Psychodynamic
Psychoanalytical theory is a method of psychotherapy seeking to allow the person to gain insight into the self and to work through unconscious feelings and thoughts which may cause behavioural/mental ill issues. Sigmund Freud (1856-1939) identified the unconscious mental processes in dealing with behaviour, feelings and thoughts.
This approach has been identified as useful in working with individuals with extreme mental health who may have difficulty communicating, or whose behaviours may be extremely unusual.
Communication is defined by Moonie et al (1994) as the interaction, giving and taking of information, sending and receiving of messages through verbal and non verbal means. Verbal communication is one way for people to communicate face-to-face. Some of the key components of verbal communication are sound, words, speaking, and language.
Verbal also includes skills such as, “listening to others this is the crux of working in the health care field. If we can listen and not judge or condemn we are already working in a therapeutic way.” (Burnard, 1992:12)
As discussed by Nolan et al (2005) a care worker needs to use verbal skills to talk to the client and be able to express understanding to them. The client also needs to use
verbal skills in the care setting because they need to be able to tell the carer if they are in pain or if there is anything wrong and also to express their thoughts and feelings on certain things.
Non-verbal communication is a way of giving out messages and signals
to other people through body signals and gestures. As discussed by Burnard (1992) we communicate to a large degree with our bodies. Sometimes messages can be sent to other people without us deliberately meaning to send these messages. Types of non-verbal communication include eye contact, facial expressions, hand gestures, touch and proximity
Written communication is also important and takes a variety of forms, there can be a number of different records you are responsible for maintaining. The information “care workers record is important, sometimes vital. It has to be written in a way that is clear and accurate, and can be easily understood by others” (Portch, 1995:97).
There are many factors which can get in the way of good communication. As a carer you “need to understand how to recognise these and learn to overcome them .... it is easy to assume that everyone can communicate and that any failure to respond is because of someone’s unwillingness rather than inability. There are as many reasons why people find communication difficult as there are ways to make it easier” (Nolan et al, 2005:46)
If the person has a speech defect a carer needs to be patient with the person and try
not to finish their sentences for them, as this would be seen as intimidating. If the person is deaf a carer needs to take into consideration their usual types of communication that are used and make sure they are sitting close to the client.
If the person who has a visual impairment or are blind, a carer will need to make sure they use verbal reinforcement. In order to avoid any environmental barriers a carer must consider factors such as privacy, room temperature, noise etc “these may seem obvious but they need to be considered when planning communication” (Nolan et al, 2005:49). If a carer had to find out personal details about the client by asking them in a room which was poorly laid out and people were sitting very close together as well as there being high levels of noise then the client will not want to give the details to the carer as they will have a lack of privacy and would want their details to remain confidential.
“Health and social care service users, and indeed those who work in health and social care services, may have physical, sensory or psychological problems that affect their ability to communicate effectively” (Walsh et al, 2000:86)
There are different aids to communication that care workers should ensure are available for people who use services, based on their individual needs, choices and preferences. This may involve the care worker undertaking specific communication training to ensure that they have the skills required to communicate effectively with different individuals. Some of the main aids to communication include:
- Makaton
- British sign language
- Visual pictures or symbols
- Braille
- Electronic computer generated verbal, written and visual communication
- Translator, where the communication differences are language based
- Texts
- Hearing aids
“Care workers should always try to find ways of adapting their own communication skills to the needs of others .... they should try and put themselves in the position of the person whose ability to communicate is restricted” (Walsh et al, 2000:86)
To ensure equality and diversity the care worker has to be aware of any communication differences and ensure that people who use services have the opportunity to communicate according to their communication abilities and choices.
If there is ineffective communication in a person's daily life it can have a major effect on them as an individual. As suggested by Nolan et al (2005) a person can feel low self- esteem, this will leave the person feeling that they are not worth much to other people because they do not take the time to communicate with them. They may feel a loss of purpose in life, excluded or alienated. If a person is not being communicated with by other people they may find it difficult to cope because their social and emotional needs are not being met.
Confidentiality is an important aspect of the care workers responsibilities in this area as all people who use services have the right to confidentiality.
“Health and social care organisations have polices and procedures for dealing with the collection, recording, storage and passing on of information held about their service users” Mason et al, (2005:39).
The Data Protection Act 1998 provides the legal framework for gathering, recording and storing information by organisations as part of their duties. There are eight guiding principles to follow. These are that data must:
- Be fairly and lawfully processed
- Be processed for limited purposes
- Be adequate, relevant and not excessive
- Be accurate
- Not kept for longer than necessary
- Be processed in accordance with the individuals rights
- Be secure
- Not be transferred to countries without adequate protective
This provides the legal framework within which organisations must keep when accessing, recording and storing any individual’s information or data. Organisations demonstrate how they are following these legal requirements through their data protection policies and related procedures, and care staff should be following these policies and procedures as part of their care practice.
The importance of data protection, confidentiality and appropriate secure record keeping is further reinforced via the Codes of Practice for health care workers. As discussed by Mason et al (2005) care workers have a responsibility to ensure that they contribute to the safe storage and retrieval of records. The care worker is responsible for following the relevant procedures and ensuring records are updated promptly within a confidential area and stored securely.
“Confidentiality is given a high value by health and social care practitioners because it is one of the foundation stones on which they build their relationships with service users” (Walsh et al, 2000:115). Disclosure of a person's private details or information about someone's condition must only be made available with that person's explicit consent.
In my Home the standard of confidentiality is excellent. Manual records about clients are kept in a locked filing cabinet, which is kept in a locked office, and only authorised staff can gain access to these particular records. There is also a policy on who is authorised to up date or make changes to records. This is to prevent information being altered or lost by accident. Confidentiality is a basic human right that has become so important that certain acts have made it a legal requirement that health and social care providers keep client details confidential.
It is important Walsh et al suggests (2000) that confidentiality is maintained in a care setting all the time and for all clients because if it is not they and their families may lose trust and therefore the institution cannot completely provide the care it needs to as they may not be aware of certain clients needs as they will not tell the carers as a result of the lack of trust.
However communication could be improved within my home between the care staff and senior care staff, when care staff are coming on duty. A handover is already in place between the ‘senior members of staff’ who are given an update on any changes with the residents and within the home, however the same should be implemented into a routine so that the care staff are given a handover from senior staff when they come on duty. I feel that this would improve communication, minimise risks and make my workplace more productive.
Conclusion
Effective communication is essential within any workplace. Good can reduce misunderstandings, errors, frustration, and conflict on a daily basis. You can’t be effective in a health and social care unless you communicate effectively.
“Communicating with people and being able to provide support are central skills in any health care job” (Portch, 1995:1)
