This process put forward by Tuckman can certainly be seen in many group interactions whether in a school, nursery or residential home; speaking in a group can be quite difficult so people are often shy until they get to know the others better. Once everyone has started to talk a little bit the atmosphere then becomes more comfortable, and from first impressions we often decide who we like better than others. Once everyone is quite well known to each other the awkwardness of speaking tends to go.
The first stage in group interactions (forming) is probably the most noticeable; for example in a primary school during a group interaction (such as ‘circle time’) the teacher is likely to notice who the quieter and shy children are, and in turn encourage them to speak and interact with the others. A good way to do this would be to ask the quieter child what they think about what another child has just mentioned, or ask them something about themselves. Getting them involved early on is important as it can help to prevent future social exclusion, which in turn has detrimental effects on self esteem.
Emotional barriers
Emotional barriers to communication can emerge when a service user become upset; this could happen in situations where there has been a disagreement between a service user and someone else, they may have lost a loved one, or could feel upset if a relative is unable to visit. To help prevent emotional barriers from forming, the care worker will need to make the service user feel safe and secure during their interactions; if they feel that they are being ignored or misunderstood, they are likely to withdraw and become quiet, or on the other hand they may become aggressive and lash out (Fisher, 2006).
The discussions care workers hold with service users should be handled differently to the sort of conversation held with a friend; the carer must remember to maintain the professional relationship and should be thinking of the needs of the service user. For example, if an elderly women who lives at home and receives home care tells her carer that she has been very upset because her pet cat has died, the carer should remember to keep the conversation focussed on the service user; they should not, for example, say something like: ‘oh I know how you feel, when my dog died I was so upset and felt...’ they should instead sensitively use open questions to help the service user express their feelings about the situation.
According to Fisher (2006) it is important that a service user:
- Feels that the care worker has empathy and empathetic understanding – care workers should try to imagine what it would be like to be in the others shoes so that they can better understand how the service user is feeling
- Considers that they are being offered unconditional positive regard – it would greatly hinder a conversation if the service user felt they may be being judged on what they tell their care worker; they should feel accepted just the way they are
- Knows that the person or persons with whom they are talking is genuine or congruent – this means showing a genuine interest as the service user is likely to withdraw if they feel that the care worker is not really interested in what they have to say
These factors help service users to feel emotionally safe and are important for helping them to discuss how they really feel, and therefore helps to prevent emotional barriers to communication from forming.
Inappropriate language
In health care a lot of technical language is used by doctors, nurses and other professionals, but it is important to remember that service users quite often will not understand what these technical terms mean; therefore if having a discussion with a service user about things such as a health condition they suffer from, any technical language should be explained a way that the service user will understand. When explaining what technical terms mean, the age and ability of the service user should be taken in to account as well as the situation under discussion.
Styles of speech can also prove to be problematic when communicating with service users, for example different people may expect differing degrees of formality when greeting someone and having a conversation. For example, an elderly person may feel uncomfortable if their younger carer greeted them in the morning with: ‘morning, you alright? When do ya wanna get up?’ And instead prefer a more formal greeting such as ‘good morning Mrs Smith, how are you today? When would you like to get up?’ The degree of formality carers should use will depend on the situation, how well the service user is known to them and their background, for example an elderly upper class woman is likely to expect a more formal style of speaking whereas a lower class man from London may prefer a more casual style of speaking; however, assumptions should not be made on the basis of such little information about people, and it is usually better to adopt a more formal tone, at least until the service user is better known to the carer. In any case, the style of speech used by carers to communicate with service users should become overly informal as carer workers must maintain a professional working relationship with them.
Lack of skills
Skills, such as using open and closed questions when appropriate, summarising and using prompts are important for effectively conversing with service users and a lack of these skills can therefore hinder communication between service users and care workers. For example care workers should remember to be patient if there are long pauses before a service user answers a question, as they often need longer to think about it and decide how to respond. A care worker without effective communication skills might think the long pause is unusual and repeat the question or ask another, which could confuse the service user as they would not know which question to answer first and they would also feel rushed and so not give full or fully thought through responses.
According to Fisher (2006) interactions which demonstrate a lack of skills are those:
- That use multiple questioning techniques
- That are full of leading questions – as the service user may give the answer they think is ‘expected’
- That have sentences that are too long and have no focus – these would just confuse the service user and achieve no goal
- That use too many closed or monosyllabic questions – closed questions allow for only very limited answers, but are necessary for obtaining certain information
- In which listening is not active and there is a lack of genuine interest – this would be displayed through negative body language (such as fidgeting and looking at the clock) and would not encourage the service user to continue with what they are saying
- Where there is a lack of congruency
- Where tone and pace are not used appropriately – for example a carer should not sound too cheerful if discussing something upsetting to the service user, such as the loss of a loved one
Inappropriate behaviour
Inappropriate behaviour includes:
- Shouting – which is seen as aggressive and intimidating, however speaking very loudly is sometimes necessary if talking with someone who has a hearing impairment
- Speaking too quietly – if the service user is unable to hear what is being said they are likely to find the situation very frustrating and may just try to ‘guess’ their responses
- Covering the face or mouth when speaking – this is negative body language to use when communicating and should be avoided
- Using abusive language – the service user may find this very threatening, even if it is meant in a ‘friendly banter’ way (which is another reason why care workers should stick to a formal or semi-formal style of speaking when communicating with service users)
- Threatening a service user with physical force – is absolutely unacceptable
Inappropriate behaviour such as this will fail to make service users feel valued and respected, and can make them feel vulnerable and frustrated with their situation which can in turn result in them displaying undesirable behaviours including:
- Being physically violent towards care staff or other service users
- Being verbally aggressive towards care staff or other service users
- Feeling sad and being tearful
- Becoming withdrawn and feeling less confident in themselves
Care workers should look out for such behaviours as they may point to problems which require attention. What may appear to be a sudden out-burst from a service user may in fact be a result of tensions mounting over a long period of time.
Furthermore a service user who displays such behaviour is unlikely to feel happy and their confidence, self esteem and likely hood of achieving ‘self actualisation’ (as defined by Maslow) will be low.
Lack of confidentiality
Maintaining confidentiality in care settings is very important and a key part of the professional relationships between carers and service users. If a service user’s right to confidentiality is not respected then it is likely to cause a breakdown in these professional relationships as the service user will not be able to trust their carer; therefore care workers should be very careful not to gossip or ‘chat’ about personal issues concerning service users. Respecting confidentiality is enshrined in government legislation and the policies within organisations which deliver care, so clear boundaries are set out for carers.
Care workers should break confidentiality only if necessary, such as in situations where there is a risk of harm to the service user or others; and because confidentiality must sometimes be overridden care workers should never promises a service user that they will ‘keep a secret’. If a service user does divulge information which clearly needs to be passed on for their own safety and well being, the care worker should explain to them that they have a duty to tell, and that only those who ‘need to know’ will be informed of the situation.
Cultural influences on communication
We live in a multi-cultural society and difficulties with communication can sometimes stem from these differences in culture and background; a person’s cultural background will influence the way they live, think, relate to each other and also how they interpret body language and what has been said (Nolan, 2008). For example in some cultures eye contact during communication is interpreted positively as meaning the person is interested and listening whereas in other cultures eye contact may be interpreted as aggression and intimidation. Another example would be how in some cultures it is acceptable to stand quite close to others whereas it could be offensive to people of other cultures (Nolan, 2008).
In some cultures it is unacceptable to a woman to speak to a man whom she is not married or related to. This could result in difficulties within care settings, for example if there is only a male carer available to look after people on a night shift, the resident may feel unable to ask for assistance if she requires anything.
Certain cultures also find it unacceptable for a woman to show her hair (and sometimes face) in the presence of men. This could also prove problematic, for example if a Muslim woman was in one of the small sitting rooms of a residential home with two of her female friends she might decide to remove her veil so that she can talk better with them; if a male carer then walked in to tell them dinner was ready it would be fine for the other two women but would put the Muslim woman in an awkward position and make her feel very uncomfortable. Carer workers should get to know the cultural needs of those they care for so that they learn what behaviour and language is acceptable to use around them.
According to Nolan (2008) in order to find the information they need, carer workers could ask the individual concerned or:
- Look in the person’s records – a care plan should contain some useful information
- Speak to the service user’s spouse, friend or relative, if this is possible
- Speak to someone else who is of the same cultural background of the service user to find out what is and what is not acceptable
The influence of positioning on communication
In our culture standing too close to someone who you do not know well is unusual behaviour and could make the person feel very uncomfortable, as we have a ‘social zone’, with people we know better being able to maintain a closer proximity without awkwardness. For example most people are perfectly comfortable with being close to their children and spouse; very good friends can sometimes have a closer proximity and for people we know less well and strangers it is appropriate to maintain a certain distance. An exception to respecting the social zone without offence could be in situations such as when on a train which is very crowded; however if someone were on an empty train and a stranger went and sat next to them it is likely that that person’s behaviour would be viewed as inappropriate and even as suspicious.
Staff in care settings should be aware of how positioning may affect the service users’ interpretation of a communication; they could take the care worker coming too close to speak to them as offensive. However in some situations, such as when very personal information needs to be discussed or when the service user has a hearing impairment it is necessary to stand close to them; if the care worker thinks that it may make the service user uncomfortable then they should simply explain why they need to stand or sit closely, and ask if it is alright with them.
However it is best to maintain a social zone if possible and care workers should be aware that people from different cultures and backgrounds may expect a different amount of distance to be maintained. Furthermore, care workers should remember that even though it is sometimes considered acceptable to comfort a child in a care setting with a hug if they are distressed (such as if they have fallen over), that children as well as adults can feel uncomfortable with the social zone not being respected and especially if they do not know the carer well.
The influence of gestures on communication
We often use gestures automatically when communicating with others and it is usually a positive thing as it can help others to understand the meaning that we are trying to convey. However gesturing too much can sometimes cause confusion, and using gestures when speaking to individuals from different cultural backgrounds can lead to misunderstandings; therefore it is very important that care workers learn what gestures are acceptable to use around service users who are from different cultural backgrounds to prevent causing offence. For example, in Western cultures holding the thumb up is a sign that something is good (or can mean ‘yes’), but in another cultures the same gesture could mean something very insulting (Fisher, 2006).
The effects of communication barriers on self-esteem and relationships
Communication barriers such as lack of confidentiality and skills, as well as inappropriate language and inappropriate behaviour can have very detrimental effects on service users self esteem and their relationships with other service users and care workers. For example, a service user who finds out that other service users are ‘gossiping’ about personal information concerning them (such as they wet the bed again) because the care staff have not maintained confidentiality may feel embarrassed or ashamed, (therefore adversely effecting their self-esteem) and are unlikely to feel that they can trust the care workers. Such a situation may also effect the service user’s relationship with the other service users; they could feel that the others are ‘laughing at them’ or think less of them, which is also likely to affect self esteem as well because how we see ourselves is effected by how we believe we are seen by others.
Inappropriate language and behaviour, such as intimidating service users or physically hurting them is also likely to make the service user feel ‘worthless’ and result in poor self-esteem, which in turn may result in a lack of confidence in their ability and they may then choose to withdraw from things such as social activities within the care setting. Care workers should be careful not to criticise service users; often if someone is criticised over a prolonged period of time they will come to believe the negative things said about them.
Furthermore low self-esteem and having poor relationships with others is likely to result in self isolation (because they will feel less valued and less accepted by others), and feelings of anger, frustration and unhappiness. Therefore barriers to communication can prevent service users from achieving what Maslow calls, ‘self actualisation’.
Summary
The barriers to communication include: environmental barriers, such as bad lighting and unsuitable room temperature, social barriers which can arise due to a lack of self-esteem, lack of skills and confidentiality, and inappropriate language and behaviour, such as threatening service users or physically abusing them.
Factors influencing communication include: cultural influences; people from different cultures, areas of the country and people of different age groups will have different expectations and will want to live their lives in different ways. Positioning and the use of gestures also influence communication; care workers should allow service users to have their own personal space and should use gestures with caution, keeping in mind that different people may interpret gestures in very different ways.
The communication barriers discussed can have very negative effects of self-esteem and relationships; things like inappropriate language, lack of skills and failure to maintain confidentiality can result in service users feeling unvalued and lead to depression and withdrawl.
