Effective communication - P1, P2, P3, M1

Level 3 Health and Social Care

Unit 1 - Task 2

P4, M2, D1

In all health and social care settings there are going to be barriers that affect your communication and interpersonal skills with a service user. These barriers can be extremely difficult to overcome or very easy, but with the right strategies, you can overcome them.
Barriers to effective communication and interpersonal skills can vary. You can have barriers as simple as somebody not hearing what you are saying properly, or someone who does not understand what message you are trying to portray to them. You can also have barriers that are a lot more difficult to deal with such as, a service user having a disability, therefore not knowing what kind of learning styles they have and how they communicate; or you can have someone that has very low confidence and self esteem, therefore not willing to talk to you and open up.

As a care worker, if I was talking to a service user that had 20/20 vision, and could hear perfectly in usual cases, yet they couldn’t hear what I was saying, it would be classed as a barrier to effective communication. This is a simple circumstance that any professional may come across. If this does happen to any care worker, it is easily fixed. For example, you could move closer to your service user so that they could hear better. However, as you move closer towards the service user, you have to respect their proximity space, and not make them feel uncomfortable, intimidated or on edge. Also,

another way to make sure they can hear you properly is to talk a little bit louder, making sure at the same time, that you do not come across as shouting at them. Talking in a louder voice and speaking in a more clear tone and voice will not only help the person to hear better, but also help them to lip read what you are saying. This is because, if you are talking in a clear voice, you pronounce your words better, meaning that lip reading can become much easier to understand.

Another example of a simple barrier that is easy to overcome is if someone does not understand what you are saying to them. This does not mean that they speak another language to you; it just means that a care worker and a service user do not have the same understanding of what is being said. A good way to overcome this barrier would be to go over what the initial subject of the conversation is about, and then explain what you are trying to say. Also a care worker, you need to check with the service user that they are clear on what you have said to them.
To make sure also that you understand what they are trying to say, you should repeat back what they have said to you in your answer. This helps any misunderstandings from happening and makes communication much more effective. At the end of a conversation, it is important to sum up with the service user the things you have both spoken about, so that neither the care worker nor the service user leaves feeling confused about what was being said.

In some cases within a health and social care settings, a care worker may need to use effective communication and interpersonal skills with a service user that cannot speak for themselves. This could be for someone who has dementia, Alzheimer’s disease or someone who has learning difficulties or disabilities.

If a care worker has to communicate with a service user that suffers from any of these things, and cannot speak for themselves, then an advocate is usually needed to come in. An advocate will speak for the service user and try to find the best possible way to receive the right amount of care for the service user. An advocate usually has to be someone that does not work for a certain health and social care company. This is so they can argue for the service user without being influenced by what is easiest for the company.

There are strengths and weaknesses for using an advocate in health and social care settings. The advantage would be that the service user does not get their needs overlooked, and they have someone to argue for them so that they receive the things that they are entitle to. However, in some cases, an advocate may not fully understand the physical, emotional, intellectual and social needs of the person they are advocating for. This can mean that in some cases, the advocate is not arguing for the right thing for the service user, which means that this is a disadvantage.

I believe that using an advocate can be effective in certain cases, if the advocate knows the person in which they are speaking for and understands their feelings and needs. It important for the service user to feel comfortable in the environment they are in, so I believe it is beneficial if the advocate knows the service user fully and can argue for the right things of the service user.

Another barrier that you may come across as a care worker in a health and social care setting is language barriers. If a care worker and a service user are communicating yet they both speak different languages, this can cause a barrier and effective communication will not happen.

In cases of this happening, a translator or interpreter is asked to attend the meeting in which the care worker and service user are communicating. An impersonator is someone who changes what someone is saying into a language that the other person will understand. For example if a care worker is English, but a service user is French, then the impersonator/translator will change what the care worker has said to French so that the service user will understand what is being said and vice versa.

Although translating/impersonating sounds easy, it can be very difficult. This is because some languages do not have the same meanings of some words. This means that the translator/impersonator has to decode the message and understand the meaning of what is being said in order to translate the information. This can prove as a disadvantage, as if the translator does not understand what is being said, they can translate the wrong message causing confusion for both the care worker and the service user.

A good way to overcome this would be if the translator speaks to the service user and/or the care worker the meeting, so that the impersonator can get a grasp of what might be said during the conversation. This may be helpful so that there is not any confusion.

Another disadvantage towards using interpreter is that if a service user speaks a different language to the care worker and they are from another culture, then they may not feel comfortable discussing their issues with the care worker if the impersonator is there. Also if the impersonator is a family member or friend of the service user then they may become judgmental and interpret things in a biased way. This is not good in a health and social care setting as the care worker and the service user will not be receiving the correct information that they need.

I do believe that using an impersonator can be beneficial with lots of advantages, as long at they remain impartial at all times, and do not become biased when translating what is being said. A good way for this to be successful is if the impersonator is a trained professional and understand the rights of confidentiality and trust, and remaining impartial at all times.

Overcoming barriers with service users who have disabilities/learning difficulties.

As a care worker, you may come across service users who suffer with a variety of disabilities or learning difficulties.

For example, if a service user ...

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Overcoming barriers with service users who have disabilities/learning difficulties.

As a care worker, you may come across service users who suffer with a variety of disabilities or learning difficulties.

For example, if a service user had visual disability then the care worker would have to support the service user in order for communication and interpersonal interactions to be effective. It may be necessary that the care worker has necessary IT technology in order for the service user to see properly.

Also it would be important for the care worker to have appropriate resources for the service user, such as glasses, magnifiers, and high quality environmental surroundings such as lighting. The option to use braille should be given to the service user to help them communicate. Along with this the service user should use a clear tone and voice and speak louder for the service user to understand what is being said, as they wouldn’t be able to lip read.

For someone who is blind, the use of braille as an option is important to be given so that the service user doesn’t feel uncomfortable about not being able to communicate in the normal ways.

For a service user who has hearing disabilities useful equipment such as hearing aids, improved IT technology and diagrams should be an option. These things would help communication between the care worker and the service user be more successful and effective.

Hearing aids are extremely useful to someone who is deaf as it allows them to hear things that usually they wouldn’t be able to here, thus making communication between the care worker and service user more effective.

As a care worker, if you are communicating with someone who is partially deaf or fully deaf, then you have to take into consideration the environment in which the communication takes place. For example, if would be more beneficial to communicate somewhere that does not have a lot of background noise in order for it to be easier for the service user to communicate.

Another resource that is useful when communicating with someone who has a hearing disability or is deaf is the use of British sign language. Sign language helps communication to be more effective for those that cannot hear what is being said. Also speaking in a more clear tone can help someone who is partially deaf as they would be able to hear what you are saying better. If you mumble the words that you say, then the service user may misinterpret what you have said; not hear you at all; or think that you are being rude and disrespectful to them.

Interpreters can also help with someone who has a hearing disability, this is because they can interpret what the care worker has said and then use sign language back to the service user and vice versa.

Many care workers will come across services users that suffer from physical disabilities. These disabilities can include things such as someone having speech impediment, meaning that when they are communicating they would benefit from having speech therapy. This would help them, as they would learn how to communicate in more beneficial ways that they can relate to.

The use of signs and symbols are also beneficial when communicating with a service user that suffers with physical disabilities. This is because signs and symbols help the service user to understand the message being portrayed.

The use of signs and symbols can be used in different ways including, facial expressions and hand gestures. These help both the service user and the care worker to understand what is being said. For example, if a care worker says something to the service user yet they understand, the service user may shake their head in disagreement, portraying the fact that they don’t understand.

On the other hand, a service user could nod their head in agreement, to show that they do understand what is being said, thus letting the conversation move forward.

Their can be many barriers affecting effective communication when working with someone who has learning difficulties. These barriers can include this such as, the service user having limited learning ability or not being able to communicate in the normal ways. To overcome these barriers, the care worker would have to use things such as makaton (another type of sign language that is used universally throughout the world) for the service user to be able to understand what is being said.

Also the care worker could use communication passports to learn about the ways in which the service user learns, reacts and responds to certain situations.

Sometimes for a service user who suffers with learning difficulties, an advocate would be called in to help with the communication.

When working with a service user that suffers from a certain disability, you have to be sensitive to their needs as to not discriminate against them because of their differences.

If a care worker does discriminate against a service user, they would be breaking the disability discrimination act 2005.

Other barriers that a care worker and service user may come across in a health and social care setting.

The use of jargon whilst talking to a service user can cause a barrier to communication as sometimes the service user may not understand the technical terms that the care worker is using.

As a professional, it is important to use vocabulary that the service user would understand, rather than using jargon and technical terms.

For example, if a doctor is talking to a service user about a certain subject, then it would be beneficial if the doctor used vocabulary that the service user actually understands rather than using technical words and jargon as the service user may get confused about what the doctor is saying as misinterpret what is being said.

Sometimes, a care worker does not intentionally use jargon, but as they use it everyday when talking to other professionals, they just do it without thinking. It is important as a care worker to find the right way of saying things to both other professionals and service users.

Another barrier that can affect communication is if a service user is under the influence of alcohol or drugs.

Alcohol and drugs change a persons mind set, thus not being able to communicate as if they would under normal circumstances. Although this is no way of overcoming this barrier, it is important as a care worker to remain impartial at all times, and to not discriminate against the service user. If a service user is under the influence of drugs and/or alcohol then it can lead to aggressive behaviour which beings me onto my next barrier.

Aggressive behaviour can cause a very disturbing barrier to communication.

If a service user portrays aggressive behaviour to the care worker, then it is important for the care worker to not respond in way that shows aggressive behaviour towards the service user.

Although this a hard barrier to overcome, it is possible. As a care worker it is important to remain a calm and positive attitude towards the service user. Using a positive body language is important as it shows the service user that you are not willing to get angry and you will give them the help that they need.

Positive body language such as open arms, relaxed posture and the use of eye contact, is important when dealing with an angry or aggressive service user.

Although it is not easy for a care worker to stay calm when dealing with someone who is showing aggressive behaviour, it is extremely important to stay calm and to show the service user that you are there to help in a non-judgmental, impartial way.

Already knowing about a service user and their way of communicating can be beneficial when seeing them in the future. For example, if you already know things about the service user and you see them again in the future but they are showing aggressive behaviour, you can talk to them in a positive way, bringing up things that have been spoken about before, mentioning how you enjoyed talking to them and would like to hear more if they are willing to share it with you.

Also letting the service user know that what is said between the two of you is being kept confidential will help lower the service users’ aggression and they may start to open up again.

As a care worker, you need to be sensitive to the services users’ needs and feelings, by not discriminating, judging or showing negative body language towards them. You must try to avoid anything that may trigger the service user to become angrier. Using interpersonal skills can be very important, along with the use of reflective listening, to show the other person that you are being sensitive towards their needs and you are valuing them as a person.

There are many advantages and disadvantages of trying to overcome the barrier of effective communication with an aggressive service user.

In some cases, if you as the care worker are trying to talk to someone who is being aggressive, but you are talking to them in a calm and collected way, they might see you as being patronising towards them, and think that you are only treating them with such care so that they won’t get more aggressive. This is why it is important to keep the same level of communication and sensitivity every time you see that service user.

On the other hand, the service user may see that you are refusing to get angry back and are remaining confident and calm, which in turn, helps the service user to become calmer, allowing communication to be effective.

Alternatively to someone having aggressive behaviour, submissive behaviour is also common when dealing with a service user. In some cases a service user will act in a submissive way, meaning that they will just agree with everything the care worker says, rather than giving their own input. This can be due to the fact that they don’t want the care worker to know what the reason for them being there is. For example, if a care worker is a counsellor and they are talking to a service user, the service user may not want to open up and talk about what it is they are there to talk about. This can be due to the fact that the service user has issues with confidence or they think that the care worker won’t respect the rights of their confidentiality. It could also be due to the fact that they think that the care worker will judge them based on what they say.

As a care worker, you should make sure the service user knows that what is said is kept confidential, and that they will not judge the service user based on what is said.

To overcome the barrier when a service user is portraying submissive behaviour, is that as a care worker you have to gradually work your way into conversation, making sure that the service user is comfortable with what you are talking about. Also whatever the service user says to you, you should repeat back in your answer to show that you are listening to them and respecting and valuing what they are saying.

Also, by making your body language positive, whilst the service users’ body language is negative, they will see that you a being confident and caring, allowing the service user to gain trust in you and start to open up. As the service user starts to talk about what they are there to talk about, it is important that you use correct interpersonal skills such as reflective listening, to show the service user that you know what is being said, and that you understand.

If a service user is using submissive behaviour, it may be down to the fact that they suffer with low self esteem issues and low confidence. To overcome this barrier, you as the care worker, needs to help turn the negative conversation into positive things, making sure that the service user feels comfortable and at ease.

You need to remain sensitive at all times, and not rush the service user to talk. Making sure that the service user is ready to talk is important, to make sure that they don’t feel intimidated by you or think that you are just changing the subject when you do not intend to.

When a care worker can cause the barriers to effective communication

In some cases, a care worker can be the one to cause the barriers to effective communication.

For example, a care worker can become emotionally attached to a service user’s feelings and needs that it starts to affect their professional role. A care worker can start to feel stressed or emotional by listening to a service user’s story, especially if they are deep or frightening. In some cases, a care worker will close off and not fully listen to what the service user has to say, in order for them to avoid emotional pains.

A care worker can also ‘switch off’ if they are tired or do not have enough time to talk to the service user. As a care worker, you need to maintain your professional role and not become emotionally attached to the service users’ feelings and needs to stop stress from overpowering you.

Evaluation of different strategies that can be used to overcome barriers to communication

As I have explained above, there are many different barriers that can occur to stop communication being effective and I have explained how to overcome these barriers. It is also important however, to understand how well these strategies work and how effective they are.

For example, if someone is discussing something with you that is emotional for them, it would be a barrier to communication as they may find it difficult to open up and talk to you. By giving that person support and showing a caring presence they would be more likely to open up to you. In some cases this may not work and communication may have to happen over a long period of time. This means you may need to have several meetings with this person until you find out exactly what it is that is wrong.

Once you have found out the issues and what is wrong you can then begin to help them. On the other hand, you may not be able to find out what is wrong, it may take a lot if time and a lot of different health/social care services to find out what is wrong with that individual.

I explained above about language barriers that may occur during communication and this a common thing in health and social care. It is important that an interpreter is there to communicate between the service user and professional so that everyone understands what is being said. In most cases this method of overcoming this barrier is very successful and works. However, there may be some cases when an interpreter is not available therefore making it extremely difficult for the service user and professional to communicate. Also, in some cases, the interpreter may misinterpret what is being said and communicate back in the wrong way. This can difficult to overcome and the professional or the service user may do something wrong as they have not understood what is being said properly. In my opinion, interpreters should be available at all times so that the service users get the right interaction with the professional. Also, all interpreters should be fully trained. This is because, in some cases, friends or family of the service user (that can speak fluent English) may stand as the interpreter for that service user. This is not a good method to use as the family member or friend may not understand the technical words that are being used and may have difficulty in understanding the different aspects of what the professional is talking about. Also, in this case, there is a risk of breaking confidentiality whist talking about personal issues with the service user and having a relative of friend translate. The relative of friend may be personally and emotionally involved with the things that are being discussed with the service user and professional meaning that they may find it difficult to give a non-judgemental response to both the service user and the professional. In my own personal opinion, interpreters should be someone that is qualified to do the job and they should be available at all times to avoid disappointment for service users and professionals. As I explained, I don’t believe that family or friends should be used as interpreters as it may seem unprofessional.

People who have hearing or vision impairments may require different things for communication to be effective. Some of these resources are very useful to people with hearing and visual impairments whereas other resources only help certain people or are not very good.

For example, as I explained earlier, people with visual impairments may benefit from using IT equipment. This is a good resource to use and can be very effective for some people. However in some cases, you may come across an older adult who doesn’t know how to use computers and IT technology. This means that this method for overcoming this barrier would not be effective for them. You would have to find other things that would be useful to them such as glasses and magnifiers. These are more useful to people who are trying to view things up close rather than from a distance.

Using a clear tone and voice would help a service user who has visual impairments massively. This is because they cannot lip read, so by using a clear tone and voice and speaking louder, they would be able to hear better. I believe that this is a very good method to use and will work for most people. For someone who is fully blind, speaking in a loud voice is effective as well as giving them the use of Braille. Braille is only effective, if the service user understands it and has learnt about it. If they haven’t then the use of Braille is pointless for them and would not have any effect.

For people who have hearing impairments, they may require different things for communication to be effective. As I said before, IT Technology is a very good resource, but may only be useful to some service users who actually know and understand how to use this technology. Other resources that are useful to people with hearing impairments are hearing aids. These help people as they enhance hearing and make things sound clearer and louder. Although hearing aids are very helpful and have known to be successful, they may not benefit all people. This is because in most cases, you have to pay for them. Some people may not be able to afford hearing aids, therefore would not be able to get them, due to lack of finances. Also, some people may have hearing impairments, but it may not be bad enough for them to get hearing aids. Another thing to consider with hearing aids is that people with hearing loss may not interested in using them. This is because they think a hearing aid may make them look older or change how strangers interact with them. Some people might think they can get by just fine using visual cues to make up for their loss of hearing.

People with hearing impairments may benefit from communicating in a place where there is no background noise, and by the professional talking in a louder, clearer tone of voice. This is not a very reliable and in some cases, may not work very well. This is because you can’t always guarantee that there is not going to be any background noise. Also, someone may have hearing impairments that are really bad, so even talking in a quiet place they still may not be able to hear. This strategy to overcoming this barrier is good in some cases, but in most situations it will not work very well or benefit the service user.

One last thing that is used for people who have hearing impairments is British Sign Language or Makaton which is universal. Although this is a very good strategy for overcoming barriers, there are a number of things to take into consideration as to whether this method would work or not. For example, British Sign Language is good for people that live in Britain, however, they still have to learn and understand British Sign Language. If they don’t, then this strategy is useless. Also, you would have to think about people from different countries that don’t speak English or understand sign language. In this situation, you would have to use a translator so that the service user can sign to the translator, then the translator can speak to the professional or use Makaton. Again this would still depend if the service user and the professional understand and can sign Makaton appropriately.

People who have self-esteem issues, depression, stress or anxiety require different methods of communication. People who suffer with any of these things may turn angry or aggressive at any point. This is a barrier to communication. In this situation, you would have to try and calm that person down and get them to be relaxed. This is not very reliable as sometimes, the service user will refuse to calm down. As part of my duty as a professional, I would have tried to contact other professionals to see if there were any identified risks, this would be necessary for lone working in the community i.e home visits A risk assessment prior to home visiting should have been done. However this isn’t always possible due to the fact that some people may have recently moved into the area, therefore you do not know anything about them and have lack of information. Also, it is not reliable because if someone has recently been diagnosed with mental health issues/problems, there may not have been any identified risks previously. The best thing to do in this situation would be before you go to visit the service user (if it’s in their own home), a risk assessment, it would have to be carried out based on the information that is known to you. You should tell another colleague where you are going and what time you are expected to be back, along with the name and address of the service user. This is good practise in the case of lone working. You should leave a code word in case of an emergency with a colleague and a strategy plan, so that if anything goes wrong during the visit i.e get them to phone me after a certain time and if I used the code word they would get help to me.

On the other hand, people with self esteem issues, depression, stress or anxiety may have a submissive behaviour. This is when they don’t communicate with you in much detail and just agree with what you are saying. They may also blame themselves for what is going wrong in their lives, particularly if they are a victims of domestic abuse. In this situation you would take things at their pace and let them talk to you in their own time. You need to try and reassure them and keep them informed on what your doing so that they learn to trust you. This strategy to overcoming this barrier, may take a lot of time as the service user would need to build up trust with you. Also, it is important, that as a professional you do not let them down and if you can’t do something you’ve said you will, you inform them straight away as this helps build up trust. In this situation, trust is the biggest barrier to communication. Although the strategy is effective, it does take time, and in this time something may drastically go wrong.

Some professionals may talk in jargon when they are talking to a service user without realising they are doing it; as I explained earlier. Professionals have to be very careful with what they are say and what terminology they use. The main way to overcome this barrier is as a professional, make sure you do not use jargon. To make sure that the service user understands, you should clarify with them that they understand what you are saying and understand the message being portrayed. This is an effective strategy, as when you ask the service user if they understand, usually they will say yes or no. If they say no, then you can reword what you are saying so that they eventually understand. Also, asking them questions about what you are talking about is another good way to see if they understand what you are saying.

In some cases, service users may communicate with professionals whist they are under the influence of drugs or alcohol. If a service user is under the influence of drugs or alcohol, then they may become aggressive, therefore you should remove yourself from the meeting and explain to them that you will talk to them another time. Also, service users who are under the influence of drugs or alcohol may not be able to communicate with the professional in the normal ways. The best thing to do with this is to wait till the effects have worn off and then talk to them. This is not always reliable however because some service users may be alcoholics or may have a drug addiction, so when you see them, they may always be under the influence of drugs and alcohol. If this is the case, then you should refer to their GP, doctors or hospitals so that they can get themselves medical care. This is part of confidentiality and if you refer them without asking then it is breaking confidentiality, however, if I believed that they were at risk of harming themselves or other people, I could refer them to other professionals without their permission.

My conclusion

All heath and social care workers will come across barriers to effective communication. I believe that as a care worker, maintaining a professional attitude is important when dealing with any service user. Knowing when an interpreter is going to be needed, and understanding the situation of the service user before communication happens is always helpful, to help avoid any barriers to communication occurring to begin with.

Care workers should always have a caring presence, and the attitude of wanting to be there to make the service user feel more comfortable. Maintaining confidentiality and trust between you and the service user is important for communication to move forward.

There are many different barriers to communication, but by showing and keeping a positive attitude and knowing and understanding the service users needs and feelings, will help any barriers from occurring to begin with.

In my opinion, some stratagies to overcoming barriers are very good, yet some are not. It is important that you use the right strategy to overcoming barriers depending on the service user and their needs. Some strategies work a lot better than others and are very successful, but sometimes these strategies are not useful for all people.

Joanne Rawden