Positioning, this can create both physical and emotional barriers that inhibit communication. If a person cannot see you this may inhibit communication. On an emotional level, looking down on someone sends a message of dominance and power and can make the service user feel very intimidated by the care worker this is why the care worker, when talking to the service user, should move to have the same eye level as the service user to make them feel comfortable in communicating with them. Also if a service user has hearing difficulty they may need to lip-read what the carer is saying so being at eye level they can see both their eyes and lips this ensures good communication with the service user. With group communication positioning is very important; the way people are sat can make people more or less comfortable with communicating in that group. Examples of group formations:
This formation suggests that everyone in the group are equal, all members of the group can see and hear all messages coming from the other members, good communication is present.
This formation allows the leader of the group ‘A’ have power over the rest of the group, this is a good way to teach a small group of students in a school as every student can see and hear the teacher ‘A’.
This is a formal formation as all the people are in rows and are all facing the main person, this is the usual set-up for schools and sometimes its not a good formation for communication because not all of the people can see the main person.
This formation is used for interviews etc.
This is not a very good formation, as ‘D’ can’t communicate with any members but ‘A’ B’ and ‘C’ can communicate with ‘E’ and ‘F’ so this is not good communication between the group.
These are the best formations because every member of the group can communicate and interact with each other no one is left out of the group.
Emotion, service users often have serious emotional needs, they afraid or depressed by the stresses they are experiencing. Sometimes service users may lack self-awareness or appear to be shy or aggressive. Carers sometimes avoid listening to avoid unpleasant emotional feelings. Emotion can create barriers because care workers can be tired this would decrease mental energy when listening, care workers may believe they do not have enough time to communicate properly with the service user, the care worker may be emotionally stressed by the needs of the service users, care workers may react with negative emotions towards different cultures from their own also care workers may make assumptions about others or stereotype others.
Care workers must be able to build a supportive relationship between themselves and the service user, if the service user trusts the care worker they are more likely to share information with them and tell them their problems and if the care worker is attentive towards them they may respond with some gratitude. Care workers must try and be happy and up-beat around the service user because this will make them feel good within themselves. If a care worker enters a room to attend a service user and is aggressive towards them the service user will feel distressed and unhappy after the care has been given, but if the care worker enters the room happy and jolly the service user will feel happy and wanted and will enjoy having the care they need.
Environmental conditions, if the noise level or lighting is not very good when talking to another person it can be difficult to understand them and communicate with them, if you are trying to listen to what a person is saying and there are other people talking or there are distracting noises around you it is hard to hear and concentrate on what the other person is saying and may not respond to what they have said the way they expected you to. If the lighting isn’t too good you may not be able to see the facial expressions on the other persons face and may get mixed messages from them. If a service user cannot understand what the care worker is saying or the care worker is not responding the way the service user wants them to respond they may become distressed and confused. Also if they are in a room that is not well ventilated it could become to hot and stuffy or too cold this will stress both service user and care worker as they will feel tired and exhausted. Space between the care worker and service user is important too. If the care worker is sat too close to the service user they may feel overpowered or intimidated by the care worker, also if the care worker is sat too far away service users may feel they are avoided by them and unhappy to be around them. Care workers must ensure the right space between them is used, with low noise level, adequate lighting and a well ventilated room is used so good communication can take place and no stress is put on both care worker and service user.
2.3 Communication skills
Within care work messages should be sent clearly and properly so nobody gets confused. If a service user gets confused they could feel helpless or worthless, so good communication is essential to keep service users aware of what is happening and keeping them up to date with their needs.
The tone of voice we use tells the listener how we want what we are saying to be perceived if a care worker uses a quick and loud fixed tone of voice the service user may feel threatened as this tone of voice implies that the care worker is angry or annoyed, whereas if the care worker used a slow, calm voice with varied tones it sends a messages as being friendly and unthreatening. The tone of voice that the service user uses can help the care worker know how they are feeling for example if the service user is talking in a flat tone it may be associated with exhaustion or depression, or a faint tone may be associated with submissive behaviour.
The pace of speech we use can also make people misinterpret messages for example if a care worker uses a fast pace of speech it could mean many different things for example it may mean the speaker is excited, anxious, agitated, nervous, angry or seeking to impress of dominate the listener. But on the other hand it could simply mean the speaker is in a hurry. This is why people may get confused when trying to interpret how people are trying to say what they want to say, so we use other messages to help interpret the meaning of what the person is trying to say.
Eye contact, the way we look at someone when communicating can help when we are trying to work out what mood they are in by their pace of speech for example if a service user is talking to a care worker with a fast pace of speech they could be angry or excited etc but by looking at their eye contact the care worker can see if they are angry or excited because if their eyes are wide they are more than likely excited but if their eyes are in a fixed stare they are angry and mad. Or if a care worker were talking with a slow calm pace of speech etc the service user wouldn’t be able to tell if they were tired, bored or interested but by looking at the eye contact they would be able to tell the care worker’s emotion for example if the care worker and client were talking and the care worker was talking with a calm slow paced voice and looking away from the service user it would indicate they were bored or not interested. Care workers should keep eye contact with service users so the service user know their carer is interested in what they are saying otherwise the service user will feel uncared for and depressed.
Body language is a broad term for forms of communication using body movements or gestures instead of, or in addition to, sounds, verbal language, or other forms of communication. It forms part of the category of paralanguage, which describes all forms of human communication that are not verbal language. This includes the smallest of movements that many people are not aware of, including winking and slight movement of the eyebrows. In addition body language can also incorporate the use of facial expressions. Our body sends messages, sometimes unconsciously to other people these are some of the most important body areas that send messages.
Using clarification makes sure the care worker has understood the context of what has been said. A service user who is experiencing emotional pain very often gives a confused explanation of what is happening to them so the care worker needs to clarify that what they are hearing, and understanding, is actually what the service user is trying to say.
Summarising means to sum-up what has been said either in a group discussion or with a one-to-one between a service user and care worker. Summarising can be a very effective technique when talking one-to-one with a service user and when used correctly. When vast amounts of information and corresponding feelings have been verbalised the service user often becomes overwhelmed and confused by what is happening to them. Summarising the main content along with the feelings they are experiencing often helps the service user to focus on the most important areas and feelings that need to be worked through. It also assures the service user that not only is the care worker hearing and understanding what has been said, but that they are treating what is being shared with them as serious and worthy of respect.
Paraphrasing is repeating, without expressing any feelings that may be implied, the content of the message that has been given to the care worker using the same or slightly different words. This reassures the service user of the care workers ability to listen attentively.
Empathising focuses on one of the important aspects of the message that may lead to further explanation that either clarifies the actual meaning of the message or further explores what has already been expressed.
2.4 Theories relating to communication.
SOLER, Egan (1986), states that people read cues from your non-verbal behaviour that indicates your interest in them, therefore being attentive to the service user can invite them to trust you and open up. A non-verbal skill that can be used to communicate with service users can be summarised in the acronym SOLER.
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Face Squarely – facing the service user without turning their body from them, the point is the quality of their attention. They have to face the service user in a way that shows they are feeling involved.
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Openness – a care worker should not cross there are arms or legs because this gives the impression to the service user that they are not feeling involved, they should try an impression of being open, comfortable and wiling to participate.
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Lean – leaning slightly forward gives the impression of involvement whereas leaning away gives the impression of withdrawal or lack of interest.
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Eye contact – the care worker should maintain eye contact without creating a threatening situation by staring at the service user continuously. However they should be sensitive to cultural differences and whether eye contact is making the service user uncomfortable, the service user should feel they are interested and listening to them.
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Relaxed – tension can convey fear or lack of confidence, where as too ‘laid back’ posture can convey non-involvement or boredom. It is important for the care worker to not move around too much and be aware of the non-verbal behaviour he/she is using.
Tuckman and Jensen draw on the movement known as group dynamics, which is concerned with why groups behave in particular ways. This offers various suggestions for how groups are formed and how they develop over time. The formation of some groups can be represented as a spiral; other groups form with sudden movements forward and then have periods with no change. Whatever variant of formation each group exhibits, they suggest that all groups pass through six sequential stages of development. These stages may be longer or shorter for each group, or for individual members of the group, but all groups will need to experience them. They are forming, storming, norming, performing, mourning and retiring.
The terms are pretty self-explanatory. When a group is forming, participants can feel anxious not knowing how the group will work or what exactly will be required of them. Storming, as the word suggests, is when things may get stormy. Conflict can emerge, individual differences are expressed and the leader's role may be challenged. The value and the feasibility of the task may also be challenged. After the storm comes the calm of norming, where the group starts to function harmoniously and where participants co-operate and mutual support develops. This enables the performing stage to occur where the work really takes off and the group accepts a structure and method for achieving the common task. When the group retires or adjourns, much learning happens through informal chat and feedback about the group performance. Tuckman and Jenson recognise that when groups dismantle themselves and the loose ends are all tied up, participants often go through a stage of mourning or grieving.
2.5 Interaction with the care worker.
Introduction
The care worker I have chosen to interview is a 35-year-old male residential home worker, he looks after the service users by making sure they take their medicine, washing and changing them and he also makes sure they are as happy and comfortable as possible. The interview will take place in an office in the residential home where it is quiet, well lit and well ventilated to prevent loss of communication between the care worker and myself. Here is a diagram of how we will be positioned in the office:
Prompt Questions
- What are your roles as a care assistant?
- Can you describe a typical day?
- How long have you been working as a care assistant?
- What skills do you need as a care assistant?
- What qualifications do you need for this kind of work?
- What are the easiest parts of your job?
- What are the hardest parts of your job?
- Is there anything u dislike about your job?
- What do you do to maintain confidentiality?
- Do you make notes on everything you do for an elderly patient?
Prompt Questions
- What are your roles as a care assistant?
Roles are to ensure a safe and happy environment for the residents, to make sure the resident’s needs are understood and met.
- Can you describe a typical day?
Goes in greets the residents, makes their drinks, ask them if they would like anything, make sure they take their medicine, make sure they are happy and comfortable, clean them and change their clothes and wound dressings.
- How long have you been working as a care assistant?
Almost 7 years.
- What skills do you need as a care assistant?
Need to be patient, caring, not get too emotionally attached to the patients and must be able to keep personal and work life separate to be 100% confidential.
- What qualifications do you need for this kind of work?
A NVQ2 in care work.
- What are the easiest parts of your job?
Making cups of teas for the residents and keeping them upbeat and happy.
- What are the hardest parts of your job?
Cleaning the residents and making them comfortable because many residents have problems mobilising and have permanent pains that are hard to relieve.
- Is there anything you dislike about your job?
When residents pass away its harder if you have been around them for a long time and have gotten to know them.
- What do you do to maintain confidentiality?
Keep all residents records in locked files and on the computers they have passwords that only a couple of people know the passwords to.
- Do you make notes on everything you do for an elderly patient?
Yes, because they need to remember if they have given the residents medication and had dressing changes.
Evaluation (Interviewer)
How good were different aspects of non-verbal communication?
1 - very effective and appropriate use of skill.
2 - some appropriate use of skill.
3 - the skill was not demonstrated or it does not seem appropriate to comment on the area.
4 - some slightly ineffective or inappropriate behaviour in relation to the area.
5 – very inappropriate or ineffective behaviour in relation to the area.
Eye contact 1 2 3 4 5
Facial expression 1 2 3 4 5
Angle of head 1 2 3 4 5
Tone of voice 1 2 3 4 5
Body language: hands and arms 1 2 3 4 5
Gestures 1 2 3 4 5
Posture 1 2 3 4 5
Muscle tension 1 2 3 4 5
Touch 1 2 3 4 5
Proximity 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
How good were verbal communication and listening skills?
1 - very effective and appropriate use of skill.
2 - some appropriate use of skill.
3 - the skill was not demonstrated or it does not seem appropriate to comment on the area.
4 - some slightly ineffective or inappropriate behaviour in relation to the area.
5 – very inappropriate or ineffective behaviour in relation to the area.
Appropriate language: speech community and register 1 2 3 4 5
Encouraging others to talk 1 2 3 4 5
Listening skill: reflecting back on what others have said 1 2 3 4 5
Clarifying: use of appropriate questions 1 2 3 4 5
Clarifying: use of prompt summarising 1 2 3 4 5
Paraphrasing 1 2 3 4 5
Pace of conversation 1 2 3 4 5
Tone of voice 1 2 3 4 5
Empathising 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
The Barriers to communication
1 – Good there are no barriers.
2 – Quite good, few barriers.
3 – Not possible to decide or not applicable.
4 – Poor – barriers identified.
5 – Very poor – major barriers to communication.
Barriers in the environment:
Lighting 1 2 3 4 5
Noise levels 1 2 3 4 5
Physical barriers to communication 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Emotional Barriers
Stress levels and tiredness 1 2 3 4 5
Being stressed by the emotional needs of others 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Cultural Barriers
Inappropriate assumptions made about others 1 2 3 4 5
Labelling or stereotyping present 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Interpersonal Skills
Degree of supportive non-verbal behaviour 1 2 3 4 5
Degree of supportive verbal behaviour 1 2 3 4 5
Appropriate use of listening skills 1 2 3 4 5
Appropriate maintenance of confidentiality 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Overall
How well was the communication between the interviewer and the interviewee?
I thought it went quite well.
Evaluation (Interviewee)
How good were different aspects of non-verbal communication?
1 - very effective and appropriate use of skill.
2 - some appropriate use of skill.
3 - the skill was not demonstrated or it does not seem appropriate to comment on the area.
4 - some slightly ineffective or inappropriate behaviour in relation to the area.
5 – very inappropriate or ineffective behaviour in relation to the area.
Eye contact 1 2 3 4 5
Facial expression 1 2 3 4 5
Angle of head 1 2 3 4 5
Tone of voice 1 2 3 4 5
Body language: hands and arms 1 2 3 4 5
Gestures 1 2 3 4 5
Posture 1 2 3 4 5
Muscle tension 1 2 3 4 5
Touch 1 2 3 4 5
Proximity 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
How good were verbal communication and listening skills?
1 - very effective and appropriate use of skill.
2 - some appropriate use of skill.
3 - the skill was not demonstrated or it does not seem appropriate to comment on the area.
4 - some slightly ineffective or inappropriate behaviour in relation to the area.
5 – very inappropriate or ineffective behaviour in relation to the area.
Appropriate language: speech community and register 1 2 3 4 5
Encouraging others to talk 1 2 3 4 5
Listening skill: reflecting back on what others have said 1 2 3 4 5
Clarifying: use of appropriate questions 1 2 3 4 5
Clarifying: use of prompt summarising 1 2 3 4 5
Paraphrasing 1 2 3 4 5
Pace of conversation 1 2 3 4 5
Tone of voice 1 2 3 4 5
Empathising 1 2 3 4 5
Additional comments:
………/………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
The Barriers to communication
1 – Good there are no barriers.
2 – Quite good, few barriers.
3 – Not possible to decide or not applicable.
4 – Poor – barriers identified.
5 – Very poor – major barriers to communication.
Barriers in the environment:
Lighting 1 2 3 4 5
Noise levels 1 2 3 4 5
Physical barriers to communication 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Emotional Barriers
Stress levels and tiredness 1 2 3 4 5
Being stressed by the emotional needs of others 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Cultural Barriers
Inappropriate assumptions made about others 1 2 3 4 5
Labelling or stereotyping present 1 2 3 4 5
Additional comments:
The interviewer made no assumptions about others and was not stereotypical at all.
Interpersonal Skills
Degree of supportive non-verbal behaviour 1 2 3 4 5
Degree of supportive verbal behaviour 1 2 3 4 5
Appropriate use of listening skills 1 2 3 4 5
Appropriate maintenance of confidentiality 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Overall
How well was the communication between the interviewer and the interviewee?
The interview went well the interviewer was quite confident when asking some of the questions towards the end of the interview.
Evaluation (Observer)
How good were different aspects of non-verbal communication?
1 - very effective and appropriate use of skill.
2 - some appropriate use of skill.
3 - the skill was not demonstrated or it does not seem appropriate to comment on the area.
4 - some slightly ineffective or inappropriate behaviour in relation to the area.
5 – very inappropriate or ineffective behaviour in relation to the area.
Eye contact 1 2 3 4 5
Facial expression 1 2 3 4 5
Angle of head 1 2 3 4 5
Tone of voice 1 2 3 4 5
Body language: hands and arms 1 2 3 4 5
Gestures 1 2 3 4 5
Posture 1 2 3 4 5
Muscle tension 1 2 3 4 5
Touch 1 2 3 4 5
Proximity 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
How good were verbal communication and listening skills?
1 - very effective and appropriate use of skill.
2 - some appropriate use of skill.
3 - the skill was not demonstrated or it does not seem appropriate to comment on the area.
4 - some slightly ineffective or inappropriate behaviour in relation to the area.
5 – very inappropriate or ineffective behaviour in relation to the area.
Appropriate language: speech community and register 1 2 3 4 5
Encouraging others to talk 1 2 3 4 5
Listening skill: reflecting back on what others have said 1 2 3 4 5
Clarifying: use of appropriate questions 1 2 3 4 5
Clarifying: use of prompt summarising 1 2 3 4 5
Paraphrasing 1 2 3 4 5
Pace of conversation 1 2 3 4 5
Tone of voice 1 2 3 4 5
Empathising 1 2 3 4 5
Additional comments:
The interviewer communicated very well in this section.
The Barriers to communication
1 – Good there are no barriers.
2 – Quite good, few barriers.
3 – Not possible to decide or not applicable.
4 – Poor – barriers identified.
5 – Very poor – major barriers to communication.
Barriers in the environment:
Lighting 1 2 3 4 5
Noise levels 1 2 3 4 5
Physical barriers to communication 1 2 3 4 5
Additional comments:
The phone kept ringing and there was a slight background noise.
Emotional Barriers
Stress levels and tiredness 1 2 3 4 5
Being stressed by the emotional needs of others 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Cultural Barriers
Inappropriate assumptions made about others 1 2 3 4 5
Labelling or stereotyping present 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Interpersonal Skills
Degree of supportive non-verbal behaviour 1 2 3 4 5
Degree of supportive verbal behaviour 1 2 3 4 5
Appropriate use of listening skills 1 2 3 4 5
Appropriate maintenance of confidentiality 1 2 3 4 5
Additional comments:
……/…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Overall
How well was the communication between the interviewer and the interviewee?
Good communication between them.
Evaluation
After having an interview between a care worker and myself I asked the care worker and the observer if they would fill an evaluation sheet in for me to assess myself I also filled in exactly the same sheet. Throughout the interview I tried to put in practice Egan’s (1986) SOLER theory, I tried to face squarely, I kept an open posture, I slightly leant towards the care worker so I looked interested about what he was saying. I also tried to keep eye contact with him but not constant as this would make him feel intimidated and although I was very nervous I tried to be relaxed and confident. The interview took place in an office in the residential home there were no barriers with lighting or physical barriers but as we were in an office the phone kept ringing and there was a background noise from outside the room, to prevent this I should have made a sign to put on the outside of the door so people outside were quiet or had the interview in another room that was more secluded and didn’t have a phone. The observer and myself found no emotional barriers but the care worker thought the stress levels and tiredness was a barrier so I should have made the interview earlier in the day so stress and tiredness from work would not have affected the care worker. The observer and care worker noticed that my facial expression, angle of head, posture and muscle tension was not demonstrated during the interview I should have made more expressions with my face with my head in the right position to communicate, also I should have leant more toward the care worker as it seems I was too far leant back and I should have tried to relax more as the observer pointed out I was very tense with nerves. The observer thought the communication was good between the care worker and myself. The interviewee/care worker said ‘the interview went well the interviewer was very confident when answering some of the questions towards the end of the interview’. So I have a few things I need to improve on but overall the interview went well and not too many mistakes were made.
Unit 2: Communication in care settings
