There are two sofas and a chair that are for residents to take a rest or wait for the bathroom. Whilst I was sat there I observed a conversation that happened in the corridor between two care assistants. I saw the two care assistants come out of a resident’s room that was occupied by a gentleman who was terminally ill and who’s wife was in there with him. The two carers were only a few yards away from the gentleman’s room when they began talking about him, although they were talking quietly I’m sure there was a possibility that it could have been overheard by the gentleman’s wife. They were discussing some personal details as well as coming out with comments like I hope he goes soon. They had only been talking for about a minute or so when they were joined by another carer who had come out of a neighbouring room. The conversation then continued with all three of them. They were talking about things that were private and personal and should not have been discussed especially in a corridor where the doors to other resident’s rooms were open. Some were occupied and not to mention the possibility of it being within earshot of the terminally ill man’s wife.
This conversation broke The Data Protection Act 1998, which protects person’s rights to confidentiality. Any personal information that is discussed in public breaks the Data Protection Act 1998.
A short time later the conversation began again in the staff room with one of the original carers, two other carers and a nurse. The door to the staff room was open and it is directly opposite the resident’s lounge. At one point during the conversation there were visitors being shown around, although they only heard part of the conversation not one of the people involved in the conversation stopped what they were talking about. These visitors could quite easily have been family of the ill man or inspectors of some kind.
Although I’m sure the comment they made “I hope it’s soon” would have been meant kindly it should still not have been said. If I had been the carer involved and I needed to discuss the care of somebody who is terminally ill I would have done it in the privacy of an office with closed doors. As for the nurse they are governed by a professional code of conduct, which states
Nurses, midwifes and health visitors should at all times safeguard and promote the interests of individual patients and clients, uphold and enhance the good standing of the profession. (Appendix 3)
Task 2 (P5)
Participate in two interactions, in the role of a carer, using communication skills to assist patient/service users.
Below is the scene setting and explanation for two statements that were obtained by two care assistants observing me doing a task that is normally done by a care assistant. Original copies of the statements can be seen in the appendix. (Appendix 4 & 5)
Statement one, is of me serving afternoon drinks and biscuits on a trolley in the residents lounge. The lounge is about fifteen metres long and six metres wide; there is a conservatory at the end where residents who smoke can sit. In the centre of the room on the wall facing the main windows is a mahogany fireplace; there is no fire but a large floral display and two ornaments on top. There is a television and DVD player in the corner at one end that is inside a large mahogany cabinet that has a large carriage clock on top. At the other end of the room there is a large mahogany display cabinet that has books, ornaments and a music system on it. The conservatory overlooks the car park and small garden and the main windows overlook the main garden that has a summerhouse, garden benches and bird table. Some of the benches have plaques on them as either residents or family of past resident’s donated them. There are approximately twenty recliner chairs in the lounge of various colours as some of them belong to the resident’s themselves and several buffets.
The room is tastefully decorated in cream with a flowery rose coloured boarder. The lounge was both busy and noisy as at the time both the television and the stereo were on. I had to go to each resident in turn and ask him or her if they wanted a drink and biscuit and if so what would they like. I had been told that a couple of the residents have diabetes and therefore are not allowed biscuits with too much sugar on them. One of the residents had a severe hearing disability so I had to use gestures in order to make them understand what it was I was asking them, because the room was noisy this was even harder to do and I was aware of my facial expressions as well as my body language. I had to continually ask the observing care assistant questions to make sure I was giving the right drinks in the correct cups/beakers as not all the residents were able to have their drinks in the standard cups. I also had to make sure that the ones asking for sugar were able to have sugar.
The second statement is of me feeding a resident her lunch in her own room. This is done because the lady is unable to get out of bed due to poor health. Most of the bedrooms are identical with the exception of one on each floor that’s a bit larger due to it being at the end of the corridor. The bedrooms in the main section are all on one corridor, which on the right hand side near the end and has a large bathroom with a bath. There is another large bathroom on the end, about 10 metres away that has a shower, and there is a toilet next to that which is for the use of visitors and staff. I was in Marjorie’s room, which is a standard size one is approximately 6 metres wide and 4 metres long.
The room is L shaped as in the corner there is a small en-suite bathroom that is approximately 2 meters by 3 metres. In Marjorie’s room there is a bed that is in the centre of the room. On the wall facing the bed there are 2 single wardrobes that are separated by a chest of draws. On the draws there is a television and a family photo. To the right hand side of the room there is a window that has various ornaments and family photos on the windowsill. On the floor at either side of the bed there are thick crash mats, which are there to protect Marjorie if she were to fall out of bed. On the wall above the bed there are several photo frames with photos of family in them and a large cross stitch that I was told Marjorie had done some years earlier.
The room felt quite claustrophobic, as it was warm and didn’t have much room. Marjorie was propped up in bed and I was stood at her side, which made me feel uncomfortable as I felt like I was overpowering her, but there was no chair for me to sit on. I discovered also on entering the room that Marjorie is blind and so I was a bit unprepared, as I had not fed anybody before that was blind. If I had been given more information before entering I would have took a moment to prepare myself and decide how I was going to approach the situation.
Task 3 (P6)
Review the effectiveness of own communication skills in the two interactions undertaken.
The two interactions that I undertook involved quite a bit of communication both verbally and non-verbally both with service users and other care workers. There were also some barriers such as hearing and sight impairments and the environment itself was noisy.
The first interaction involved me serving afternoon drinks and biscuits to residents in the residents lounge. I had to take a trolley that had teapots, coffee pots, juice, milk, sugar, sweeteners as well as cups and beakers on it. It involved me approaching individual service users one at a time and asking them if they would like a drink and a biscuit and if so what would they like. At the start of the interaction the supervising care assistant told me that there were some residents with diabetes and some who had their drinks served in beakers, which had lids with spouts. As I approached each individual service user I asked them what it was they would like to drink and would they like a biscuit. Before I gave any of the drinks or biscuits I checked each time with the supervising care assistant that I was ok doing what I was doing.
One of the residents had quite a severe hearing impairment and so I had to use gestures such as simulating having a drink and dipping a biscuit in a cup. As I was giving each service user their requested drink and biscuit I did have to get quite close to most of them and should have been more aware about their personal space. I also assumed that each one spoke English, which is an assumption I should not have made.
The room was very noisy as the television was on and another resident had the stereo on listening to music, also the trolley itself made quite a bit of noise when being pushed around. This environment was quite difficult to work in as all the noise made it both distracting and frustrating. Because of the lack of information such as just being told some residents had diabetes and some had their drinks served in special beakers it made the whole task very time consuming. If I had known the residents better then I would have been able to do the task quicker and more effectively. Also because some of the residents were diabetic I could have accidentally given sugar or a sugary biscuit to the wrong person, which could have been a health risk.
The second interaction involved me feeding a resident their lunch in their own room. When I went into the room I had not been told that the resident was blind and was totally unprepared for the job. I had not fed a service user before who was blind and so had to think fast how I was going to approach the task. Because of the lack of information and therefore unprepared I could have done the job better. I did introduce myself on entering the room and once I realised the resident was blind I explained that I was there to give them their lunch. I then explained what was for lunch and what for desert.
Before approaching the service user with food I told them what was on the spoon and when I was approaching them. There was no chair in the room for me to sit on so I was stood up; although the service user was blind I still found it difficult and was conscious of not over powering them. I also found that I used the same facial expressions I used to do when feeding my own children as babies and that was opening and closing my mouth in time with the service user, I would still have done this if the service user had sight but I might have made more of a conscious effort not to.
Because the service user was blind it took much longer to feed her than a sighted person because I had to explain with each mouthful what was on the spoon and when I was approaching them with the spoon. I also had to hold the beaker for the service user when she had a drink and so I was within very close proximity and was therefore conscious about personal space. The environment itself was a bit distracting as the door to the service users room was open and the care setting was being decorated and at the time of doing the task the decorators were in the corridor and they were talking.
Task 4 (M3)
Explain how own communication skills could have been used to make the interactions more effective.
For the first interaction my own communication skills would have been very much improved if I had (1) known the residents better, (2) known who could and could not have sugar and (3) who had a cup and who had a beaker. Because I didn’t know the residents I had to ask each one in tern if they would like a drink and if so what would they like i.e. tea, coffee, milk etc, did they have sugar or sweetener in their drink and would they like a biscuit. The task was therefore very time consuming for me personally. I also had to use my own communication skills to both get my message across and to understand what was being said to me. Almost all of the residents wore a hearing aid but if you spoke clearly and slightly louder they could both hear and understand what I was saying. There was one resident who’s hearing impairment was quite severe and so I had to use more communication skills on her such as using gestures to simulate having a drink by pretending I had a cup in my hand and taking a drink. If I’d had an empty cup in my hand then it might have been easier for the lady to understand me. As there were several choices of drinks it would also have been better if I’d had a teabag or jar of coffee etc on the trolley as it was hard to explain what the choice of drinks were. Proximity and empowerment could also have been improved if I’d had more time. I was stood up and some distance away. I was aware that I had quite a few residents still to serve and if I had not been a student being observed then I would have had help doing the task and therefore been able to take the time and sit down next to the resident and explain more effectively.
The lack of information about residents with diabetes also made the interaction more difficult because I had to check with the supervising care assistant that who asked for sugar was able to have it. This wasted time because I went up to the supervising care assistant to ask discreetly because I didn’t want the resident in question to feel like they were being treated like a child. My facial expressions could have been better too by relaxing and smiling more instead of frowning, which could have made the residents feel uneasy about me. I was a bit stressed because I was aware I was being supervised which made me nervous and I was aware of time.
The second interaction could also have been improved if I’d had more information about May (the service user) before entering the room. When I went into the room I had not been told that May was blind and so I was totally unprepared for the task. If I had been given the information before hand I could have taken a moment or two outside the residents room and prepared myself, instead I had to think fast which would have affected the way in which I communicated. On entering the room I introduced myself but soon realised I was going to have to approach the task differently so I then became aware that I had gone quiet because I was thinking and this could have made May feel uneasy and lose confidence in me. I did explain to May that I was there to feed her, her lunch and told her what was for lunch and for desert. What I should have done is ask May if she liked what was for lunch, I just assumed that she did which was wrong.
Whilst I was feeding May I told her that I was approaching her with food but I should also have told her what was on the spoon. I also had to stand whilst feeding May, as there wasn’t a chair to sit on. Although May couldn’t see she will still have been able to sense my positioning and I was aware that I didn’t get too close and make both her or myself feel uncomfortable with my close proximity. The interaction could also have been improved if I’d made adjustments to the environment. The door to the May’s room was open and at the time the care setting was being re-decorated and the decorators were in the corridor outside May’s bedroom. The decorators had a radio on and were singing along to songs as well as talking to each other and telling jokes. Both myself and the supervising care assistant were paying more attention to the jokes etc being told and if I had closed the door I wouldn’t have been able to hear them and so I would have paid more attention to May. When I had finished feeding May I left the room. What I could have done is spent a bit more time with her and chatted, but as time was a luxury I had to leave and do other tasks.
Task 5 (D1)
Analyse the factors which influenced the interactions undertaken
For both of the interactions I took part in there was quite a few factors that influenced what I did.
For the first interaction the setting was extremely noisy which made communication very difficult. As stated earlier, the room was busy with service users and members of staff, the television was on quite loud and the stereo system was also on. On top of this, the drinks trolley, which was being used to take the drinks round to the residents, was also noisy.
All of the above influenced the interactions undertaken. Quite a lot of the service users are hard of hearing and the excessive background noise made the task of communicating with them all the more difficult. If we look at the communication cycle, it is possible to analyse exactly how the communication was hindered, but also how it was overcome.
It was my job to serve the afternoon drinks and snacks to the residents. I wanted to ask a resident if they would like a drink or a snack. I put my thoughts into language and asked the question, using a slightly louder tone of voice due to the fact that the room was noisy. It became obvious that the service user had not received my message, as she did not respond to it. I therefore asked the question again; only this time I also gently placed my hand on the service users shoulder to get their attention and some eye contact between us before I asked the question again. The service user looked at me and I asked the question again. On this occasion, although I had got the attention of the service user, the background noise was too loud for her to hear my question. She replied by saying “Pardon” I knew that she had not heard what I had said and again I adjusted the way my message to her was coded. I asked the question again only this time more loudly and I also used the gesture of pretending to have a drink from an imaginary cup. On this occasion my message was received and understood by the service user and she replied to me that she would like a cup of tea.
I asked the resident if she would like any sugar in her tea and she replied that she would. I checked with the carer who was supervising me that she was able to have sugar in her tea. I did this discreetly as I did not want the service user to think that I did not believe or trust what she was saying. The supervising carer informed me that she was ok for her to have sugar in her tea, as she was not a diabetic. At this stage, I also checked with the carer whether she would require her drink to be given in a cup or a beaker, as the carer had already told me that some of the residents used beakers because of their shaky hands.
The carer told me that she used a cup and I prepared the residents tea as requested. I then asked her if she would like a biscuit to go with her tea, but the resident was not looking at me as I had just handed her a drink and once again she did not hear me. I again placed my hand gently on her shoulder to gain her attention and the all-important eye contact. This time when she looked at me, I asked the question again in a louder tone of voice but I also used the gesture of pretending to dip a biscuit in the cup of tea and eating it. The service user then received and understood the message and replied that she would like a biscuit. I let the resident choose her own biscuit and smiled at her before moving onto the next resident.
The problems that were encountered during this first interaction were mainly due to excessive background noise. If the environment had been quieter then I am sure that the interaction would have been easier. When a person has to speak very loudly to be heard it can sometimes make the other person involved in the conversation feel that they are being spoken to in an aggressive manner even if this is not the case. Another problem encountered was the time restraint. I had a lot of service users to serve in quite a short space of time and this made me rush in order to get the job done within the time that I had. If I had had more time then this would have also helped with communication. When a person speaks slowly and concisely then it is easier to understand.
One of the things that I could have improved upon was getting down to each service users level in order to empower them instead of perhaps making them feel overpowered due to me being stood up and at a higher level than the service user and making them look up at me. Also the proximity between the persons involved in the conversations is important, especially I this noisy kind of environment. If the proximity is right it should be possible to speak to the service user in a voice that is loud enough to be heard but not too loud as to be overpowering. It is also important not to invade the other people’s personal space as this can make people very uncomfortable.
In the second interaction, to some degree I had the same problem with it being a noisy and distracting environment. As I stated earlier, the main obstacle in this communication was that the service user was blind. I did not know that she was blind when I entered the room. I did however introduce myself as I walked into the room, as I do with all service users. I am after all entering their own private room, as was the case in this interaction.
I immediately realised that the service user was blind, which initially threw me, and I had to think quickly on my feet to decide how I was going to approach this conversation. I had entered her room in order to feed her and give her a drink, as she is unable to do these things for herself due to ill heath. I told the service user that I was there to feed her lunch and I described what was on her plate.
During this interaction I had to get some food from the plate on a spoon and describe o the service user what was on the spoon. I then brought the spoon towards her mouth and let her know when the food was nearing her mouth so that she would open her mouth for the food at the correct time. I also kept asking her if she needed to have a drink at regular intervals.
Throughout this interaction I was opening and closing my own mouth whilst I was feeding the resident. This must be a natural thing to do as most people would do this and I have seen this happening when parents are feeding their young children. It must be a natural instinct to do what you want the other person to do in the hope that they will see what you are doing and copy you. Obviously this service user could not see me opening and closing my mouth so I had to verbalise what was required.
I was standing up throughout this interaction, which made me feel uncomfortable, as even though the service user could not see me, I was very aware about standing over her and the empowerment issues that this raises. I was also very aware about the distance between us, and how close I had to get to her in order to perform this task successfully. Even tough the service user was blind, she would still have been very aware of how close I was to her as when one of the five senses is lost the others are heightened in order to compensate for its loss.
Again, time was short and I was conscious that there were other residents to feed. This did not make me rush during this interaction, as it was simply a job that could not be rushed. The elements of facial expressions, and body language use by myself are in this case of little use as the service use was blind. However, the use of language such as tone of voice, and the speed of speech and the use of vivid descriptions are even more important in this case as the service user relies heavily on this element of interaction for her cues due to her loss of sight.
Bibliography
Portch, T. (1999). Communication and Interpersonal Skills. Great Britain: Hodder and Stoughton
Stretch, B, Boak, A, Dunn, O, Haws, H, Herne D, Mason, L, Moonie, L, Webb, D (2006) BTEC National health studies. Oxford: Heinemann
Nolan, Y. (2005). Care S/NVQ Level 3 candidate Handbook Great Britain: Heinemann