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1.4 Communication

Candidates should have knowledge and understanding of the different types of communication and their importance in contributing to quality care of individuals as well as the effective working of others within the care team. Candidates need to understand and be able to evaluate the factors that govern the effectiveness of verbal and non-verbal communication.

Communication can be:

• formal

• informal

and can take place:

• one-to-one

• in groups

Different types of communication

There are different types of communication, these include:

• written

• verbal

• non-verbal

• graphical

• alternative

Written communication

Written communication involves the use of written words or information we wish to convey. It can be used in both formal and informal situations, such as:

• letters

• reports

• memos/notes

• e-mail/text messaging

• records

Verbal communication – speaking, singing, active listening.

There is a well known saying: ‘it’s not WHAT you say but HOW you say it’.

There are a number of paralinguistic skills that can make all the difference to what is being said and can therefore help, or hinder, communication. These include:

• volume (how loud or quiet)

• tone (the quality of someone’s voice)

• pitch (high or low)

• pace (fast or slow)

It is important that attention is paid to these aspects of verbal communication to prevent poor communication.

Non-verbal communication

Including: body language, gestures, mime and drama, music, art and craft.

People can sometimes say a lot without uttering a single word.

Non-verbal communication involves the use of:

• Facial expressions (e.g. a smile, frown, grimace, raised eyebrow)

• Hand gestures (e.g. thumbs up, pointing, waving, beckoning)

• Body language (e.g. leaning forward, hands on hips, folded arms, slouching)

• Eye contact (direct, staring, looking away)

Graphical communication – posters, signs, symbols and diagrams

Graphical communication uses visual materials (text and images) to convey information, e.g.

• drawing/illustration

• cartoon

• photograph

• map

• sign/symbol

• text

• diagram/chart

Alternative methods of communication – British Sign Language, Makaton, Braille, Widget

Alternative methods of communication are used when other methods of communication are not possible, e.g:

• signs and gestures (e.g. British Sign Language)

• Morse code (telegraphic code of short and long sounds)

• symbolic (e.g. Braille, Makaton, tactile systems, picture boards, widgets)

Factors affecting the effectiveness of communication:

Communication is something we all do every day of our lives so you might think it should be easy. Often, though, problems arise and misunderstanding occurs. This is because something gets in the way and makes communication difficult, or even impossible. This is a BARRIER to communication, which may arise because of:

• emotional factors

• environmental factors

• physical or intellectual disabilities

• cultural influences

• stereotyping and labelling

• time constraints and pressures

• use of technical terminology or colloquialisms

• appropriate use of speed, clarity and loudness

• use of eye contact, facial expressions and body language

• legibility and accuracy

• lack of resources

Emotional factors – personality clashes, stress and anxiety, empathy, worry and mood,

Emotions can affect the ability to communicate with others. These include:

• Personality clashes: tension, conflict, avoidance, resentment

• Stress or anxiety: arguments, blaming, distracted, physical symptoms

• Fear: afraid to speak up

• Sadness: may not feel like talking and want to be left alone

• Low mood: e.g. depression – may be disinterested/not feel like talking

• Happiness: high spirits can make it difficult to say what we mean

• Excitement: not listening, too talkative, unable to concentrate

• Empathy: feel you are understood, more willing to talk/share

Environmental factors – personal appearance, proximity, seating arrangements, background noise, lighting, comfort and warmth.

Environmental factors are features around us in day-to-day life which we often do not think of as being a help or hindrance to communication. These include:

• Personal appearance: clean/dirty, tidy/dishevelled, smart/scruffy, pretty/ugly

• Proximity: too close or too far apart

• Seating arrangements: configuration, cramped, inadequate

• Background noise: hard to hear people/be heard, concentration

• Lighting: too dim/too bright

• Comfort/warmth: too hot/cold/draughty

Physical or intellectual disabilities

Physical disabilities

This includes visual, hearing and speech impairments as well as disabilities that affect the motor abilities of an individual, e.g. a wheelchair user. Factors include:

• Use of speech or need for alternative methods

• Equipment, e.g. hearing aid, amplifiers, computer, etc

• Special suppor,t e.g. signers

• Use of non-verbal communication

• Height at which you speak to people

Intellectual disabilities

Intellectual disabilities such as IQ differences, limited speech ability or impediment, can make communication difficult due to lack of understanding but, with patience and willingness, both parties can make themselves understood by:

• using simple language/no jargon

• having support from another person (family, friend, carer)

Cultural influences

• Eye contact is considered respectful in western culture and shows that a person is interested but some cultures believe that looking away is a mark of respect.

• Non-verbal communications: not all gestures are universally acceptable, e.g. thumbs up or showing the soles of your feet can cause offence in some cultures.

• Humour differs between cultures, e.g. subjects such as death, religion, politics are sometimes joked about in the UK but this can offend other cultures.

• Gender roles: men and women communicate differently, e.g. women may not be comfortable talking to a man who is not a close relative.

• Language differences: can create clear difficulties but even where a common language is spoken, accent, dialogue, slang can pose problems.

Stereotyping and labelling – making assumptions about others

Stereotyping

A stereotype is “ … a fixed, over-generalised belief about a particular group or class of people.” (Cardwell, 1996)

By stereotyping, we infer that someone has all the characteristics and abilities that we assume all members of that group have, e.g. all blondes are dumb, all women are bad drivers. Clearly that isn’t true!

Negative stereotyping can lead to social categorisation, one of the reasons for prejudice and discrimination.

Labelling

Labelling is defining or describing a person in terms of his or her behaviour, e.g. describing someone who has broken the law as a ‘criminal’. It can be the same as ‘pigeon-holing’, e.g. all sufferers of schizophrenia are violent and dangerous. Not true, by the way!

Once labelled, an individual may take on the characteristics associated with the label and become what they have been labelled … a self-fulfilling prophecy.

Time constraints and pressures

Time constraints and pressures can affect communication, e.g. high workload/staff shortages, causing:

• less time during interactions – poor listening

• rushed interactions – lack of clarity can lead to misunderstanding

• poor record-keeping – misinformation, errors, omissions

• low morale

Use of technical terminology or colloquialisms

Technical terminology

Sometimes called jargon, this is a special language for use by a group or profession, e.g. doctors, nurses, social workers. This could include the use of specialist terms to describe parts of the body, medical procedures, specialist equipment or the use of acronyms which the patient may not understand.

Technical terminology should only be used during communication with those who are familiar with it, e.g. ‘DNR’ is a term sometimes used in nursing/medicine. A doctor would understand it to mean ‘DO NOT RESUSCITATE’, while a cleaner within the hospital might interpret the initials in a completely different way. This could easily cause confusion which might lead to all sorts of unexpected outcomes.

Colloquialisms

A colloquialism is an informal expression that is more often used in casual conversation than in formal speech or writing. It may be a word, phrase or saying that is often understood in specific geographical areas, e.g:

• to be pleased with something – chuffed

• to be drunk – ratted, wasted, trollied

Use of technical terminology, jargon or colloquialisms can:

• be misinterpreted

• cause confusion/lead to misunderstanding

• lead to individuals feeling excluded

• speed up communication when used appropriately

Appropriate use of speed, clarity and loudness

This is linked with ‘paralinguistic skills’ associated with verbal communication. These skills can both help and hinder communication.

• Speed:

Too fast – hard to understand and follow conversation

Too slow – hard to follow; may feel you are talking down to them

• Clarity:

Be clear – say exactly what you mean and avoid vagueness

Speak clearly – mumbling, muttering, not facing the person makes it hard to hear or understand what is being said

• Loudness (volume):

Too quiet - hard to hear what is being said

Too loud - distracting, viewed as disrespectful, even threatening

Use of eye contact, facial expressions, body language

These are also ‘paralinguistic skills’ which can help or hinder communication.

Eye contact

You can tell a lot from just looking at someone’s eyes as they often reveal what someone is thinking/feeling, e.g. happiness, sadness, shock, suspicion, boredom.

• Shows someone is listening, paying attention

• Some cultures show respect whilst talking by looking away/down

• Staring can be off-putting; can indicate aggression

Facial expressions

Provide a form of feedback alongside the words involved in communication that adds to the interpretation of what is being said, e.g.

• smiling

• frowning

• grimacing

• raising eyebrows

all add to the interpretation of what is being said.

Body language

So much can be said without ever opening our mouths, e.g.

• hand gestures – pointing, beckoning, thumbs up/down

• head – nodding/shaking head, inclined to one side

• body posture – leaning back/forward, crossed arms/legs, shrugging

• other gestures – winking, rolling the eyes, pursing the lips

NB: non-verbal communication must match what is said verbally. If this isn’t the case, there is a risk of sending ‘mixed messages’ which hinder communication.

Consider … an elderly patient asks for help to visit the bathroom. The care worker agrees but, as she goes to help her, she pulls a face and rolls her eyes at a fellow care-worker. What message is sent to the elderly lady? How do you think she would feel?

Legibility and accuracy – written documentation

Legibility: being clear enough to read and understand, e.g. handwriting, notes, files.

Accuracy: being free from mistakes and relaying the truth.

Both these factors are important in written, computerised and electronic methods of communication.

All records, notes, letters, memos, etc MUST be legible. Attention to detail, spelling, grammar and relevance of information is important and information must be recorded with care.

Good written communication can be easily understood at a later date without raising questions or uncertainty.

Example: A telephone caller leaves a message for a manager who is unavailable. He wants the manager to call him back as soon as possible. What information would you ask the caller for and record to later pass on to the manager concerned?

Lack of resources

This could mean anything that is of limited availability. Lack of resources that can affect communication could include:

• technology, e.g. computers, telephones, fax machines

• recording materials, e.g. paper, pens, books, files

• faulty equipment, e.g. broken PC, TV, telephone, no internet service

• personnel, e.g. signers, care workers, nurses, social workers

• time, e.g. staff training, meetings, client activities

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Discuss: When and how is written communication likely to be used within health and social care settings?

Discuss: How do paralinguistic affect communication between individuals?

Find out: What the different types of communication are, how they work and who is most likely to benefit from them.

Discuss: What is the effect of non-verbal communication on communication between individuals?

Discuss: Where or when are these are likely to be used in Health and Social Care settings?

Discuss: How does stereotyping and labelling cause a barrier to communication?

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