Communication

Introduction

On this page, we will be looking at the importance of communication in health and social care.

This will include the different methods that people use to communicate, as well as barriers to communication and ways to prevent misunderstandings. We will explore how to establish an individual’s preferred methods of communication and how effective communication can be used to positive effect in a variety of different situations.

We will also be touching on the importance of confidentiality in health and social care settings and how independent advocacy can be used to support individuals receiving care to have their voices heard.

Why do people communicate?

There are several reasons that people communicate, but they can be broadly categorised as follows:

Method	Description
Social	Communication is a way to establish and maintain meaningful relationships and reduce stress
Direction	Communication can be used to give or receive instructions about how to carry out a task
Expression	Communication is a way for us to express ourselves. This isn’t restricted to verbal or written communication but can extend to arts such as painting, music and dance
Recording	Communication is used to create and maintain records
Sharing	Communication is also a way for us to share ideas and experiences

Different ways that people communicate

There are several different methods that people may use to communicate with others, including:

• Verbal (e.g. through speaking and listening, face-to-face, on the telephone, via TV/radio/Internet etc.)
• Written (e.g. through reading and writing, digital or paper records, email, books, websites etc.)
• Pictures (e.g. through drawing, painting, pictorial aids etc.)
• Actions (e.g. dancing, hitting, ripping, rocking etc.)
• Gestures (e.g. through pointing at something, acting something out etc.)
• Body language (e.g. slouching or sitting upright communicate different things)
• Facial expressions

How communication affects work and professional relationships

The way that we communicate can have either a positive or negative effect on our work and professional relationships.

Positive effects of communication

If we communicate honestly, effectively and positively, we can establish and maintain strong bonds with our colleagues, the individuals that we support, their families and other professionals. Relationships built on mutual trust and respect lead to everyone feeling comfortable in putting forward their ideas to improve the way that the service works.

Positivity is also infectious and can improve confidence and wellbeing.

Negative effects of communication

Conversely, if we communicate in a negative way, it can have a detrimental effect on the way that others perceive us and people may even go out of their way to avoid us. This can make it more difficult to perform our work.

If we are unable to get our views across in a way that others understand, it may be difficult to introduce new ideas. A lack of negotiation skills and the inability to compromise can lead to conflict, which can also lead to the deterioration of relationships. Similarly, if we are not honest with others and they find out, it can lead to a breakdown in trust.

And of course, if we are unable to provide instruction, direction or guidance in a way that can be understood by others, it can lead to errors, mistakes and misunderstandings.

The importance of being observant and responsive to an individual’s reactions

When we communicate, it is essential that we are observant and responsive to an individual’s reactions because their behaviour may be more indicative of their true feelings than their words.

For example, consider providing an individual with some information and then asking them if they understand. They may say that they understand but have a confused look on their face. This could be an indicator that you need to ask them if they are sure or request that they repeat what you have explained in their own words.

As well as facial expressions, other things to be observant of can include body language, gestures and behaviour.

How to establish an individual’s communication and language needs, wishes and preferences

In a health and social care setting, you will find yourself working with individuals that have a range of communication and language needs, wishes and preferences. To communicate with them effectively, you will need to be aware of the favoured communication methods of each unique person.

This information should be provided in the individual’s care plan, however, you may also obtain information and guidance from your co-workers that have experience with working with the individual. If you have the opportunity to speak to the individual’s family, they will often have a lot of useful insights about how best to communicate with them.

However, perhaps the best way to establish an individual’s communication is to have a conversation with them and ask them what their preferences are!

Some examples of communication preferences are included in the table below:

Needs/preferences	Reason
Must be facing an individual when talking to them	Hearing impairment means the individual has to lip read
Sentences must be kept short (2-3 keywords) and simple	Acquired Brain Injury (ABI) means the individual cannot process a lot of information at once
To be addressed using their title of ‘Professor’	The individual is proud of their title and wishes it to be used when they are addressed. This also demonstrates respect for the individual and their dignity.
Requires time and patience when having a conversation	The individual has a learning disability, which means it can take longer for them to process information and respond.

Barriers to communication

Barriers to communication are obstacles that can make communication more difficult. They can be broadly categorised as follows:

• Physical disabilities – difficulties with speech or hearing. Can also extend to visual impairments and mobility difficulties.
• Mental conditions – depression, anxiety and the experience of hallucinations/delusions can make communication more difficult.
• Cognitive difficulties – difficulty processing and understanding information. May be permanent (e.g. learning disability, ABI etc.) or temporary (tiredness, intoxication etc.)
• Language differences – if individuals do not share the same language, communication can be difficult. This can also include accents, dialects, jargon, slang and different levels of vocabulary.
• Environmental – uncomfortable conditions can make communication harder (e.g. too hot, too cold, background noise, distractions etc.)
• Emotional – if we are angry, upset or nervous, we may not be able to communicate clearly. Similarly, if we are tired, hungry, thirsty or disinterested, we may not be motivated to communicate.

How to reduce barriers to communication

Some common barriers to communication, as well as ways that they may be overcome, are included in the table below:

Barrier	How it may be overcome
Environmental – background noise from roadworks outside makes it difficult to hear one another	Close the windows or communicate in an alternate location
Language – individuals do not share the same language	Use an interpreter or translator
Emotional – individual is upset and in a heightened state of emotion	Provide comfort and reassurance until they return to a baseline level or reschedule the meeting
Physical disability – individual has had a stroke, which has affected their speech	Communicate with gestures, writing or drawing instead. Work with a Speech and Language Therapist to regain vocal ability

How to check that communication has been understood

It is essential to ensure that the messages and instructions that we send to others have been understood.

To do this, we can pick up visual clues from the person we are communicating with – things like facial expression and body language can help with this. If the individual asks pertinent questions or summarises what you have said, these are good indications that the communication has been understood.

Sometimes, you may need to prompt others to repeat what you have said in their own words to ensure that they understand, and it is good practice to get into the habit of doing this yourself. This helps to prevent miscommunication and misunderstandings.

Using communication skills to manage complex, sensitive, abusive or challenging situations and behaviours

Effective communication is a key skill when managing complex, sensitive, abusive or challenging situations and behaviours.

When faced with these kinds of challenges, it is important to remain calm, display non-threatening body language and demonstrate compassion. You should also be honest and transparent, non-judgmental and show empathy.

Some examples of such situations/behaviours are included below:

Example 1: An individual disclosing to you that they have been abused

You should listen to the individual and treat their disclosure seriously. You should provide reassurance and explain that you will do everything you can to protect them from further abuse. You should also explain that, as part of your duty of care, you must report their disclosure to others to prevent further abuse to the individual and others. You should not ask leading questions.

Example 2: An individual with schizophrenia experiencing frightening hallucinations

Although what the individual is experiencing may not be real, it will feel very real to them and so you should acknowledge their experience and reassure them that you will stay with them until it has passed.

Example 3: An individual in a heightened state of emotion becoming aggressive and threatening

You should remain calm and maintain non-threatening body language. You should talk in short sentences in an even monotone voice and invite the individual to accompany you to a private area where you will listen to their concerns and help them to return to baseline.

Example 4: An individual that is deafblind and only able to communicate via touch

You should have already reviewed their communication needs, wishes and preferences in their care plan and know how to communicate with them effectively. This may involve light touches on the shoulder to let them know you are present or using the tactile alphabet to spell your name on the palm of their hand. Other ways of communicating with deafblind individuals include hands-on signing, Braille and Moon.

Confidentiality in day-to-day communication

As care workers, we have access to a lot of personal information about the individuals that we support. We also have a legal and ethical obligation to ensure that this information remains confidential. When individuals share personal information, they expect their confidentiality to be respected.

Ways of respecting an individual’s confidentiality can include:

• Not discussing an individual in places where we may be overheard
• Not leaving written information about an individual (e.g. their care plan) in public or communal areas
• Ensuring documentation is securely stored in a locked filing cabinet or password-protected computer system

From a legal standpoint, there are three main pieces of legislation that relate to confidentiality:

• The Common Law Duty of Confidentiality is case law, which effectively means that any personal information shared in confidence must remain confidential
• The Data Protection Act 2018 (incorporating the General Data Protection Regulations – GDPR) sets out how personal information can be collected, stored, processed and shared
• The Freedom of Information Act 2000 – certain public agencies must be transparent and share information that is of the public interest when requested

In addition, the Caldicott Principles are a set of eight guiding principles for best practice in the processing of patient and service user information. Further information can be found on the Handling Information page

The tension between maintaining an individual’s confidentiality and disclosing concerns

Although we have a duty to ensure that we keep information about an individual confidential, there may be times when we must share information with others, even without the individual’s consent. Some examples of when this is permittable include:

• An individual discloses to you that they have been abused – this must be reported to prevent further abuse and protect the individual and others
• Significant harm or damage may be caused by not disclosing information
• Following a request from a court of law

When information must be shared, it should only be passed on to others on a need-to-know basis and not shared with anyone else. It is also good practice to explain to the individual that you have a duty of care to share the information and request their consent to do so.

This can create tensions and dilemmas because the individual may feel that you have betrayed them, which may affect your relationship with them, however, it is important that concerns are disclosed to ensure everyone’s protection.

What is independent advocacy?

Independent advocacy is a service whereby an individual that has difficulty expressing their views and concerns can employ the services of somebody else to speak on their behalf. In general, advocates can be friends, family or healthcare professionals, however, an independent advocate will have no conflicts of interest, which means they are able to work in the best interests of an individual.

An independent advocate can be used in any situation, however, there are certain times when they are commonly used, including:

• During a needs assessment by the local authority
• When an individual is detained under the Mental Health Act, they have the right to an Independent Mental Health Advocate (IMHA)
• When an individual lacks the mental capacity to make a decision for themselves, an Independent Mental Capacity Advocate (IMCA) may be appointed to speak for the individual during a best interests meeting

Obtaining further support and guidance

Further support and guidance about communication, confidentiality and independent advocacy should be provided by your employer as part of your mandatory training. You may also get further information from your organisation’s policies and procedures or by conducting your own research. If you are unsure about anything, you should speak to your manager or other knowledgable individuals, such as your tutor or senior co-workers.