The communication cycle may look like this:
- Ideas occur: you have something you want to communicate.
- Message coded: You think about how you are going to communicate what you are thinking, you put your thoughts into a form of communication, such as verbal, or British Sign Language.
- Message sent: You speak or sign your message, either in the form of speech, Sign language or writing etc.
- Message perceived: The other person picks up your message, for example they hear your words.
- Message decoded: The other person has to understand or ‘decode’ your message. The other person uses body language, facial expressions and tone of voice to understand exactly what you mean.
- Message understood: Your message is understood, however, it does not always get understood.
P3: Describe factors that may influence communication and interpersonal interactions with particular reference to health and social care settings.
There are many factors that can, and will affect communication and interpersonal interactions in a health and social care setting. Therese vary from each setting, be it a hospital, nursery, school, care home or ambulance for instance. This assignment will explain many of the different factors, which may influence communications in different ways; these are also known as, the barriers to communication.
One of the biggest barriers to communication is if the communication is not received by one of the members of the conversation. This is simply when person A says something, but person B does not hear it. This could be because Person B is deaf, or hard of hearing, or that Person A had not spoken clearly or loud enough. The communication does not work, because an appropriate language system or technique had not been used, and therefore, no information can be passed on. To overcome this, the conversation could be moved from verbal communication, to non verbal, perhaps by, instead of talking, using British sign language. However, if the sign language is not seen by the other person, then again, the communication fails. Therefore, when using verbal communication, both parties need to be able to speak and hear clearly, or, be able to make sense of hand gestures, understand British sign language and be able to respond. For example, a care worker is on a visit to a woman at her home. As she tries to talk to the Service user, there is no reply. The woman carries on looking out of a window, because she has not heard the care worker, as the user is deaf. Secondly, is if the communication is not understood. This is similar to the point made above, however, in this case, the message is received, and however, it is not decoded correctly, for example. Person A speaks to Person B, who hears exactly what was said, however, Person B does not understand what Person A has said. This could be because Person A and B are from two different speech communities. Person A may be from London, whereas Person B is from Bangor. The Jargon and slang from the two different areas are so different, that Person A may not understand Person B. Another example of this is if a Doctor and patient are discussing possible treatments for a stomach disorder, the Doctor may use technical jargon and names. The doctor may state ‘We cannot use Isosorbide Mononitrat for the pain just in case of an anaphylactic shock’ Where what the Doctor could say is; ‘ We can’t use Aspirin for your pain in-case you have a reaction.’ As a non-medical professional may not know the technical terms for that Aspirin, or an allergic reaction.
The third type of communication barrier is if the communication is distorted. This is where the understanding of the information is false. This is because we decode the message wrong, either as we mis-understand a word, phrase of piece of jargon, or how we stereotype and assume things quickly. A problem with distorted communications is that it is not easily noticed, and requires selective listening to notice it.
People have a first language; this is the language that they have learnt to think in. Usually people’s first language is the language they were brought up with. Some people learn a secondary language, which, if someone’s first language is not English, may be English. People prefer to talk in their first language, which is their preferred language. This is because they think in it. It is much easier to be spoken to and understand instantly the meaning of the message, rather than have to translate the message.
Objects can also be used as a form of communication. Simple things such as household items, photographs and toys can be used to communicate with a service user. For example, If there is no verbal form of communication available to a patient in hospital, the staff may use a toy to comfort the patient, and use pictures and diagrams to explain a procedures.
Language systems need not simply be confined to verbal communication, but could be by British Sign Language. BSL is a full language system developed using hand and arm gestures. BSL gives people who cannot use a verbal language, a language to communicate in easily.
However technological aids also help in developing effective communications. Information technology has brought the health and social care sector a wide variety of aids for communications. It is now possible to provide patients in hospitals with large visual displays to help them read and see. Hearing impaired induction loops have been brought into most public buildings, such as supermarkets, hospitals, police stations and council offices, this allowed people with a hearing aid to be able to hear much clearer, meaning that effective communication is much easier to establish. Smaller pieces of technology such as flash cards, text messaging, computer screens and picture books can also improve the communication cycle. For example, a Nurse can now check a patient’s observations on a small hand held device, which updates the doctor’s notes automatically.
P4: Identify how the communication needs of patients/service users may be assisted, including non-verbal communication.
M2: Explain the specific communication needs patients/service users may have that require support, including the use of technology.
D1: Analyse how communication in health and social care settings assists patients/service users and other key people.
In Health and social care there are many different ways to assist people in order to communicate. This may be by developing a new system of communication or by removing the barriers of effective communication. Advocates act as a voice for often seriously disabled people, for example a patient who is unable to communicate effective to members of the hospital staff, due to a disability such as dementia, will often have an advocate employed for them. It is the advocate’s job to get to know the patient and then speak for that patient. The advocate is usually an independent contract and therefore not part of the hospital staff. This means that the advocate will argue for the rights of the patient, and for his or her best interests, not for the hospitals best interest, which could be the easiest, cheapest or quickest option. This way the patient gets the best possible treatment, without the hospital influencing the patient to what they say is the best option, as the advocate can argue the rights and wants. However, even though an advocate looks like the ideal option for a patient who cannot communicate to get the best possible treatment, volunteer advocates may not fully understand what the patient wants, needs or how the patient feels. Many people argue that hospitals, care homes and other health and social care settings should provide training so that patients can self-advocate. This is where the patient is trained and supported so that he/she can argue their own case.
One of the barriers of communication which is often seen in hospitals is there being two different languages spoken. For example a Nurse may be speaking English to a patient, but the patient may not understand or speak English. This is where an interpreter or translator is brought in. Interpreters and translators interpret between both spoken and signed language. For example, a Doctor speaking English, to a deaf patient, the interpreter will sign to the patient what the Doctor is saying, and then in turn, tell the Doctor what the patient is signing. Many languages do not however, have equivalent words in translation. This means that the interpreter needs to understand the message from Speaker A, and word it in a way which makes sense to speaker B. This is an extremely difficult process, however a simple example is that there is no word in the Czech language for motor home. It is simply ‘Karavan’. However in Britain a caravan is a trailer and a motor home is a driven house in sense. Therefore when translating from Czech to English, the interpreter would need to express this differently. Interpreters in Health and Social care are often employed by a local authority, council or health board. However in some situations the interpreter is a friend or member of the family, This allows the patient to trust the interpreter as they know them.
There are however, many issues that are associated with using an interpreter or translator. It is not as simple as just changing words or signs into another language, when translators or interpreters work, they become part of the communication cycle, which in turn can create barriers to effective communication. When a patient has an interpreter, they need to have confidence in, and lay their trust in to them.
There are several aspects to the issue of trust with interpreters. Firstly the patient needs to trust that the interpreter is communicating to them the accurate information. This is very important for example if an unaccompanied child asylum seeker is found in the UK, the social services will bring in an interpreter. However the child would need to trust that what the social worker or case worker is saying, is being translated correctly by the interpreter, who could be in fact not stating exactly what had been said. An interpreter is likely to be much more helpful when he/she understands the matter at hand. A qualified translator may be able to explain the fine points of a piece of legislation or the procedures of a serious operation, because they comprehend the issue. However, if a friend or family member is the substitute to an interpreter, they will have to make sense of the jargon and technical details and then communicate that clearly to the service user. This shows that understanding of a language does not constantly ensure effective communication. Many people may feel that they should not discuss private matter while using an interpreter from the opposite sex. For example a woman may not feel comfortable talking via an interpreter to her doctor about sensitive issues. Often when an interpreter is brought in to a medical setting, the staff must make a choice on the basis that the interpreter must support the self-esteem needs of the patient.
P5: Describe two interactions that you have participated in, in the role of a carer, using communication skills in assist patients and/or service users.
P6: Review the effectiveness of your own communication skills in the two interactions undertaken.
M3: Explain how your own communication skills could have been used to make the interactions more effective.
D2: analyse the factors that influenced the interactions undertaken.
- During my work experience placement at a care home, I spent time with an elderly lady (Person C) who was extremely hard of hearing, and could not talk very well. I had to ensure I spoke slowly, and clearly, but loud enough for her to hear. In order for myself to communicate clearly and effectively I needed to use hand gestures. Person C was able to sign in British Sign Language (BSL), however I cannot. Therefore I needed to use hand gestures as well as speech in order to be understood. I would point at certain things while saying their name in order for her to understand. When offering a cup of tea, I would pick up a cup and shake it a little while we had eye contact, so she knew I was offering one. I feel I was able to meet the physical and emotional needs of Person D during my time spent with her, even thought we could only communicate through hand gestures mixed with speech. We were however, able to hold a good conversation, about her past and my future, her family and so on. I felt that Person C felt comfortable in my presence, as she was relaxed and open to communicate, she would ask open ended questions, and reply to my questions, often with a question of her own, meaning she wanted to communicate. When I would leave for the day, Person C would often move to hug me and ask me when I was coming back, this showed me that she enjoyed my company, showing that even though we could not fully communicate, she enjoyed the communications we had. I spent 48 hours on this placement, the majority of the time spent with Person C. My main reason for feeling that my communication systems succeeded was because after I had left, I was invited to the funeral of Person C by her family. To me this meant that she had informed her family about me, and obviously I was there to support her and comfort her enough for her to tell her loved ones about me.
Looking back however, I feel I could have communicated slightly better at the start, possibly by drawing things to her, or writing on a whiteboard. I did draw pictures for her to see after my third visit, but I feel even though it is a simple thing to do, it would have made the opening visits much easier, and the communication easier. Burnard and Morrison (1997) said that in order to effectively care and communicate, the carer must actually care about the service user. I felt that I cared a great deal about person D and this showed as she was able to effectively communicate with me.
- On my second work experience placement, I was placed into a school, and in particular, a year 2 class. In this placement I had to communicate constantly with small children around the room. My body language, tone of voice, facial expressions and hand gestures were extremely important here, especially as many of the children’s first language was Welsh, and may did their work in the medium of Welsh. Even though many could speak English at a suitable level for a year 2 pupil, it was still hard to communicate effectively as I could not use complex words or phrases, and had to keep the conversation at a suitable level.
My body language was very important as I had to show that I was relaxed and approachable. For the pupils, if I had been ‘closed up’, as in my arms around myself and so on, they would not of approached me, as I do not look welcoming. However, I spent a lot of the time at their eye level, on my knees, so that it was not only easy to talk to me, and hear me, but it was also easy to communicate non-verbally, such as showing me pictures and so forth. I used many hand gestures such as thumbs up and high fives. These hand gestures would be very different to my previous placement, as they had to suitable to my setting. It is acceptable to high five a child who has done well, but it is not suitable to high five an older woman who is in a residential care home, it is certainly not a norm for society, or the setting, and I do not feel that the staff or service users would have appreciated this as it may have come across that I did not respect the service user, and therefore my chances at effective communication would have depleted. I also had to ensure I smiled a lot, but in a friendly manner, not an awkward one. This was to show the children I was happy to help them, happy to be there, and approachable. If a child sees a man in their class room who looks angry, they will not approach them.
I also had to communicate in group sessions. The best example of this is when the children were put into two groups of fifteen to talk about what everyone had done on the weekend. The situation was difficult to communicate at the start, as all the children wanted to talk at once, and to talk over one another. This made the noise level rise. To overcome this, I used my body language and hand gestures to stop them talking. I simply put one hand in the air, and a finger over my lips in a ‘shh’ manner, as the children saw this they stopped talking amongst themselves and sat quietly. This showed me that even though I could not talk and be heard, and I didn’t feel it was appropriate to shout, a simple hand gesture let me take control of the situation. I then used my watch to pass around the group, and the only person who could talk was myself, and the pupil wearing the watch. This worked well as everyone in the class abided by this rule, so even though I was not a teacher, and I was friendly and nurturing, I had still communicated enough to have the children listen to me.
I do feel however, that some of the language I used, created a barrier in the communication cycle. When I first arrived at the school, I was asked to stand in the front of the assembly, and talk about myself, so the children knew who I was. The head-master had thought that because of my military background, the children may enjoy talking about my time in the army. However, when I was trying to explain my answers to their questions, such as ‘What guns did you use?’ I wasn’t able to use the language I normally would, and had to explain things in a slower, simpler way. As-well as avoiding the answers to questions like ‘Did you ever kill someone?’, as it would not have been acceptable to discuss this, in any form of communication. When I was asked to describe what my ‘camp’ was like, I found it very difficult to explain, which may have left the children, confused. What I should of done here was drawn a diagram on the board, as this would have been much easier to show them.
Referances:
Books: Beryl Stretch/Mary Whitehouse. Health & Social Care Book 1 Level 3. (2010)