the Multi-Store Model by Atkinson and Shriffin (1968). They made a model of memory: first sensory memory, everything from the environment goes into the senses, if an individual pays close attention, this will then be transferred into short-term memory, if the information decides it is then lost. However, if the information goes through a rehearsal loop, it will then be stored in long-term memory which potentially lasts a life time.

As I am caring for Majella, I may notice that communication with her has become more difficult and she struggles to communicate with not only me but also family and friends.

Service users who have memory loss lose particular communication abilities during the early, middle and late stages of their memory loss. Here is what I can expect and what kinds of communication challenges can occur during my interaction with Majella:

Early Stage  -

- Increased concentration may be required to follow conversations during the therapy

- Trouble staying on topics we have planned to discuss

- More time may be required to formulate verbal responses to questions I ask her

- Increased frustration

- Difficulty finding the right word to say to me, at times

- May lose her train of thought more often than when memory loss began

Middle Stage -

- Difficulty understanding long conversations

- Difficulty understanding reading material

- Decreased ability to interpret facial expressions

- Trouble explaining abstract concepts

- Decreased vocal expressions and ability to raise or lower voice

- Difficulty finishing sentences

- Apathy, including a reduced interest in communicating with me and others

- May speak in vague and rambling sentences

Late Stage -

- Inability to understand the meaning of most words

- Problems realizing when I am addressing her

- Diminished use of proper grammar

- Majella could even become totally mute

It is important that I remember Majella may appear to be uninterested in communicating with me, however this could mean that her memory loss has simply mad her incapable of showing a desire to communicate. I should not take any offence to this. That is why it is so crucial that I always strive for meaningful communication with Majella.

Although communication is often taken for granted, it is what connects everyone together. It is important to all of our relationships as it allows us to accomplish goals we may have, it also gives us a sense of self-worth. Unfortunately, memory loss creates barriers to communication that can strain the service users relationship with family members, friends and care workers. Before I learn how to better communicate with those who have memory loss, it is important to understand the meaning of communication.

Communication is the exchange of information, sharing ideas, expression of emotions, and sending and receiving of messages. It is a verbal or non-verbal way of relating to another, a representation of who both care workers and service users are as human beings, as well as a reflection of feelings and thoughts through words, attitude facial expressions, tone of voice and body language.

Although all service users are different, memory loss can create distinct challenges in regard to how service users are able to express themselves and understand what is being communicated to them. As I communicate with Majella I may notice she does things such as:

- Difficulty finding the correct words

- Creating new words for ones that are forgotten

- Repeating or overusing a word of phrase

- Trouble organizing words into logical sentences

- Cursing or using other offensive language

- Diminished speech

A big help to communicating with Majella would be listening properly. I need to ensure that I am an active listener when I communicate with her because she may need assistance expressing her thoughts. I should be sure to:

Show patience – Majella will be able to sense when I am inpatient or agitated, and this will only increase her own frustration.

Providing reassurance – If the service user is having trouble communicating, I need to tell her that it is fine and encourage her to keep trying to put her thoughts into words.

Focus on the positive – Criticizing or correcting things Majella says is non-productive and it may also be harmful. Instead, I should focus on what she has said and try to find meaning of her message. However, if I cannot, I should not assume she means one thing when I am unsure, and should instead politely ask her to repeat what she has said.

Agree instead of argue – If I do not agree with – or are offended by – a statement Majella has made, I should just let it go and not get upset or over think it.

Offer alternatives – If the service user is really having difficulty finding the right words, it would be OK to offer a guess as long as Majella appears to want some help.

Concentrate on feelings – Although the content of a message may be hard to understand, it is often possible to uncover the feelings behind it by observing tone of voice. I should also observe facial expressions, gestures and Majella's body language.

Reduce distractions – It is harder for service users such as Majella, who have memory loss, to communicate in chaotic environments, so I should try to talk in a quiet, calm place. I will discuss this further in my plan.

While being a good listener is vital to communication, it is also important that I convey my own ideas and information. Regardless of how difficult communication becomes, service users with memory loss, will all benefit from frequent communication from those who care for them; such as me in Majella's case. When I am speaking to Majella, I should try to:

Set myself up for success – I should approach Majella from the front as this will eliminate the possibility of me startling her and getting off to a rocky start.

Be aware of tone and body language – It is important that I speak clearly in a relaxed tone of voice, this will put Majella at ease. Friendly gestures will also foster positive interactions.

Keep it simple – If I use difficult words or long sentences, this may overwhelm the service user.

Wait for a response – It may take longer for the service user to respond, so I need to be patient and give Majella the time she needs.

Be clear – I should avoid phrases that can be interpreted literally, such as “break a leg” or “chew the fat”, this may confuse or even offend the service user.

Focus on the key word or idea – Emphasizing the most important word in my message either verbally or non-verbally.

Account for hearing or vision problems -  I need to make sure that Majella is wearing a working hearing aid and/or clean and correct glasses, if prescribed.

I need to make sure I treat Majella with dignity and respect, regardless of how difficult communication may be. If Majella appears uninterested in communicating, I need too make sure that I do not assume that relating is no longer necessary or possible. It could be that the memory loss has simply impeded the service users ability to show a desire to communicate. That is why it is crucial for me to always strive for meaningful communication with service users like Majella.

Planning a one-to-one reminiscence session

It is important that I make a plan of interaction. The reason for this is because it helps me to aid organised thoughts and to put them into a correct sequence which will help me clearly understand the best way to communicate with Majella. It enables me to think about what information I will need to find out during the communication and before the communication, as well as what skills I will need to use. I will also be able to understand what body language I can use to help communication with Majella to be more effective.

Types of sessions

Time spent thinking through, planning and doing preparation will ensure a successful interaction with Majella. First, I need to decide what type of one-to-one interaction it is going to be

Is it going to be:

- An interaction which enables Majella to discuss and share her past experiences with me on topics that have been agreed. Sessions will be based on themes such as school, growing up, work or raising a family.

Or

- A task orientated session. The aim might be to complete a task such as writing a personal memoir, perform sketches or a short plan, provide an exhibition using drawings, photographs or a booklet of poetry or memories around a theme.

I have decided that I am going to follow the first type of one-to-one interaction. This is because I feel that giving Majella a chance to talk about topics she wishes and remember things from her younger days will help incredibly.

Aims, objectives and outcomes

Once I have decided on the type of one-to-one session I want, I need to work out some aims, objectives and outcomes. This will help me to focus and give a framework within which to plan a programme and the individual sessions I am going to have with Majella. I will also be able to ensure that the outcomes will be achieved.

Aims:

An aim is the changes we hope to achieve as a result of the work and effort put into the situation. These are my aims:

            1. To provide Majella with an opportunity to share recollections of past experiences

            2. Discover common ground

            3. Form a good relationship with Majella

            4. Help Majella to gain a sense of value in her life

I am hoping to achieve these aims by using appropriate cues to reconstruct Majella's memory. This can be done through:

            1. Visual aids – this can be photographs of Majella's friends, family, old houses she has lived in and her old school

            2. Written communication – these include things such as letters, these will have been popular during the early generations when Majella was young. I could also use cards from special occasions such as her 18th, 21st, 30th, 40th and 50th birthday. Her marriage certificate could also be useful

            3. Video tapes – these can also be good aids. I can get tapes of such things as holidays she has been on, school plays she was in, happy occassions such as her wedding. A very good idea would be the birth of her daughter Tegla; this could bring back many meomories

            4. Music – this could be music which was popular when she was younger, music that she was fond of and also her wedding song. Popular nursery rhymes may also be good.

By using these types of materials I hope to grasp information on the types of things that interested Majella. We will then be able to discuss them in therapy and this should help her to recall some memories. I will speak to Majella's family – her daughter Tegla and son-in-law Sanjit – and ask for their permission to use objects from Majella's past. I will form a diary of nots on information from the family such as the music she likes, certain songs, objects that are precious to her such as her wedding ring, clothing she was very fond of such as a fashion fad she went through when she was a teenager and ornaments that may be significant to her.

Objectives:

An objective is an activity that I will undertake and the services I will offer to bring these changes to occur. The outcomes will be linked into my above aims. I will have high considerations of Majella's individual needs and deliver a plan to ensure Majella gets all the possible opportunities which are sensitive to her condition.

-To meet with Majella one a week

-To discuss aspects of everday life when she was a teenager

-To put together an exhibition of how life was lived when she was a teenager

I hope to achieve the following points in order to achieve Majella's objective targets I have set. These include the following:

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            1. Majella being able to recreate a small scope of post experience within the first three sessions

            2. Majella repeating those memories in order to have a stronger recall, as rehearsal helps us remember

            3. Majella re-visiting her memories by going back to places, ceremonial occasions such as the church she was married in, her old house, holding she went on (as long as the distance to them is appropriate)

            4. Relaxing Majella and trying to ...

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