The effectiveness or success of communication in health and social care settings is influenced by a number of interpersonal and environmental factors. Some of these factors enhance, or help, communication, whilst others inhibit, or reduce, its effectiveness. Health and social care workers can often overcome interpersonal and environmental barriers to effective communication by:
- Being aware of possible problems and solutions associated with each factor
- Adapting their interaction approach to take account of each factor
- Making simple modifications to the physical environmental of a care setting.
I am going to consider a number of factors when doing my interactions, that can both enhance and inhibit the effectiveness my communication. The factors that I will consider are classified under the following headings:
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Such as a persons appearance and grooming, clothes and hairstyles communicate self-image, allegiance to culture or subculture, and even a sense of rebellion or conformity. In some ways it communicates a message about a persons message about a persons values and self-image and about how they value others. In a care setting you should never read too much into how people appear, as you may well be stereotyping them on the basis of a false or misleading first impression.
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Non-verbal communication plays an important role in effective interaction in care settings, the ability to listen to or read the non-verbal or physical features of communication.
- The use of touch and proximity
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The quality and character of the physical environment, if there is lots of background noise it can hamper people’s efforts to communicate, because they are not under the control of the people who want to communicate with each other. Also the ability to see and receive another person’s non-verbal signs can be affected by the quality of light in the care setting.
- The availability of privacy
- Interactions are most effective where clients are able to communicate in an appropriate emotional atmosphere. Clients communicate best when they feel relaxed in themselves and in the presence of other people; when they are able to empathise with other people; when they experience and express warmth, genuineness and sincerity; and when they give and receive respect. Genuineness involves being yourself and contributing to interactions with honesty and integrity, this helps to avoid being authoritarian, defensive or professionally detached.
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Unconditional positive regard is phrase that conveys the need for helpers to be unconditionally warm and accepting towards other people, without approving or disapproving of them. By accepting people and not bringing reservations to an interaction, helpers are better able to communicate with the real unique person they meet.
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Empathy a person’s awareness of the emotional state of another person and their ability to share an experience with them. It involves the ability to enter the client’s frame of reference in order to understand their feelings and behaviour. It is a critical feature of effective communication in the LSU, because it is the ability to see life through another person’s eyes, and because you gain understanding you communicate more effectively. The helper should still try and remain objective and should still try to remain objective and should always avoid confusing empathy with sympathy.
● Social and Cultural factors
- People’s ability to communicate in a care setting can be affected by acknowledging and responding to important features of another person’s identity and cultural needs. You need to be able to see the real person behind the label that service users are often given in care settings. In order to do this they need to be conscious of how care workers perceive the people they work with.
Respecting the identity and needs of others is an essential part of relationships in care settings. Saying these situations do occur in which cultural assumptions are taken for granted, and even imposed. This can lead to marginalizing people who are not part of the dominant group or culture.
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Labelling, stereotyping and prejudice the assumptions
that people make about another group of people can affect their communication, because they all involve negative assumptions and judgements about other people. Labelling and stereotyping close down communication possibilities, while prejudice is likely to make one person treat another negatively and unfairly.
● Special needs factors
- It is important for care workers to be alert to the possibility that clients may have difficulties or impairments, such as, physical, sensory or psychological problems. Care workers should always try to find ways of adapting their own communication skills to the needs of others and, where possible, should try and adapt their environment and provide communication aids. They should try and put themselves in the position of the client whose ability to communicate is restricted and work out a communicating their message across in appropriate and effective ways.
I will consider all of these factors when I do my interactions at the LSU.
How Effective Communication at the LSU can contribute to HSC workers valuing people as individuals
In the LSU individual clients have a wide range of needs, and they all have different requirements and opinions even if they have difficulty expressing them. When the clients first come to the LSU they identify their needs, and because it may be difficult for clients to convey their needs and choices they work on building their confidence and trust.
Clients are allowed to express themselves and state their feelings and opinion at ‘circle time’. This happens once a day everyday, and the clients say what short of day they have had. They have to tell the truth and if the other clients know that they’re not telling the truth then there is an understanding that they will express this. ‘Circle time’ is very effective and successful because the clients support each other and build up a trust with each other, it results in them looking out for each other and depending on each other. The staff always showed an interest in the clients by asking them about their experiences in and out of school.
Care workers treat each client as an individual, so they expect a mutual respect, and manners and school rules still imply. The LSU feels that it is important that each client is free to express their own individuality and that the client talk to each other to try and establish a trust. This has proved that this makes the transition from primary school to secondary school more straightforward.
They also try to work on the client having a clear, positive picture of who they are (self-image) and how they feel about their selves (self-esteem). This builds up the individual’s self-concept, which is the central part of his or her identity, and helps to give the client a sense of security and so they feel safe and protected, it also affects the way that they relate and communicate with other people.
The LSU is very aware of stereotyping, and especially that the assumptions that people make about another person or group of people can affect their communication. They are conscious that labelling, stereotyping and prejudice all involve usually negative assumptions and judgements about out people. They release that labelling and stereotyping close down communication possibilities, while prejudice is likely to make one person treat another negatively and unfairly. The LSU works hard in trying to prevent stereotyping though educating the clients.
The LSU encourages their clients to make their own choices and to give them control. Giving people choices and control in their lives is called empowerment. Empowering clients is good because it shows that you value them as individuals and that you are doing things for their benefit. Effective communication involves making sure that clients are empowered. Holden et al (1996) write, “Good practice will ensure that clients are empowered for this to happen – i.e. that the power is shared between clients and staff”. She goes on to write “those that are disempowered may in turn feel helpless, which causes depression”. Learned helplessness is a concept when people who have all power taken away from them and they just accept what they have, even if they are deprived. People with learned helplessness become very withdrawn and apathetic.
Ineffective communication
Communication can be inhibited by staff not appropriately using the knowledge and techniques l will now describe.
Prejudice and emotional barriers can also inhibit effective communication. A summary of inhibiting factors is set out in a diagram below.
I will consider all of these factors when I do my interactions at the LSU.
Possible effects of inappropriate/ ineffective communication on the health and well-being of clients
Ineffective communication such as that in the diagram above, can immediately result in:
- A loss of self-esteem – the client may feel that they are not worth much if people don’t communicate with them.
- A loss of purpose in life – the client may feel excluded or alienated from others if they cannot communicate.
- A loss of support – the client may find life difficult to cope with if their social and emotional needs are to met.
- A feeling of being threatened – if you do not communicate with the client they may not be able to predict what is likely to happen.
These problems may result in the client believing that they can no longer control their life circumstances. The theory of learned helplessness explains how a loss of control over the client’s life circumstances can result in a process of learning to become withdrawn, depressed and helpless. Helpless begins when the client learns that no matter what they do they cannot control what is going to happen. Clients can develop a general helpless attitude to daily living when key needs like communication are used ineffectively.
According to Seligman, the first stages in the process of becoming helpless are to react with frustration and anger e.g., shouting or damaging property. Seligman explains that aggression can be a last attempt at control – when nothing else works a client can lose their temper. In a ‘stressed’ care environment such as the LSU a client’s anger is unlikely to get them the attention they need. Instead they maybe labelled as disturbed or difficult and isolated further.
The next step in the process is learning to ‘give-up’. Giving up saves energy, and withdrawal from trying to communicate may be their best coping strategy. Being ‘withdrawn’ can protect a person. If a client cannot get their social and self-esteem needs met there may be a sense of safety in not attempting to communicate. Ineffective communication may not matter so much if the client comes to expect no communication at all.
The process of learning to become helpless does not stop with the client withdrawing. If they can’t predict what is likely to happen to them then they are likely to become anxious. The stress of anxiety can cause a deeper level of withdrawal, and then withdrawal can lead into depression. Seligman argued that helplessness and anxiety could result in clinical depression due to changes in brain chemistry. A lack of communication could be enough to cause anxiety.
If inappropriate communication occurred at the LSU then a client may not know what is happening around them or what to expect from the staff. If he or she feels unable to respond to discrimination and exclusion they may experience anxiety and withdrawal, which may result in serious mental ill-health.
Finally, Seligman believed that severe depression resulting from learned helplessness could be fatal. This may be predominantly true when an individual is in poor health.
Therefore effective communication is consequently not just a right which clients may expect – not just a quality of care issue. Effective communication is necessary to protect the mental well-being of vulnerable clients. Poor communication can be understood as a form of abuse. If Seligman’s theory is correct then it is possible to argue that this abuse may be enough to cause death.
Inappropriate communication may perhaps suggest a breach of confidentiality. If client confidentiality is not protected then the clients personal information might be passed on to people that have no right or need to view it. In the case of the LSU this could mean that one of the other clients could find out about another clients confidential information e.g. family or medical situation, which could cause the client embarrassment and maybe they might get bullied. There is a duty on all of the LSU staff to respect the confidentiality of information in their care, and it is entrusted and delegated to them in their professional capacity and this should never be abused.
It is essential that all the individuals and organisations involved with a clients care, health and well-being work together in his best interests a key factor to this is communication. All the staff involved in the care of the client, along with their family, need to be kept informed and up to date and as a result accurate and objective communication is vital.
Recommendations for improving communication
Before I judged the effectiveness of communication at the LSU I decided to consider the purpose of the communication and the responses of other people involved. It appeared to me that effective communication in the LSU resulted in the other people understanding the communication and also feeling valued and respected. Some of the conversations between the clients and staff I witnessed, involved the staff needing to create emotional safety for the clients. This was done successfully as the clients responded by behaving in an understanding, warm and sincere manner.
To help me evaluate the communication skills used at the LSU, I used a rating scale:
1 = very effective and appropriate use of communication
2 = some appropriate use of communication
3 = area not applicable or relevant
4 = some ineffective or inappropriate communication
5 = general inappropriate or ineffective communication
I decided to give the LSU the rate of 1, so I don’t have many recommendations for improving communication, but one of the reasons that I gave the rating was, they have a high-quality and clear system of maintaining client confidentiality or record keeping, which results in the clients trusting the staff, and their self-esteem and safety is sustained. Another reason was that as a result of the appropriate communication used, the clients feel that they can rely and depend on the staff and address them with their difficulties, uncertainties, and fears, ranging from settling in to a new school too out of school problems. There were several additional reasons why I gave the rating, which I have stated before.
On the whole I have very few recommendations to make. There was a few things that I observed, firstly, as there is only two members of staff running the LSU if they absent for what ever reason, then it would be hard to find a replacement. So in extreme cases it would have to be closed so the clients would have to go to their normal lessons, which might result in them getting in to trouble and having no where to turn to. I was informed that this hardly ever happened, so this is not a major problem. I would recommend that they always have a back-up member of staff that could take over straight away when ever they were needed.
The other recommendation was that they need to improve appropriate communication with staff in other parts of the school. For example, occasionally clients would come to the LSU claiming that they had a supply teacher, so that they could stay in the LSU. Another example is that a teacher would have to waste valuable time leaving a lesson to find out if a client is meant to be in their lesson or the LSU.
Even though I know that the staff members at the LSU relay on the clients trust, and they do have a copy of each clients timetable, I would recommend that the LSU staff members and the other school members talk to each other at the begin of each day, and inform each other on any changes prior to this to help improve this matter.
Interaction no. 1 (one-to-one)
For my first practical communication demonstration I interviewed Gemma. Gemma is eleven years old and has been at the LSU since she started the secondary school. She has communication, emotional and behavioural difficulties, and like many clients with these difficulties, she faces particular challenges with literacy as a result of her inability to maintain concentration and stay on task.
When doing my interaction there were only two other clients in the room working quietly, so there were no interruptions and a very calm environment.
For my interaction we discussed Gemma’s likes and dislikes, and the section of work that she was doing at the moment. I asked her about her interests so that she would not get bored and it would be more enjoyable for her.
I choose to complete my interaction with Gemma because she was quite talkative and confident, and comfortable with strangers, so I knew that she would be the best person to interview.
Transcript of part of my conversation with Gemma
(I sat on a chair directly opposite to her and made sure I maintained eye contact)
Me – hello Gemma would you mind if I asked you a few questions about your interests, school and work?
Gemma – Ok then (she looks a bit uneasy and fiddles with her work)
Me – I’m going to start with the boring bit first, school, if that’s all right with you?
Gemma – yeah that’s OK. (Looking at her feet)
Me – do you like school at the moment?
Gemma – (half-heartedly) well its all right I suppose, I liked the school I used to go to, but we all had to leave cause we were to old.
Me – why do you like you old school more than this school?
Gemma – (enthusiastically) it wasn’t so big and there are too many other kids and teachers here (she pulls a face). I didn’t get in to as much trouble in the old one, and all of my friends were there.
Me – do you miss your friends from your old school?
Gemma – yeah I guess, we did use to have loads of fun.
Me – that’s sounds good, what did you do?
Gemma – we played lots of games and stuff, the best game was chase, I was best at it. I liked playing catch too, we played every break time, it was really, really fun, we don’t play catch any more.
Me – it must have been really exciting. You must like something about this school?
Gemma – (shrugs her shoulders) I like the food I guess, there’s a ice cream van at dinner times, I spouse that’s cool, and I like getting the school bus like a grown up.
Me – what are your favourite subjects at the moment?
Gemma – (in an unimpressed manner) I don’t like any of the subjects?
Me – you must like some of them, if you had to pick one what would it be?
Gemma – all right then, I suppose I like art, I’m pretty good at painting. I used to like English, cause I really like writing stories but I don’t like my teacher she picks on me, and I definitely don’t like maths. Its really hard and boring, and I hate P.E, they even make us do it in the rain, and the teachers are really mean.
Me – I get the impression you were not too happy about that?
Gemma – no way, I hate it.
Me – all right enough about school then (Gemma smiles) what do you enjoy doing out of school?
Gemma - (eagerly) I like watching TV and films and stuff, my favourite film is ‘Harry Potter’. Me and my best friend Megan always watch it together, I nearly know all of the words.
Me – what else do you like doing with Megan?
Gemma – we go ice-skating every weekend, I’m really good, a lot better than Megan she always falls over, but I hardly ever do (laughing)
Me – it sounds like you have a lot of fun?
Gemma – yeah we do but not in school?
Me –what is you don’t like about school?
Gemma – (thinking for a long time) its really, really boring.
Me – there must be more reasons than that?
Gemma – well the older kids pick on me, and so do the teachers. Also I don’t like doing lots of work, I get really bored real easy.
Me – that’s not very nice that the other children pick on you, what do you do when it happens?
Gemma – (shrugs her shoulders) tell a teacher mostly.
(Gemma goes quiet so I decide to bring the interaction to an end with less serious questions)
Me – your teacher tells me that you are really good at music.
Gemma – yeah, I can play the keyboard real well, I’ve got one at home that I got for my birthday, so I get to practice loads and loads. It’s really fun.
Interaction no.2 (group)
For my group interaction I took a group of clients out to the school fields to do some bird watching, as they were doing a project on English birds. We took some binoculars and a pen and paper so that the clients could write down what birds we spotted, and describe what they looked like.
I had three clients in my group; Daniel, Joshua, and Liam. Their ages ranged from ten to eleven and they were all in the same tutor group so knew each other well. They were very excited about the bird watching, as they would normally be in a classroom and not out doors, as a result of this they were very noisy and they found it quite hard to concentrate on the task. Daniel and Liam are both very chatty and outgoing, and it was for this reason that I choose to do my interaction with them, Joshua on the other hand is quite shy but intelligent, but still talks quite a lot to me.
For my interaction I came to the decision that I would discuss the topic of birds and so that they didn’t lose interest I would also talk about their interests.
Transcript of part of my group interaction
Me – lets go out to the field to do some bird watching.
Daniel – (shouting enthusiastically) yeah, can I carry the binoculars please?
Liam – no I want to carry them, that’s not fair why does Danny get to?
Me – you can take it in turns to look after them, now stop arguing you will scare away the birds.
(Daniel and Liam walk ahead whist I chat to Joshua)
Joshua – (quietly to me) they always fight with each other those two, they are trouble for it all the time.
Me – that’s not very good is it, do you get in trouble a lot?
Joshua – yeah quiet a bit but not as much as them two they’re really, really naughty.
Me – why do you all get in trouble so much?
(Daniel and Liam over hear and rejoin the conversation)
Liam – well I get told off for most things but it normally about my uniform, I always forget my tie and stuff.
Daniel – (smiling) other kids always start fights with me so it looks like I started it, but it never is then the stupid teachers always blame me.
Liam – (laughing) he’s a great big liar.
Me – what about you Joshua?
Joshua – (timidly) normally it’s because I’m late for lesson and when I do finally get there I don’t have the right books or pens and stuff.
Me – why are you late for lessons?
Joshua – (whispers) the older kids pick on me and take my stuff and I always get blamed.
Me – that’s not very nice is it?
Joshua – no…
Daniel – (interrupting) look there’s a bird.
Liam – (shouting excitedly) oh yeah it’s a blackbird.
Joshua – no its not it’s a magpie, its got a white belly.
Liam – it’s a blackbird stupid.
Me – (quickly cut short their argument) Joshua is right it is a magpie, don’t forget to write it down on your paper.
Liam – look over in that tree now that one is a blackbird.
Me – well done Liam, your right.
Daniel – (notices other people in their PE lesson) ha, ha I’m glad we aren’t doing boring PE.
Me – why don’t you like PE?
Daniel – it’s rubbish and cold.
Liam – its cause he’s the one that’s rubbish at it.
Daniel – I am not
Me – what subject do you like then?
Daniel – (excitedly) science, I like all the experiments and stuff. We watched sir cut open a pig’s eye the other day it was gross.
Liam – I like music best.
Me – what’s your favourite subject Joshua?
Joshua – I don’t know really.
Me – you must have one you like more than the rest?
Joshua – well I suppose I like history and maths.
Daniel – boring.
Me – why do you like those subjects Joshua?
Joshua – I guess I like history cause it’s interesting, I like all the fighting and the knights in armour and guns and stuff.
Daniel – look there’s a bird what one is it?
Liam – I don’t know it’s tiny.
Me – do you know what it is Joshua?
Joshua – I don’t think so, is it a sparrow?
Me – no it has blue on it, I think it’s a blue tit.
Daniel – its really tiny and cute.
Me – do any of you have pets?
Liam – (unhappily) no my mum won’t let me she’s really mean.
Daniel – I’ve got a dog-called patch and my brothers got a hamster called Harry. Harry really stinks cause he never cleans out his cage.
(They all laugh at this)
Joshua – I’ve got a tortoise, and three rabbits they’re really tiny.
Review of the effectiveness of my interactions
In my opinion I thought that my interaction with Gemma went fairly well. I’m pleased that I choose her, as she clearly had communication and behavioural difficulties, as she had a short intention span and, she was also quite rest less and she found it hard to concentrate with out fidgeting. I also observed that Gemma didn’t like discussing school, so I quickly realised that I should change the subject so that I could find a topic that she enjoyed discussing. I now realise that I should have discovered this at the begin of my interaction, so that Gemma would be more willing to talk to me, and as a result I would have a more valuable interaction.
Another thing that I detected was that to was very hard to maintain eye contact with Gemma, as she was continuously looking at her work, down at her feet, or fiddling with her pen.
The LSU room was very hot when I was doing my interaction so this may have made Gemma uncomfortable and tired, you can’t open the windows in the LSU due to security reasons, so I could have done little about this problem.
I also recognize that even though there was only two other clients in the LSU at the time of my interaction, Gemma was easily distracted, and it was quite difficult to keep her talking, and when she did stop it was also quite difficult to get her back in to the conversation again afterwards. She also might have been embarrassed to talk to me in front of her friends, taking this in to account if I were to do my interaction again I would do it when I was alone with the client. But the majority of the time Gemma gave the impression that she enjoyed talking to me.
When doing my interaction we were sat at a desk opposite each other. I should have been sat at right angles to Gemma with no desk in-between, as desks can provide a physical barrier; it also prevented me from being able to observe non-verbal gestures and Gemma’s body language. On the other hand our chairs were not too close together, which was important so that Gemma had personal space.
I believe that my group interaction went reasonably well, but it was not as easy as my one-to-one interaction, due to the fact that it took a lot longer and it was complicated to get Joshua to talk as Daniel and Liam were very loud and chatty. I often had to ask Joshua individual questions or I had to repeat them, but if I were to repeat my interaction I would still question all three of them for the reason that although it was hard to get Joshua to open up he was a lot more intelligent than the others and his answers was very helpful. I would still question Daniel and Liam because they were happy to talk to me and very friendly.
It was also hard because they were they excited and quite hyperactive so it was hard to get them to stay on task (bird watching) and they were easily distracted and unfocused, they were more interested on what was going on around them. It was also hard to keep eye contact with them, as they sometimes walked a head. Next time I would maybe not do my interaction out doors, but on the other hand there was no other people to distract us and it was a lot more enjoyable for them and me because we were not trapped in a classroom.
Sometimes Daniel and Liam and occasionally Joshua would get into arguments, or Daniel and Liam would pick on Joshua, but I was always managed to prevent potentially difficult incidents by intervening or by quickly asking them another question.
Communication skills used
Factors that influenced my interactions
The main thing that influenced my interaction with Gemma was the subject; she was to not willing to talk about school so she went quiet. Maybe I should have let her choose what she wanted to talk about so that she would have enjoyed it more and felt more comfortable, I would have also got more information and detail.
Also the relative positions of the people involved would be an influence, for example, she would have communicated differently to her friend or teacher. The emotional state she was in that day would also be a factor, if she was in a bad mood on the day I questioned her or something had happened the lesson before than she would be less willing to talk to me.
They all have behaviour and communication difficulties so this influenced my interaction, as they found it hard to stay on task and were easily distracted. This meant that I did most of the talking especially with Gemma, and I had to ask more questions and it was very hard to keep eye contact. On the positive side the interactions did help me monitor other peoples communication and practise and learn about my own.
With the group interaction it had another purpose, bird watching, so that was a major influence. It really challenged my communication skills, as I had to worry about looking after them as well as my interaction. It was also a lot harder as there was more distractions as they are easily distracted in a normal situation it was a lot worst out doors. I repeated questions to make sure that they had all heard and understood, and I looked out for any non-verbal signals. Daniel and Liam had a different personality to Joshua so this was another factor. They also didn’t know me very well so if I did my interaction again once I had got to know them better, they would trust me more and probably go in to more detail.
How I avoided potential barriers to communication
Below I have I identified the potential barriers to communication and planned how to avoid them.
Potential barriers to communication
Bibliography
Advanced Vocational Health and Social Care, Mark Walsh, Collins 2000
Health and Social Care for Advanced AVCE, Clarke, Sachs and Ford-Summer, Stanley Thornes 2000
Advanced Health and Social Care, Neil Moonie, Heinemann 2000
Web sites – search on yahoo and google for information on communication