Unit 17 Support Individuals with specific communication needs … · This unit is for those who...
Transcript of Unit 17 Support Individuals with specific communication needs … · This unit is for those who...
Unit 17
Support Individuals with specific communication needs
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Unit purpose and aims
This unit is for those who support individuals with specific communication needs. It
provides the learner with the knowledge and skills that address personal interaction and
the use of special methods and aids to promote communication. This unit builds on the
content presented in Unit 1: Promote communication in care settings.
The learner will:
1. Understand an individual’s specific communication needs
2. Understand how to support the use of communication technology and aids
3. Be able to contribute to identifying and addressing specific communication
needs of individuals
4. Be able to interact with individuals using their preferred communication method
5. Be able to promote communication between individuals and others
6. Be able to review an individual’s communication needs and the support provided
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1.1 Explain the importance of meeting an individual’s communication
needs
What is communication?
Speech and language are just a part of human communication. Non-verbal
communication such as facial expressions, gestures and posture along with written
communication, use of social media and creative expression are important ways that
people communicate too. In health and social care settings you are likely to work with
some individuals who have specific communication needs. People who have severe
difficulties with communication may show their frustration with behaviour that challenges
others such as screaming or hitting. In this context, this behaviour can be seen as a form
of communication too. This unit explores a range of specific communication needs and
alternative communication methods including sign language, communication aids and
assistive technology.
Why is communication important?
Good communication increases the chances of an effective working relationship
between professionals and individuals in their care
Good communication is extremely important to help the individual retain
as much independence as possible
Good communication will help to reassure and support individuals and their
family and friends
Open, honest communication from the start will allow realistic goals to beset
Poor communication can result in misunderstanding and cause unnecessary
distress for the individual and his or her family and friends
Poor communication can result in the individuals' fears and questions remaining
unanswered and this can increase stress for individuals, their relatives and friends
and also for care staff
Significant communication difficulties can lead to anxiety, depression and
sometimes behaviour that challenges others.
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Meeting the needs of individuals with specific communication needs
Specific communication needs arise from an individual having difficulty communicating
with others or having difficulty understanding the communication of others (or both). In
health and social care settings service users may have a range of specific communication
difficulties. These are some examples shown in the table following.
Difficulties understanding others Difficulties communicating with
others
Sensory issues such as impaired vision
or hearing hamper an individual’s efforts to
observe facial expressions, body language
etc. or to hear what others are saying.
Individuals may lack motivation to
communicate with others (for example
due to mental health conditions such
as depression or schizophrenia)
Some conditions such as autism
make observing and interpreting
non-verbal communication very
difficult
Some illnesses make it difficult for
individuals to put sentences together or
find the right words so speech is
garbled (stroke, head injury)
Processing of speech can be difficult for
individuals with dementia, autism,
dyspraxia or learning disabilities.
Speech may be slurred (a
symptom of many brain disorders)
or lacking in fluency (stammering)
and difficult for others to understand
Language barriers can be
experienced for those with English as a
second language, restricted vocabulary
or if medical or other jargon is used
Individuals on the autism spectrum or
with some mental health issues may
lack awareness of the pragmatics
of communication and stand too
close, talk ‘at’ people rather than ‘to’
them, be
repetitive or have restricted conversation
Memory problems (for example due to
dementia, stroke or head injury) can create
difficulties in understanding the
communication of others
Any individual using sign language or
communication aids will struggle to be
understood if others do not
understand the signs or give them
the chance to use appropriate
communication aids
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All individuals have a right to communicate in the way that they prefer, and the specific
needs and rights of individuals must be actively promoted.
The way that you communicate with an individual will depend upon the person’s
individual needs. Attempting to communicate with an individual in a manner that they do
not understand will only cause unnecessary frustration and distress and could lead to the
individual misinterpreting what has been communicated. It cannot be over emphasised
how important it is to the individual’s wellbeing to be able to communicate their needs,
wishes and preferences to ensure that their communication needs are fully met.
Equity
The dictionary definition of equity is: “Fairness; Legal system founded on the principles of
natural justice that supplements common Law”.
The principle of equity in the care sector relates to individuals’ needs, by ensuring that
individuals are treated in a fair manner. The individuals’ right to have their needs met is
therefore recognised and the care sector acknowledges that it has a responsibility to fulfil
these needs.
Every care organisation should have a Mission Statement and/or Philosophy of Care.
This should be displayed in a prominent position where all service users, staff and visitors
can see it.
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This document will state exactly what standards of care the individual should expect and
how the organisation aims to achieve this. These standards will be in line with
international, national and local legislation and all care staff should be aware of their
responsibilities.
Diversity - ‘Variety, differences’
Recognising and respecting the diversity of people is vital. It is essential that the care
worker behaves in a way which clearly demonstrates that they accept the diversity of
people and are not passing judgement. People have a right to express their beliefs and
views. We are all diverse individuals, with differing personalities, skills, interests and
talents and the benefits of this diversity to individuals and society as a whole, must be
acknowledged.
Defining Inclusion
Inclusion is defined as “accepting people’s diversity without discrimination in order that
they can participate in equal tasks”. Those with specific communication needs should
be communicated with effectively to promote inclusion and avoid isolation.
Being Involved
An individual needs to communicate, to be listened to and to be involved with others. All
individuals have the right to be included in all aspects of their care, social activities and
personal life. It is the responsibility of all health care professionals to ensure that
individuals are interacted with in an inclusive way.
Expressing Needs and Preferences
All individuals should feel they have the right to express their needs and
preferences and communicate their needs in a way they choose.
Wellbeing
The dictionary definition of wellbeing is “a good or satisfactory condition of existence; a
state characterised by health, happiness and prosperity”. The World Health Organisation
defines health as “a state of complete physical, mental and social wellbeing and not
merely the absence of disease or infirmity”. It is important therefore that individuals’
specific communication needs are met in order for them to strive to achieve a state of
wellbeing.
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Person Centred Care
Person centred care is an approach which aims to put the individual at the centre of
everything you do. Therefore, all care revolves around, involves and includes the
individual in order to fully meet their needs, wishes and preferences. A person centred
approach recognises the individuality of the person and will enable their communication
needs to be met. Person centred care is one of the Fundamental Standards, required in
care settings, by the Care Quality Commission.
1.2 How and when to access information and support in relation to
communication needs
There may be a number of reasons why you may need to access information and
support about identifying and addressing specific communication needs. These may
include:
Your role and responsibilities may require the you access information and
support particularly where certain aspects of identification and addressing
needs is beyond the limits of your role and competence
Change of needs or abilities of the individual
Concerns with regard to progress rates of individuals
The need for referral to specialist services
Professionals who may be able to provide support and guidance
If you have difficulty communicating with individuals using their preferred communication
method or language you may need to change your approach and call on other people
for support.
Depending on your role you may be responsible for accessing these services. If this is
not within your role the ways to access support should be discussed with your line
manager.
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Support services could be either within or outside your workplace, and may include some
or all of the following:
Speech and language therapist
Audiologists, Ear, Nose and Throat Specialists
Ophthalmologists or Opticians
Psychiatrists, specialist Mental Health Nurses or Psychologists
Translators
Interpreters
SocialWorkers
OccupationalTherapists
Signers.
1.3 The impact of your own role and practice on communication with
an individual who has specific communication needs
Active support
It is important that you support individuals to express their wishes, with regard to who
they wish to communicate with and the ways in which they want to do this. You, as a care
worker, must make every effort to form a therapeutic relationship with the individual. They
must trust you. Open and honest communication, treating each person with respect,
upholding their rights and freedom of choice, and challenging discrimination wherever
this occurs, will ensure a trusting relationship between service user and care worker
develops.
Respect
It is vital that every individual is treated with dignity and respect. Every effort should be
made, by all members of the care team, to assist the individual to communicate their
needs and interests so these can be met in full.
You must show individuals that you recognise and put their specific communication
needs at the centre of everything you do. This is particularly important for individuals who
have a specific communication need and may have difficulty expressing their wishes and
need support to do this.
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It is vital that you understand and appreciate the impact your own role and practice
has upon communication with an individual who has specific communication needs.
Understanding and modelling good practice
As a care worker you must be aware that, at all times, you and others are influenced by
the practice you observe and experience. All health care workers should be models of
good practice and should develop their knowledge and endeavour to learn from those
who demonstrate excellence in their role, responsibilities and standards of care.
Skills and abilities
It is vital that you are aware of the skills and abilities required to communicate effectively
and that you develop knowledge, acquire practical expertise and analyse your level of
competence. The level of your skills and abilities will directly impact on how effectively
you are able to support communication. Well-developed abilities and knowledge will
enable you to use your skills to positively impact on communication with individuals who
have specific communication needs.
Analysis and appraisal of your skills will identify your level of competence and your
training and development needs.
If service users use sign language such as Makaton, or communication aids it is very
important that you are trained and competent to assist them. You will also need related
skills including using praise and positive reinforcement to encourage service users to
communicate.
Care workers who rush an individual who has specific communication needs, ask them
too many questions and don’t allow sufficient time for a response are likely to have a
negative impact on the individual. Care workers who are too loud, use medical jargon,
figures of speech or who do not take note of the individual’s signing or non-verbal
communication, also have a negative impact.
Failure of care workers to cooperate in the use of communication aids will also have a
negative effect on service users.
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Seniority
Your role in supporting individuals with specific communication needs will depend partly
on your level of seniority. More senior staff have a greater role in referring service users
to other agencies and liaising with other professionals. They are also responsible for
ensuring all staff are adequately trained and competent to assist individuals with specific
communication needs.
All care workers need to be aware of the range of communication methods and aids
available to support individuals to communicate as described in learning outcome 1.4
below.
1.4 A range of communication methods and aids to support
individuals to communicate
What is a communication aid?
A communication aid is anything that can help an individual to communicate more
effectively with those around them. This could range from a simple letter board to a more
sophisticated piece of electronic equipment. Selecting the right communication aid will
depend on many factors such as access and personal preference. It is always
recommended that a specialist assessment is sought through a speech and language
therapist or communication aid centre.
It is not essential for the user to be able to read text in order to use a communication aid.
Many aids are symbol or picture based and still enable individuals to communicate with
others. A basic example is the Picture Exchange Communication System (PECS) used
by some individuals with learning disabilities and specific communication difficulties. The
individual has a number of cards each with a picture on it. They can communicate some
needs and choices by handing the appropriate picture to a care worker, such as choosing
a picture of a drink to indicate that they are thirsty.
An electronic communication aid can be a device that has been purposely built for that
particular task, and does nothing else, or a standard computer which runs specialist
communication aid software with the added benefit of being a computer as well.
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Some individuals with physical disabilities which make speech difficult or impossible use
voice output communication aids (VOCAs). These can detect small movements by which
the individual can choose words and phrases on a screen which are then translated to a
voice output. Probably the most well-known example is the system used by physicist
Professor Stephen Hawking who activates his computer-generated voice by small
movements of his cheek. Some computerised systems are set up so that individuals can
indicate choices by eye movements, making complex communication a possibility for
some individuals who are virtually unable to move.
Computer applications (apps) such as ‘Image2talk’ are increasingly used to assist
communication. This app gives an individual access to a huge range of pictures on their
screen to choose from in order to communicate their needs, feelings and preferences to
others. These are revolutionising life for individuals with significant communication
difficulties, as these apps are easily installed and give the user access too far more
options than the traditional picture card systems.
Human aids
Specialist services
It may be necessary for you to access and use other specialist services and facilities,
to enable individuals to communicate. This will include human aids to communication
such as:
Interpreters
Speech and languagetherapists
Signers.
Using touch to enhance verbal communication, to get a person’s attention or to convey a
message can be very effective. Allowing the person to use touch may also be an
acceptable way for the individual to communicate with carers. individuals can convey
many emotions through the use of touch. For example fear, pain, understanding,
calmness and happiness may be conveyed by a person who can hold your hand, touch
your face or grasp your arm. This may be a useful vehicle for communication when an
individual is unable to communicate in other ways.
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In order to fully support individuals to communicate with others you may need to ensure
that specific aids are set up to enable any barriers to be removed. This will involve
working with other members of the multidisciplinary team and calling upon them for their
expertise and help. It is essential that channels of communication remain open within the
multidisciplinary team and that everyone involved in the care of service users has access
to the same information which will be based upon a thorough assessment of the
individual’s communication needs. It is essential that any concerns that our outside your
level of understanding and competence are reported to your manager or to an
appropriate member of the multidisciplinary team who can arrange for specialist support
for individuals.
Aids and equipment
Equipment and aids to communication are many and varied and may include the
following, although you may be able to think of others:
Hearing aids
Spectacles
Electronic / computerised aids and systems
Visual aids - picture boards etc.
Braille
Talking books, CDs, audiotapes
DVDs /videos.
Aids to Speech
Symbols, pictures
Sign language and Makaton (a simplified version of British Sign Language used
by individuals with learning disabilities) - although this will only be useful in care
settings if care workers are able to sign or understand signing. Makaton training
is essential for anyone working with service users who communicate using
Makaton. Workplaces should provide training and the Makaton charity website
(www.makaton.org) offers training sessions and instructional DVDs as well
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Computerised systems - can be extremely useful but may not convey all of the
message, as non-verbal communication will be absent. The care worker must
understand how to communicate, although verbal responses may be completely
acceptable
Aids and equipment must be checked and maintained regularly.
Braille alphabet and numbers
Braille Alphabet
Braille Numbers
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Moon alphabet
Some people, particularly if they lose their sight when they are elderly, find Braille too
difficult to master. However, they may be able to read Moon, a system made up of lines
and curves.
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For people who are deaf and blind, signs from the Manual Alphabet can be spelled out
on their hand as shown below
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For communicating with a deaf-blind person
The Manual Alphabet
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Physical aspects
You can help to support a person by ensuring that there are no physical reasons why
they should have difficulty in communicating by:
Providing aids and equipment such as augmentative aids
Ensuring that hearing aids are worn, have a functioning battery and are switched on
Facing a person who is hard of hearing
Ensuring that spectacles are clean and worn when required
Providing a clear description for a visually impaired individual
Adjusting the level and pace of communication to suit the individual’s needs
Being patient with those who have problems expressing speech
Assisting individuals with mobility problems to access areas where
communication can take place.
1.5 Features of the environment that impact on communication
Environmental issues
It is essential that the environment in which the communication takes place is
suitable in all respects.
Environmental features that may hinder communication
Factors such as:
Background noise /interruptions
Poor or very bright lighting
Extremes of temperature
Uncomfortable seating
Unattractive or unwelcoming décor and furnishings
Lack of privacy
Large groups of people creating noise and distractions.
If the environment is the individual’s own home, family members, telephones and the
television can all be sources of distraction. Within health care settings, interruptions can
occur frequently. It is essential that other health care workers are aware that you should
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not be disturbed. Within hospital settings, where very often the only thing that separates
people is curtains, this means that others may be able to listen to conversations.
Features of the environment that may help communication
Low noise levels and limited interruptions and distractions
Private areas with adequate personal space
Good lighting
Ambient temperature
Comfortable and attractive décor and furnishings
Smaller groups of people.
Some individuals are especially sensitive to environmental factors such as noise. People
who are on the autism spectrum for example can become highly anxious and
overwhelmed in environments that pose little problem for others. To someone with noise
sensitivity, noises can seem amplified and busy environments can be dizzying. The effect
on such individuals can be overwhelming anxiety sometimes leading to loss of emotional
or behavioural control (such as screaming or crouching with ears covered). Effective
communication with individuals who are especially sensitive to the environment relies on
others recognising their need for a calm, quiet environment or somewhere to withdraw to
if overwhelmed.
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1.6 Reasons why individuals may use a form of communication that is
not based on a formal language system
There may be a number of reasons why individuals do not use a form of communication
based on a formal language system. These may be due to the abilities or preferences of
the individual.
Their abilities and preferences may be influenced by a specific communication need.
Specific communication needs
To understand how to communicate with individuals with specific communication needs,
it is vital that you recognise what is considered to be a specific communication need and
what creates a communication difference or barrier. You must also be able to identify
these when they affect individuals. Barriers to communication may include:
Individuals who have visual, hearing or sensory impairment
Individuals who have a speech impairment
Individuals who have limited understanding, e.g. due to brain damage,
dementia or learning disabilities.
Barriers to communication
Communication is about a speaker talking to a listener (sender to receiver). We may think
this is a simple process, this is not always so. There are a number of barriers or obstacles
that can affect the way the message is sent or received. These may be present initially, or
may develop as service user’s needs and preferences change. Any changes must be
reported and recorded immediately, in order for the individual’s needs to be met.
Physical barriers
The service user may experience:
Hearing or visual impairment
Speech impairment
Mobility problems
Physical disability
Pain.
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Hearing problems
Impaired hearing is the single most important communication difficulty experienced in care
work. It is a common difficulty for older people.
Hearing impairment can vary from those who become hard of hearing as they get older,
to those individuals who are profoundly deaf, possibly from birth.
Those who are hearing impaired can easily become isolated as they lose important
parts of the conversation. Individuals who lip read may miss conversation if the person
they are lip reading turns away.
Individuals who understand sign language will be very disadvantaged if care workers do
not have this skill. Poor hearing can also be worsened by a build-up of wax in the ears
and hearing aids that are not functioning properly.
Sight impairment
Sight impairment is another common disability. Again, this can vary from poor eye sight to
blindness. Certain degrees of poor eyesight can be corrected by glasses, whilst others will
only be helped to a certain degree. Individuals may also not wear their glasses (or care
workers forget to make sure the individual is wearing them). Alternatively, glasses may
not be strong enough, may need repairing or simply just need cleaning.
Speech impairment
People can have a variety of speech problems. Individuals may have no speech, limited
speech or an impediment (e.g. a stammer). Alternatively, they may be unable to
understand speech or have difficulty expressing themselves (e.g. after a stroke). Some
speech problems may be permanent, while others may improve over time with intensive
therapy. Some people may use signs to communicate. However, if care workers do not
understand, the person will be unable to communicate effectively.
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Behavioural barriers
The behaviour of individuals and others may at times present a challenge to the care
worker, therefore creating a barrier to communication. Supported by the care team you
must challenge this behaviour. Any form of discrimination, intimidation or withdrawal of
rights is not acceptable, whoever displays this behaviour, and must not be tolerated.
Mental health barriers
The service user may:
Become isolated from others, due to the impact of the illness on the ability to
communicate
Be detached from reality
Become poorly motivated to communicate
Be significantly affected by attitudes, beliefs and ideas
Believe that personal issues must not be discussed with those outside the
family group when dealing with individuals with mental health problems.
Certain individuals will lack social understanding and imagination. This may be due to
mental or physical factors, or to life experiences (upbringing etc). These individuals may
not be aware of how to behave and what is appropriate in various social situations, and
this may create a barrier between the individual and others.
Impairment of understanding
As mentioned previously, certain individuals may be unable to understand speech, for
example following a stroke. Other people however, suffer from dementia, which affects
their short-term memory and they cannot remember what is said, so are unable to
respond appropriately.
Unfortunately dementia (e.g. Alzheimer’s disease), is progressive and eventually the
person will be unable to understand the meaning of words, and communication through
speech may be practically impossible.
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Cultural barriers
Between the two parties there may be:
Differences in the use / understanding of individual words. This can occur in the
same country, between people who speak the same language, e.g. the word
‘bonny’ means pretty to some people, which is viewed as complimentary.
However, to others it means ‘overweight’ or ‘fat’, which may be
consideredinsulting
A lack of understanding of language. This can occur in many care settings,
especially in areas where there is a large cultural mix and English is not the
person’s (or indeed, the care worker’s) first language. Other language barriers
may exist when the individual’s first language is Scottish, Irish Gaelic or Welsh.
Even when English as a second language is spoken and understood well, age,
illness or memory impairment can affect the individual’s ability to converse in
English
A lack of understanding of accents and dialects. A foreign accent can be difficult
to understand, as can the vast range of regional dialects and accents in the
United Kingdom
Misunderstanding of body language and gestures. This can happen between
people who speak the same language. Eye contact can be seen by some as a
gesture of interest and attention, however others may view it as threatening. This
can be a particular problem in mental health settings
Differences in interpretation of body language and gestures. One culture may
interpret a gesture as polite and appropriate, whilst another may consider the
same gesture rude, insulting and inappropriate. For instance, in certain cultures,
it is inappropriate for a female to have eye contact with men to whom they are
not related.
Language difficulties
Language barriers can cause individuals to become very isolated. It may also lead to feelings
of mistrust and paranoia, as they feel others are talking about them and keeping them ill-
informed.
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Personal barriers
The individual or key person may have:
A quiet, shy personality that prevents them from communicating
An impatient, abrupt or loud manner that makes others feel uncomfortable
Care worker and others
Care workers and others, such as relatives, can create barriers to communication.
These are rarely deliberate, and are generally due to misunderstandings.
1.7 The potential effects on an individual of having unmet communication
needs
Potential effects on an individual of having unmet communication needs are:
Frustration
Anger
Aggression
Sadness
Loneliness and isolation
Embarrassment
Fear
Unmet physical, social, emotional and spiritual needs
Illness, preferences not heard
Exclusion
Lack of choice/no choice
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Adverse effects on wellbeing
Specific communication difficulties can lead to frustration and distress at a
level which triggers behaviour that challenges (such as screaming or kicking)
Severe specific communication difficulties can cause severe anxiety and
depression as the individual struggles to have their needs met, to express their
individuality and to enjoy close confiding relationships with others
Individuals with significant communication difficulties may be vulnerable to
bullying and exploitation by others.
If individuals become depressed or angry this may cause them to withdraw from
communication or react with aggression. Recognising and understanding specific
communication needs is a vital step to planning strategies to overcome these, and
improve the quality of life of the individuals in your care.
Individuals may be fearful, feel isolated and unable to have their needs met due to their
inability to communicate. Care workers may be upset or even frightened by individuals’
responses to their feelings. The relationship between individual and care worker may fail
to develop and the health and wellbeing of individuals may suffer as a result.
2.1 Specialist services relating to communication technology and aids
There a number of specialist services and personnel related to communication
technology and aids who will assess and provide support for individuals in their use,
including:
Technology services including Information Technology specialists
Communication aids centre - where individuals may obtain technology and aids
Assessment and training services
Speech and language therapy.
A good starting point for information and advice on communication technology and aids
is the charity Sense. Their website at www.sense.org.uk outlines the range of
communication methods and aids available. The charity advocates a ‘total
communication approach’ which means considering that several different communication
methods may be helpful for each individual in different situations. Sense have an advice
line for those wanting more specific advice on technology and aids.
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Service users who use communication technology also can be advised by specialists
from the companies supplying the technology. There is also online support and advice
available for users of communication apps such as www.image2talkapp.com.
The lead professionals who can advise on all aspects of communication are speech and
language therapists. Unfortunately there may be a wait to be referred but individuals with
severe specific communication needs should be a priority. Speech and language
therapists can assess the causes of the difficulties, oversee treatment and advise about
communication aids.
2.2 Types of support that an individual may need in order to use
communication technology and aids
The healthcare professional or specialist may demonstrate the use of communication
technology and aids and give specific guidance and instructions for their use.
Individuals may also require support to access technology and aids. This may involve
referral to specialist services or personnel who may obtain communication technology
and support the individual in its use. Care workers may provide specific guidance and
instruction for the implementation of communication technology and aids. Individuals
may require assistance and guidance, for example, to alter volume, pitch and
brightness. Other types of support that may be needed are:
Motivation to try and persevere with recommended communication aids (such
as praise and encouragement from care workers)
Assessment of how well the communication technology and aids are working
for that individual, with changes made if needed
A written record of the aids and technology in use as well as wider communication
preferences, strengths, weaknesses and interests. This may be recorded in a care
plan, a communication plan or a communication passport. The purpose of a
communication passport is to ensure that everyone (in all settings) understands
the individual’s communication needs. The passport will typically provide
information on the person’s interests, preferences, what works for them and what
does not and how others can best support their communication
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A consistent, positive approach to supporting the individual with their
communication aids and technology.
Specialist technology advice is usually available from the firm that supplies equipment
as well as training in how to use devises for service-users, family members and care
workers.
2.3 The importance of ensuring that communication equipment is
correctly setup and working properly
The importance of ensuring that communication equipment is correctly set up and
working properly cannot be over emphasised. There is little point in providing an
individual with equipment that is not functioning as it should, as they will be unable to
benefit fully from its use and their specific communication needs will not be met. It is
imperative that all communication technology and aids are checked to ensure that
equipment is:
Fully charged
Working
Effective
Positioned correctly
The environment should ensure that the equipment and aids are positioned
correctly and that lighting is adequate.
Hearing Aids - Care and Maintenance
If a service user wears a hearing aid, it is important for the care worker to:
Understand how to check it is in working order
Be able to fit an individual with a hearing aid correctly
Know how to switch the hearing aid off and on and adjust the volume
Know how to clean a hearing aid
Be able to replace a hearing aid battery
Know where and how to obtain a hearing aid battery.
Report difficulties with hearing if the hearing aid is working: there may be
another cause such as a build-up of ear wax that needs to be removed by
syringing.
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Communication aids
Physical communication aids such as communication boards and cards should always
be clean and available to the service user. If the individual uses electronic aids these
must be kept in working order and set up for the service user to use at any time.
3.1 Work in partnership with the individual and others to identify the
individual’s communication needs
It is important to understand the value of working in partnership with individuals and
others. There are a number of benefits including:
Encouraging on-going support
Valuing the individual
Promoting good relationships
Improving quality of care
Promoting rights.
Others may include:
Unpaid carers providing unpaid support to relatives, friends or partners
Family members
Friends
Advocates
Colleagues
Other health care professionals
Others who are important to the individual’s wellbeing
Specialist communication professionals.
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The care team and the individual can work towards developing ways of
communicating, which overcome the communication difference and encourage and
motivate the individual to communicate. In order to do this the care team must plan
strategies for dealing with each person’s communication difficulty.
Communication should be consistent with the individual’s level of understanding,
culture, life experience and preferred way of communicating
In order to effectively support individuals who have specific communication needs it is
imperative that you can recognise when an individual requires support. There are a
number of barriers that can affect the way that a message is sent, the way that it is
received or in the receiver’s ability to respond to messages.
When communication is difficult it can take time to establish relationships and it is
important to get to know the person first and to build up trust. Supporting these
individuals can also be helped by gaining knowledge of the individual’s needs by
obtaining accurate information from appropriate sources at appropriate times. This can
help the care team to prepare for a service user, or to obtain the expertise of those who
provide specialist services, including aids and therapies. The need for third party
translation, interpretation and advocacy services may be identified.
3.2 Contribute to identifying communication methods or aids
to meet the individual’s communication needs
There are a number of ways you can contribute to the identification of suitable methods
and aids to support communication.
Observation and monitoring
Following assessment and identification of specific communication needs it is important to
observe how the person communicates and monitor whether any particular methods or
aids improve or enhance communication or have the potential to do so.
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Interaction
Observation and monitoring can take place during and after interactions with individuals.
Aspects such as verbal and non-verbal responses may demonstrate how well the person
has understood and becomes involved in the interaction and whether any particular
strategies, methods or aids promoted or inhibited communication.
Feedback, review and evaluation
All your observations and monitoring should be recorded and fed back both verbally and
in writing to others. This will enable all aspects to be reviewed and methods, strategies
and aids evaluated in order that care may be planned with the aim of identifying the
communication, methods or aids that will best suit the individual.
Identifying communication and language needs
Undertaking an assessment of any individual requires skill and should be based on the
general principles of a person-centred approach and the individual's right to a high
standard of assessment and services. A person-centred approach means ensuring that
everything we do is based on what is important to a person from their own perspective. It
is important to take into consideration the whole care needs of the individual and any
assessment should take into account the psychological, social, spiritual and physical
needs of the person. It is not enough to simply look at the person’s medical condition. In
order to provide care that is holistic you must look at the person as a whole.
We are all diverse individuals and have differing needs. We have different personalities,
biographies, social and psychological experiences, skills, interests, knowledge and
preferences. It is important to acknowledge this when assessing the needs of individuals.
What is right for one person may not be right for another. Two people who share the
same communication difficulty will not experience that difficulty in the same way. For
example, one person who is deaf may communicate using sign language whilst another
person may lip read, and each person will cope with the situation in his or her own
particular way.
Within your role as a health care worker, you probably will not be solely responsible for
undertaking an initial formal assessment of the communication needs, preferences and
difficulties that a person may have. However, if you work in the community you may well
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be the first person to meet an individual and may make an initial assessment of their
communication needs. It is important that you are aware of appropriate referral systems
that will help individuals if they have difficulty in communicating or if you have difficulty in
understanding the individual’s chosen method of communication. If the individual is new to
your care organisation it is likely that he or she will have undergone detailed needs
assessments prior to being admitted, in order that care can be planned and all of the
required facilities can be put into place.
Initially when an individual is referred to any social or care services a thorough
assessment will take place, this assessment will take into consideration every aspect of
the person’s life and will involve many members of the multidisciplinary team such as:
General Practitioner
Specialist doctors such as ophthalmologists
Psychiatric services
Care home manager
Social Workers
Nurses
Care Workers
Key workers
Speech and Language Therapists
Audiologists
Opticians.
Individual assessment
Before you even talk to the individual you will make your own personal observations
about that person. Those observations will directly influence the way in which you
communicate with them. Getting to know the individual will help you to understand their
communication needs.
It is important that the needs of individuals are assessed and a plan of care developed. It
is essential that all members of the care team take part in this process, and that they
understand and are supported in implementing this plan. Taking a comprehensive history
during the admission process will assist this, and any communication difficulties may be
highlighted.
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All those involved in the care of the individual should be fully aware of the contents of
the plan of care and work together to promote effective communication and meet the
individual’s communication needs.
Preparation
Obtaining accurate information from appropriate sources at appropriate times, can help
the care team to prepare for an individual or to obtain the expertise of those who provide
specialist services and therapies. The need for third party translation, interpretation and
advocacy services may be identified.
Information and advice
Information and advice with regard to the nature of an individual’s specific
communication and language needs and preferences, is essential. In order to identify
and meet the needs of service users it is important to have available as much relevant
information and advice as possible.
It is important that you support individuals, key people and others to identify the
communication needs of individuals. This may be done by:
Questioning - asking the individual themselves, or others who may know the
service user well (although this information must be viewed subjectively).
Maintain confidentiality and share information only with those with the right and
need to know
Observing - this will help you to form a fuller picture of the difficulty that exists. You
may also notice any sensory equipment in use (e.g. hearing aids). Observing facial
expressions and body language may indicate whether the person understands and
feels comfortable with the communication
Listening - this involves active listening and not just hearing what is said. Paying
attention to what is said and how it is said, and noticing any speech impediment.
Listening carefully will alert you to any inappropriate or inaccurate responses or
comments
Using your past experiences - you may have encountered a similar situation
before. This will assist you in recognising the difficulties people may face
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Discussing with the manager and liaising with services who may be able to
provide necessary information
Arranging for individuals to be assessed by other care professionals.
Other Services
Information may come from a member of the care team, based on an individual’s
observations and assessments.
Information may also come from the individual themselves. This is an extremely important
source and should never be overlooked. In certain care settings, and with certain
individuals, obtaining information may be more difficult.
This may be because an individual has no awareness or insight into their communication
difficulties, such as people with dementia or those who are unable to communicate due to
an unconscious state.
Family and friends may also give information to the care team. Although valuable, this
information may not be entirely accurate, as it may be subjective rather than objective.
However, family and friends may be the first to alert care professions to communication
difficulties and may encourage individuals to seek help for sight, hearing, speech or
memory impairment.
The care team must make its own assessment of the individual, based on all the available
information.
Sources
Initially when an individual is referred to a community care agency, admitted to a care
home or is referred to other care services, information will come from those who have
requested the referral or transfer. These may include:
Doctors - GP’s, Specialists (e.g. Ophthalmologists)
The Courts - Criminal Justice System
Social Workers
Nurses
Care Workers
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Speech and Language Therapists
Audiologists
Opticians
Specialist Social Workers
Occupational Therapists.
It is important that all those concerned work together to provide an integrated service.
The information you have gathered, which includes your observations and discussions
with the individual and others, will highlight the ways individuals communicate and the
communication
methodthatbestsuitstheindividualandisunderstoodbythosetheyaretryingtocommunicatewith
.
4.1 Prepare the environment to facilitate communication
Surroundings should be comfortable and relaxing and interruptions kept to an absolute
minimum. An environment that has been carefully thought out can assist individuals to
communicate effectively and make their needs and wishes known. It should be
comfortable, and provide privacy for the discussion to take place. Peace, quiet and
privacy are essential elements of the environment.
It is important to create a comfortable atmosphere where individuals can share
thoughts and process information. The following should be taken into account:
Check and adjust lighting
Minimise background noise, turn off radio/television, divert telephones etc
Ensure the room is warm but not too hot or cold
Provide privacy
Ensure the seating is comfortable
Provide pleasant and welcoming décor and furnishings
Assist with positioning to enhance communication
Donotsitbehindadesk,ensurethatthereisanopenspacebetweenyouandtherecipient
Provide any aids and equipment required.
Areas where people can meet and socialise should be available. This also applies to
those who live alone. Assistance to access those areas may need to be given to those
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with mobility problems. An environment which has been thoughtfully designed can assist
individuals to communicate effectively and make their needs and wishes known.
Individuals who are especially sensitive to their environment (such as those on the
autism spectrum) will need additional consideration. More forward planning may be
needed, such as choosing quiet times and thinking ahead about how a quiet ‘safe
space’ can be arranged if the individual needs it.
4.2 Agreed methods of communication to interact with the individual
Care worker interventions
Be sure of the nature and scope of the communication needs and the individual’s plan
of care
Don’t wait for the individual to approach you. Don’t make the person feel
communication only takes place when absolutely necessary – initiate
conversation
Adopt a relaxed posture, showing you have time to listen and converse
Face the person, avoid covering your mouth or turning away - this is particularly
important if the individual lip reads
Ensure speech is clear and at a manner, level and pace to suit the individual’s needs
Do not dominate the conversation
Do not suddenly change the subject
Use non-verbal communication to enhance verbal communication. The use of
gestures, eye contact, facial expression and touch can assist enormously
Observe the individual’s body language to assess understanding
If the person mis-hears and responds inappropriately, do not be afraid to repeat
yourself or ask the individual to clarify or confirm that they understand
Allow the person time and space to respond
Write things down and use symbols
Report any changes immediately.
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It can be difficult for care workers to communicate with individuals with a dementia, but
there are ways to bridge the gap and overcome the difference. These may include:
The use of symbols, pictures, gestures, pointing
Relaxed posture – individuals with dementia can sense anxiety or impatience in others
Gentle, calm tone of voice
Smiling and looking interested
Being patient
Talk simply in clear, short sentences
Be prepared to repeat yourself
Theuseofpictureboards,colourcodingondoors,leavinglistsandpicturesofmenuchoice
s, andnamesofcareworkersandfamilymembers-photographscanalsobeveryhelpful
Diversional techniques - diverting an individual’s attention or changing the
subject can relieve distress and avoid confrontation
The use of ICT
Augmentative and alternative approaches
Braille, British Sign Language, Moon, Makaton - some of these have been
covered in learning outcome 1.5 of this unit.
Mental health barriers
Mental health problems require thorough assessment and a care plan developed to
address and problems or issues identified.
Language barriers
You as a care worker can support individuals who have a language barrier:
Use gestures, symbols and pictures
Adopt a friendly tone and positive body language
Speak formally - do not use slang or local sayings.
If an interpreter is used, make it clear that all that is said is to be translated. Ensure that
the interpreter talks directly to the individual. If the person is ignored and conversation
takes place between the other parties he/she will feel excluded. This may lead to feelings
of mistrust and paranoia.
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It is important to highlight here the possible problems that may occur if an individual’s
children, family and friends become interpreters:
The individual may not be happy to be completely honest - there may be things
they do not want those close to them to know
The individual may be afraid the conversation will be repeated
The family / friend may not translate all the individual’s conversation if they feel
there are details the care team should not / do not need toknow.
Dialects and accents
This can create a huge barrier as even though people are speaking the same language,
they do not understand each other. As a care worker, you need to be aware of any accent
you have and ask colleagues if they have a problem understanding you. Be aware when
talking to individuals to speak clearly and more slowly if you think they have difficulty
understanding you.
If you do not understand a person’s accent, be honest and tell them. Ask politely for them
to repeat themselves more slowly. Colleagues may be able to understand the individual
more easily than you do. Seek their help.
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Cultural differences
Being aware of the need to use body language and alternative ways of saying
things when a person misunderstands
Speaking in short, clear sentences
Using your listening skills to check understanding
Making greater use of pictures and non-verbal communication
Being aware of the way different cultures understand and express themselves
Avoid using regional expressions - say things in a factual, formal manner.
Personal
Accepting personality differences
Supporting, respecting and understanding the person
Providing feedback and encouragement
Showing acceptance of the person
Providing encouragement to communicate
Adapting communication to accommodate changing needs and preferences.
Life experience
All individuals will have differing life experiences that will affect the way they
communicate. Family background, education, social experiences, physical and mental
health and wellbeing will all contribute to the total life experience. Remember the
experience of being dependant on others will also affect communication and will be one
life experience that all individuals in your care will have.
Care worker
Practicing self-appraisal to identify knowledge and understanding
Asking for help to address areas of which you are unsure. It can take a long time
to feel comfortable when communicating with others, especially if the relationship
is outside your experience. This may be especially relevant when you first
become a care worker as you may have had little experience of ill or disabled
people and limited contact with care professionals. This may make you feel
inadequate or ill-equipped to communicate in a care setting. The importance of
gaining support, advice and guidance from your colleagues and manager cannot
be overstated. This will prepare you to communicate effectively and will eventually
enable you to support others
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Obtaining education to develop knowledge.
Acceptable use of physical contact
When communicating it is vital to understand what type of physical contact is acceptable,
and what is not. You must also understand the circumstances in which certain types of
physical contact can be used. Physical contact should never be used to relieve your own
distress.
Acceptable forms of physical contact
Holding a person’s hand
An arm around the shoulders
During physical care activities (e.g. bathing etc.).
This must be agreed with the individual and care team and consistent with the care plan
and the needs of the individual.
Unacceptable forms of physical contact
Invasion of personal space
When the individual is made to feel uncomfortable
Inappropriate restraint
Where the contact is abusive (e.g. physical assault or any form of sexual contact).
Situations where physical contact can be useful
To communicate care and concern
To aid recognition by a visually impaired individual.
Situations in which physical contact must not be used
When cultural issues make contact unacceptable
When the individuals body language suggests this is not acceptable
Where the actions may be misinterpreted.
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The appropriate use of physical contact can help to form relationships between
individuals and care worker. Individuals can be reassured and made to feel valued and
cared about. However, everybody must be assessed individually as what is considered
acceptable and appropriate by one person may not be by another.
Ways of communicating
The care team and the individual should develop ways of communicating that overcome
the communication barriers and encourage and motivate the person to communicate. In
order to do this the care team must plan strategies for dealing with each individual’s
communication difficulty. Communication should be consistent with the individual’s level
of understanding, culture, life experience and preferred way of communicating.
Motivating individuals to communicate
It is extremely important to interpret the needs of different individuals, and to motivate them
to communicate. A clear set of strategies for each individual, planned following assessment
of their needs, should be understood. This should be communicated to all members of the
care team.
Each worker should be supported and guided through this process.
Surroundings are important. These should be appropriate and accessible with adequate
lighting and heating and limited external noise.
When communication takes place, the care worker should maintain eye contact and
demonstrate an open body language, e.g. relaxed posture, sitting down close to the
person. The use of gestures such as nodding, smiling and the appropriate use of touch,
will show you are listening and interested.
Adhering to the care plan
It is essential that you, as a care worker, adhere to the plan of care and ensure that all
those involved in the communication process do so. This consistent approach will
ensure continuity of care.
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Allowing individuals time to communicate
It is very important to give individuals sufficient time to communicate, avoiding
interrupting or finishing off individual’s communication. Being interrupted may make a
person feel angry or that you have lost interest in what they are saying, are bored, or
that you feel your opinion is more valid, important or interesting.
Finishing off another person’s communication can suggest impatience on the care
worker’s behalf. Although the person may believe they are being helpful, they may feel
humiliated, frustrated or angry as they fail to get their point across. This can be a
particular problem for those who have a communication barrier, difference or difficulty.
Showing they are relaxed and interested will enable the individual to gain the confidence to
communicate in a supportive environment. It is an essential part of your role to give guidance
and support to others to enable them to communicate effectively with the individual.
4.3 Monitor the individual’s responses during and after the interaction
Checking information
It is essential that all information is checked with the source for accuracy. The
consequences of misunderstanding or misinterpreting information can be very serious.
Individuals may as a result, not be able to communicate their needs, causing their
physical and mental health to suffer.
Inaccuracies and omissions can lead to staff inadvertently mishandling situations, with
the result that communication breaks down or fails to develop at all.
It is essential that observations and monitoring are recorded and reported and
review and evaluation are carried out to check the effectiveness of
communication.
Effective Strategies
There may be a situation when all the necessary information about an individual is not
immediately available. In order to establish the extent and limits of specific communication
needs, you may need to use other strategies (methods) to determine this.
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Reflection
Reflection involves paraphrasing and reflection of feelings. Paraphrasing is not simply
repeating what the person has just said, but it is about taking the ideas that the person
has conveyed and translating them into your own words. Paraphrasing is about:
Summarising what the person has to say to check understanding
Rewording the person’s speech to confirm your understanding
Using similar language to ensure understanding.
Reflection has many functions, but above all, it demonstrates that you are interested in
what the person is saying and that you are listening and understanding what they are
saying.
It is important that you encourage individuals to engage with others, give appropriate
responses and express their emotions and feelings in acceptable ways.
The use of a staged approach, demonstration, exploration, guidance and support from
healthcare professionals will enable individuals to develop communication methods that
will help them to understand others and be understood by them. Strategies and methods
may be tested and trailed and their effectiveness reviewed and evaluated.
4.4 Adapt own practice to improve communication with the individual
Individuals you care for need to experience communication as this will help them to
perceive themselves as worthwhile individuals who still have contact with reality and who
can interact with other people. Communicating becomes more challenging when there is
a barrier to communication, for example when hearing is affected or where individuals are
unable to speak or understand the language of the carer worker, or are unable to
communicate verbally because of a physical disorder or illness. A person who is also
paralysed and unable to move or use facial expressions is even more restricted in the
options available for communication.
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It is very important to remember that each person is an individual with their own
communication skills and style. Ensuring that you speak at a level and pace to suit each
individual, is a skill that will take time and practice to perfect. Speaking very simply to a
very able, intelligent person can appear patronising or worse, insulting and humiliating.
However, using complicated language and complex instructions to an individual who has
limited understanding, can result in them misunderstanding and becoming confused and
anxious. The use of medical terms and jargon should be avoided, as this can be difficult
for people to understand and may prevent them from receiving all the information they
require. It may also create a barrier between care worker and individual.
The following are some ways you could adapt your practice:
Using regular communication style may inhibit effective communication and
therefore affect the other person’s ability to express their needs
Need to be prepared to use the individual’s form of communication and
language (avoid jargon)
Need to be aware of own and individual’s body language - maintain personal
space, eye to eye contact, maintain the same level (don’t look down) to avoid
individual feeling intimidated
May need to make eye contact more obvious, may have to be facing people
for some people to get your attention or understand or hear what you are
saying
Need to be a good listener
Need to be patient, respectful and sensitive to time required to communicate
Need to follow the lead of the person you are communicating with and move at their
pace
Need to be aware of tone of voice
May need additional privacy to heed respect and confidentiality if have to
communicate loudly
May try to over compensate and then unintentionally become patronising
so avoid shouting, speaking too slowly or too quickly, over exaggerating
words
Must not rushing the person
Must be aware that you may put your own interpretation of a situation into
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conversation if we do not just repeat words when relaying or translating for an
individual
Must also remember to talk about non-caring aspects as individuals might wish to
have a casual exchange of ideas or conversation
Need to have empathy not sympathy
Remember to communicate with and then facilitate individuals to communicate with
others
Need to be aware of individual’s mood - may not always wish to communicate
Must not pretend to understand if you do not.
5.1 Support the individual to develop communication methods
Active Support
It is very important to interpret the needs of individuals and to motivate them to
communicate. This is particularly important when an individual encounters new and
changing situations and environments. The way in which you approach individuals and
your willingness to help, will create an atmosphere in which individuals feel relaxed and
able to communicate. Positive reinforcement and patience are essential, as individuals will
feel uncomfortable if they are aware of being rushed, or feel that you are becoming
impatient when they are trying to communicate. Provide individuals with alternative
methods to assist communication, and seek the advice and support of people within and
outside your care organisation, to provide extra support.
Preferred ways of communicating
It is important that people are encouraged to communicate in the way they prefer. This
should be appropriately and socially acceptable, taking into consideration the rights of
others. For example, a person may use offensive language which may upset others,
therefore encouraging this way of communicating would be inappropriate.
Individuals should never be forced into communicating. Those with speech difficulties may
find the process of trying to speak very tiring and frustrating. They should be free to choose
the use of gestures, symbols, drawing and the written word if they wish, providing this does
not interfere with therapy or progress.
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Some people way not wish to communicate at all. This may be due to a specific
communication difficulty or it may be a psychological or emotional reason. This should
be reported so that the person can be referred for assessment by specialists.
Individuals should be actively encouraged to identify and overcome the barriers they
have when communicating with others. The individual’s acknowledgement that they are
having difficulties may be the most significant step to overcoming barriers to
communication. The individual’s ability
/ inability to communicate their wishes may also be an indicator of any difficulties they
may have. Therefore, it is vital that you observe closely and listen carefully to
individuals.
Once barriers have been identified and care planned to overcome these barriers, you can
support the individual to develop and use the communication methods and skills detailed
in the care plan, in order that they may be understood by others.
Overcoming barriers and obstacles to communication
In order for barriers to effective communication to be removed, various ways need to be
developed within the work team. These are only likely to be effective after a full
assessment of these barriers has been completed. Information should be communicated
effectively, verbally, and written accurately, completely and legibly.
5.2 Provide opportunities for the individual to communicate with others
It is extremely important to create opportunities for individuals to communicate with
others. This will help maintain existing relationships and encourage the development of
new ones. It will boost self-esteem and maintain an individual’s identity.
Opportunities can be provided formally in meetings, assessment and reviews. Care
workers can liaise with all concerned to ensure effective interactions and involvement
and inclusion are promoted.
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You will need to employ extra strategies for individuals who have specific
communication needs, difficulties or differences and for whom communication is
particularly problematic. Positive reinforcement and supporting the individual and others
to use effective methods to overcome barriers to communication will encourage social
interaction.
Supporting communication with family and friends
Many people who move into a care home still have a partner or a husband or wife, and it
is important to appreciate that this relationship can become affected by the move. These
people may have been married for many years and now, because of circumstances one of
them has been moved to a completely unknown environment and is living with people who
are complete strangers.
This will have an even greater impact on a person who has a difficulty in communicating
and this person may express feelings of anxiety and fear.
It is essential that you do all you can to help support the relationship of these
individuals as this may be the most important thing in the person’s life and the warmth
love and affection a person brings to a relationship can help to maintain the individual’s
sense of happiness health and wellbeing.
Supporting communication between individuals
There are many things you can do to encourage communication between people, and
hopefully when a person moves into a care establishment they may begin to develop
new friendships. This may be made more difficult if a person has a difference or a
difficulty in their communication. In order to facilitate friendships and communication you
can:
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Organise social events for example a dinner dance or a singsong
Help people to sit together if they share common interests
Ensure a quite area where people can talk in private if they wish
Introduce people to each other
Ensure that the atmosphere within your care environment facilitates free
movement of individuals so that they can socialise with each other.
If required, ensure that individuals have access to aids and resources in order to
facilitate communication.
5.3 Support others to be understood by the individual
It is important that you encourage individuals to engage with others, give appropriate
responses and express their emotions and feelings in acceptable ways.
The use of a staged approach, demonstration, exploration, guidance and support from
healthcare professionals will enable individuals to develop communication methods that
will help them to understand others and be understood by them. Strategies and methods
may be tested and trialled and their effectiveness reviewed and evaluated.
Supporting individuals to communicate must also include supporting others to be
understood by them. Family, friends, care workers and other key people may require
support to communicate with the individual to make themselves understood. Others
should be aware of agreed communication methods and be supported to use these.
You should further support others who communicate with individuals, to communicate
through others that are able to use the individual’s preferred method of communication
and language. This may include using the individual’s preferred language, employing the
services of an interpreter or using electronic / computerised equipment.
A number of interventions and strategies required to ensure that others are supported to
become competent in the implementation of agreed methods and that they are given
extra support, guidance and assistance where this is required. Support may include:
46
Sufficient time to become competent and to facilitate communication
Training
Resources - including specialist personnel
Interpretation; translation
Aids and adaptation.
5.4 Support others to understand the individual
It is equally important to support others who communicate with individuals to do so
effectively. You must explain how to communicate with the individual (whilst maintaining
confidentiality) and the best strategies and methods that other people can use to
understand and be understood by the individual. Those communicating with individuals
should be encouraged to use any aids and equipment available and speak in a respectful
and appropriate manner to the individual. People should be discouraged from avoiding
talking directly to the person e.g. referring to the individual in the third person and
directing questions, answers and comments at care staff.
Those communicating with the individual should be supported by the care worker. This
support could take the form of monitoring the situation and offering advice and guidance
(including use of communication aids) before and during the communication.
It is vital that you support others to understand the individual. This may involve you
interpreting what the person says, especially if there is a communication or language
barrier, encouraging them to speak more clearly, or to explain certain aspects in more
detail. Alternatively, you may need to provide explanations and information, to help
others to understand the individual.
However, care must be taken not to intrude or interfere. People should be encouraged to
be patient with the individual and not to be too embarrassed to say if they do not
understand or are having particular difficulties. It is important that care workers are
competent and receive adequate training in order to support others. Care workers should
be aware and be able to use any aids, or adaptations required. Sufficient time should be
given to communicate. Knowledge of how to access services such as interpretation and
translation are vital to ensure that the requirements of the care plan can be implemented.
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Above all, the communication experience should be seen as positive for all parties
concerned.
6.1 Collate information in relation to an individual’s communication and
the support provided
Observing and monitoring communication needs
It is important that the communication needs of individuals are monitored, so that any
changes can be detected and the effectiveness of the plan of care can be measured.
There is little point in agreeing a plan if nobody takes responsibility for measuring how it is
working. If monitoring does not take place, changes which affect the individual and others
may go unrecognised and result in the needs of the individual not being met.
Recording specific communication needs and processes
The purpose of observing and monitoring individuals’ communication needs is to assess
whether the actions of the care team, key people and others have carried out have been
of benefit to the individual concerned. Review and evaluation allows us to decide whether
the interventions made have been effective and provide a basis for ongoing assessment
and planning.
Feedback
Feedback is an important aspect of collating information in relation to reviewing an
individual’s communication needs and the support provided to address them.
Feedback may come from a number of sources, such as:
The individual themselves
The care team
Other care professional and specialist personnel
Family and friends of the individual
Others.
In order to fully evaluate an individual’s communication needs, it is important that you
observe them when they are communicating with a cross section of people in a variety
of situations and circumstances. These people will include:
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Yourself
Key people
Others.
You will probably have noticed that individuals’ communication will vary according to who
they are communicating with and the circumstance in which this takes place. These
variations may be even greater for those experiencing communication difficulties or
differences. For instance, an individual may be more comfortable and find communication
easier with close family and friends, but may have more difficulty with you and may find
making themselves understood outside your organisation even more difficult.
However, it must be considered that certain individuals may make more effort to improve
their communication skills if they are communicating with those outside their circle of
family and friends. Additionally, those closest to the individual may feel guilty about
pressuring them to improve their efforts and may be worried about adding to their
frustration and stress and may accept signs and gestures more readily. This is particularly
relevant when communicating with people who have speech, language or hearing
problems.
Documentation
A high standard of record keeping is fundamental to the delivery of safe and professional
care. The NMC state that it is a tool of professional practice and should help the process
of care. It should provide security to both service users and to health care workers. The
quality of your record keeping is also a reflection of your own professional practice. Good
record keeping is seen as the mark of a skilled and safe practitioner, whilst carelessness
or incomplete record keeping often highlights wider problems with the individual’s
practice (NMC 1998).
You need to ensure that the documentation examined is accurate, legible, complete and
current. It is not possible to observe and recognise changes if written information is
incomplete and does not contain a full assessment and ongoing review of the individual’s
communication needs. There is no starting point from which you can base your
observations or decide whether change has taken place if this information is missing.
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6.2 Contribute to evaluating the effectiveness of agreed methods of
communication and support provided
Every member of the team will have a contribution to make to the review and evaluation of
communication needs. The extent of your role in evaluating care will depend on your
responsibilities within the care team. It is important that you check your own
responsibilities and those of others, in providing feedback on the implementation of the
care plan. This will ensure that you are clear about what is expected of you and that a
complete picture is presented when communication needs are evaluated.
Individuals and all others involved in their care should be supported to take an active
role in the evaluation of communication needs. The individual and / or their
representative should be encouraged to offer opinions and make suggestions.
Evaluating individuals’ communication needs
It can be argued that evaluation of communication needs is an ongoing process and, for
some people with particular needs and problems, evaluation once a month would not be
sufficient. The frequency of evaluation will depend entirely on the type and degree of
change.
Evaluating care can be a complex process. Knowledge and skills are required on the
part of the person(s) undertaking the review.
The skills that are used when reviewing care are:
Observational
Questioning
Examining techniques
Testing
Measuring.
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When evaluating an individual’s communication needs, it is important to ask some
questions, such as:
How do we know whether the strategies and methods developed to
address communication needs have been effective?
How can we measure this?
How can we record this?
To what extent have the outcomes been achieved?
Were the goals fully achieved?
Were the goals partially achieved?
If the goals were only partially achieved:
Is more information required?
Should intervention be changed or stopped?
Do the goals need to be changed?
6.3 Work with others to support the continued development of
communication Observing and monitoring communication needs
In conjunction with your examination of records and reports, you must work with
individuals and key people to observe and monitor any changes in the individual’s
communication needs. The individual and all those involved in their care must be aware
of, and be implementing consistently, the methods and strategies contained within the
plan of care to meet the communication needs of the individual.
Looking to the future is important if individual’s needs are to be met fully. Obviously it can
be difficult to predict outcomes, so assessment should also include identifying medium
and long term needs.
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Long term communication needs must never be overlooked, even if the individual is
expected to leave your care setting in the future. In order that they are able to
communicate effectively in the long term, support should be planned once long term
needs are identified.
Conflicts and dilemmas
Occasionally, there may be differences in the way the individual, key people and the
care team perceive an individual’s short, medium and long term communication needs.
It is important that these are thoroughly discussed and concerns expressed, in order to
avoid conflict.
Misunderstandings must be clarified, questions and queries addressed and the possible
consequences of the individual’s decisions clearly explained to them. Failure to resolve
conflict must be recorded and reported.
Identifying changes
Individuals should be encouraged to identify any changes that may lead to alteration to
any existing care plans. Support should be given for them to understand the reasons for,
and the implications of, any changes. Changes can either be:
Physical Psychological
Social Spiritual
It is vitally important that the plan of care be reassessed within an appropriate
timescale when needs have changed. You must record and report changes to the
communication needs of individuals, within confidentiality agreements and according
to legal and organisational requirements.
Changes to the plan of care
The plan must be reassessed within an appropriate timescale, when needs have
changed. This will depend entirely on the type and degree of change. Changes to the
care plan are recommended and discussed with the relevant people. Any problems in
meeting the needs and interests of the individual, due to, for example, lack of resources,
should be fully explored with all those involved. A revised plan of care may then be
agreed.
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Implementing changes
Any agreed changes should be discussed and recorded in the care plan. Each member
of the care team and the individual should fully understand their role and responsibilities
when implementing this change. As a care worker, you must implement any changes
you are responsible for using a consistent approach. If the agreed changes that are
outside your responsibility are not being made, you must take action. Report your
concerns, monitor the situations, ask questions and make a record.
Conclusion
The information you have read within this unit should increase your knowledge and
understanding, which will benefit you, the individuals you care for, key people and others.
Now complete the assessment questions for this unit in the workbook section.