On Tuesday 19th December 2006 at 9am I went to my workplace. The weather was dull and cold outside. Mr A was sat in his usual chair in the living room. He had his arms relaxed by his side, and one knee across the other. There was one other service user in the room, and the radio was on low. The radio is always on for Mr A; he likes to listen to either the radio or the television at all times. Another member of staff was also in the living room writing up paper work. The temperature was warm, the room was well lit but not too bright and the atmosphere was calm. Mr A appeared relaxed. My body language was relaxed, and I smiled and said ‘good morning’ to Mr A, and he said ‘yeah’ in response. He shuffled around in his chair at little as he spoke to me. I sat in a chair in close proximity to Mr A so that he would be able to hear me clearly above any background noise, and know where I was location to him as he has very limited sight. Mr A needs a lot of help with his needs, and he is comfortable with carers in his personal space. I sat relaxed, with my body turned towards Mr A, my arms leaning across my knees. I made sure I looked at Mr A so when I spoke to him he would know I was making as much eye contact as possible. Mr A does not make eye contact with anybody, he tends to look down towards his knees and occasionally look up towards the centre of the room. Although Mr A was not making eye contact with me, I felt it important to maintain contact, as I may be able to guess his thoughts and feelings by looking at his eyes.
Mr A settled back into his chair and his body posture was relaxed. With my voice at a calm slow pitch I said ‘who is it Mr A’, Mr A said ‘Sarah been on days too long’. This is an affectionate term for Mr A. I responded with ‘yes I think it is time I had a holiday’ and Mr A laughed and said ‘its time you did’. I laughed with Mr A to show I found his remark amusing. He shuffled around a little in his chair again. I continued to talk to Mr A in a varying tone to ensure my voice sent a friendly message. I asked Mr A how he was feeling today and he said ‘yeah’. I asked him if he was feeling poorly and he said ‘didn’t say that’, so I asked him if he was feeling well. Mr A responded ‘yeah’. By maintaining eye contact and looking interested, I assured Mr A that I was actively listening. Mr A’s receptive language is very good however his expressive language is very limited. In order to find out something from Mr A I have to clarify what it is I want to know. By asking if he felt poorly or well first I knew from experience that Mr A would respond ‘didn’t say that’ to the wrong one. I paraphrased what I had asked, reflecting back on the question to ensure I had understood what Mr A was telling me. I touched Mr A on the arm and told him that I was pleased he felt well. I felt touch was appropriate in this instance, however I recognise that this is not always the case.
I asked Mr A if he would like some breakfast, and he responded ‘yeah’. He got up from the chair and made his way to the dining table. Mr A is very good at finding his way around the house and does not like being guided. By not intervening until Mr A asks for help, I am empowering him. This gives Mr A a feeling of confidence and higher self esteem. He sat down in his usual place. I asked him if it was ok to put an apron on him, he responded ‘yeah’ and lifted his arms up so I could tie the apron. It is important to offer choice to Mr A as this empowers him further. Mr A has muscle wastage in his right arm and has very little use of it. He eats well out of a specially designed bowl and a special spoon using his left hand. Mr A is unable to put cereal or milk into the bowl himself, or to spread toast or make drinks. He requires someone to do this for him.
I asked Mr A what he would like for breakfast. Mr A responded ‘not much’. This is a typical response so I asked whether he would like Weetabix or Shreddies. This again ensured Mr A had a choice. Mr A answered ‘Weetabix’. Mr A will most often copy the last thing a person says, so I encourage his responses by saying the cereal he has every morning first. After Mr A had finished his Weetabix I asked him if he would like any toast and he said ‘yeah’. I then asked Mr A if he would like marmite on his toast. Mr A responded ‘didn’t say that’ and shuffled around in his chair, indicating to me that he was not very happy. His body language became defensive as he turned away from me. With my voice at a calm slow pitch I asked Mr A if he would like jam on his toast (which he always has) and Mr A said ‘yeah’. I used this tone of voice to calm the situation. Mr A then relaxed and turned back towards the sound of my voice. The questions used at this point were closed because I know that Mr A has little expressive language so at times this is unavoidable.
I thought I would offer Mr A a drink at this point so I asked him what he would like to drink. Mr A answered ‘tea’, so I went and made him a cup of tea. After he had finished the tea he stood up and made his way to the kitchen with his cup. He removed his apron and held it out to me. I asked Mr A what he wanted me to do with the apron and he responded ‘rubbish’ so I took the apron and threw it in the bin. Mr A then made his way back to his chair in the lounge. He sat down and crossed his legs, tapping his foot to the song on the radio. I sat back down in the chair close to Mr A, again with my body posture relaxed.
I asked Mr A if I could turn off the radio and talk. Mr A’s muscle tone became rigid and he started shouting ‘that’s stupid’ over and over again. I waited a moment until he calmed down and stopped shouting, and then, using a calm, quiet tone of voice, I said ‘we can talk with the radio on low’ and Mr A responded ‘yeah’. I asked Mr A what he had done yesterday evening. Mr A did not respond, so I waited a few moments before I asked if he had been busy yesterday after tea. Mr A said ‘not much’. I asked him I if he had been out and he said no. I asked him if he had listened to the TV or the radio, Mr A answered ‘TV times’ which means he listened to the TV. Mr A was shuffling gently in his chair as he spoke to me and he seemed very relaxed. He uncrossed his legs and crossed them the other way so he was facing towards me even more. I was still sat in the same relaxed position, with my arms resting on my knees, turned towards Mr A as much as possible. I asked Mr A what he would be doing today, again Mr A responded ‘not much’. I asked him if he was going out and he said ‘don’t know about it’, I said to Mr A that he would have to think about it and see how he felt later. I told Mr A that I was going to put my feet up for the rest of the day and do no work. Mr A laughed at me and said ‘she does that sometimes!’ I asked Mr A if he had enjoyed talking to me this morning and he answered ‘yeah’. I touched Mr A on the arm again and said goodbye. Mr A responded ‘Yeah’ and continued to tap his foot.
I felt the interaction went very well. Mr A responded very well in conversation, and I feel that was due to the factors involved. The location was quiet, warm and calm. Mr A was seated in an environment he is very comfortable with. Mr A appeared comfortable with the proximity, that is, the fact I have to be very close to him, in his personal space. This is due to his personal difficulties, and his need for support with a lot of his personal needs. As he is quite an elderly gentleman, he has relied on carers being very close to him and helping him do things his whole life and seems very comfortable with this. If the support offered to Mr A is more than he wishes for, he quickly becomes very angry. At no time did Mr A appear to be unhappy with the support I gave him.
During the interaction, Mr A was not able to see my body language due to his visual disability, however I sat close to him and faced him at all times so he would be aware that I was listening fully. Mr A’s body language was good throughout most of the interaction, he leant towards me and his muscle tone was relaxed. My body language was relaxed throughout the interaction, both when seated and when assisting Mr A with his breakfast. Mr A does not use hand gestures when he speaks, mostly due to his muscle wastage in his right arm. At one point when I asked him if he would like marmite on his toast, he exhibited a little negative body language by turning away from me. When I suggested turning off the radio Mr A’s muscle tone became very rigid and he shouted at me. This was an indicator that Mr A was very unhappy with the suggestion and wanted the radio left on. The radio was turned down low and did not hamper the conversation in any way as we could clearly hear each other.
My conversation with Mr A was informal. This is because I know Mr A very well so do not need to speak to him in a formal manner. I gave Mr A appropriate lengths of time to respond to my questions, and I listened carefully to his answers. By giving Mr A time to respond to my questions, I ensured that he had time to think about what I was asking, and formulate the correct response. I followed up by responding to his answers with appropriate further conversation. At one point I had to clarify a question by changing it from asking ‘what he had done yesterday evening’ to ‘if he had been busy yesterday after tea’. By asking the question in a different way I was checking that Mr A had fully understand what information I required from him. This in turn encouraged Mr A to respond when maybe he did not wish to, or maybe did not understand the question.
Mr A is a person who likes to be as independent as possible. He appreciates when I understand his needs and what he is trying to tell me. Throughout my interaction with Mr A I used empathy at all times. Empathy is “a person’s awareness of the emotional state of another person and their ability to share an experience with them” (Richards, 2003, p.121). I was aware of Mr A’s emotional state and my ability to build an understanding. On two occasions I touched Mr A’s arm briefly to show friendliness and compassion. I feel Mr A was very responsive to our interaction and I was very happy with how it went. I think that given Mr A’s verbal disabilities I engaged him in a good conversation, listened well and used correct techniques to aid this. I also provided him with the correct amount of support during his breakfast.
The other staff member present in the room was my deputy manager. I asked her to complete a witness statement for my to say I had completed an interaction with Mr A. She agreed to this. I also asked her for feedback on the techniques I had used, and how she felt the interaction went. She told me that I had engaged Mr A well. When Mr A is listening to the radio he doesn’t always want to talk. He responded that he was happy to talk to me with the radio turned down low. She said Mr A appeared very relaxed and seemed to enjoy talking to me. He was also happy to go to the dining table and let me assist him in getting some breakfast. When asked, Mr A said he had enjoyed talking to me. He also appeared to be happy with the support I offered him when getting his breakfast. As he can become angry quite easily when offered too much support, I also felt this was good feedback.
