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ANSWER

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Communication is important for all aspects of effective work in health and social care.
Communication is a two-way process which is affected by the environment in which the communication takes place. It is never straightforward – it is never about one individual, but always about relationships, environments and understanding the specific needs of the individuals you work with. Communication is about making sure that our needs are recognised or our wishes known by another being. It is about one living person interacting with another in any way, and about the other person listening, understanding and communicating back.

Perhaps the most important aspect of communication is that it is a two-way process. It is about both giving and receiving a message.

In order to relate to other people as individuals, we need to be considerate around their communication styles, preferences and needs, and to ensure that our own communication enables the other person to relate to us. All relationships are built on mutual, two-way communication. Communication is:

? about understanding other people’s needs and wishes
? about letting people know that you have heard and understood them
? about being honest and open about what you can and cannot do to meet those needs and wishes
? on its most basic level, about getting on with people – ie treating them with respect as individuals and as equals.

This is why good communication at work builds effective relationships with colleagues and service users, and why barriers to communication have to be overcome to aid effective mutual understanding

There are four main reasons people communicate: Instrumental communication We communicate in order to:

? ask for something
? refuse something
? choose something
? tell someone what we need or want.

Informative communication We communicate in order to:

? obtain information
? to describe something.
? give another person information

Expressive communication We communicate in order to:

? express our thoughts or feelings
? shares ideas. Social communication

We communicate in order to:

? attract attention
? maintain relationships.
? build relationships

Communication and relationships are very closely linked. The way in which we communicate with others will be affected by the relationship we have with them. In much the same way, the quality of communication has an effect on relationships. For example, when people don’t communicate effectively their relationship suffers. The links between communication and relationships should never be underestimated by health and social care professionals.

In health and social care settings, communication occurs:

? between individual workers and individual users of services
? between individual workers and groups of service users
? within groups of service users
? between team members
? within staff groups
? between staff members, managers and partner agencies
? between service users and their carers, family and friends
? between staff and service users’ carers, family and friends.

Communication is two ways. If carers are failing to understand what a person is communicating, the problem is with the worker, not the service user. The view taken should be more along the lines of ‘the person working with this service user can’t understand their communication’.

People communicate in a variety of ways, such as:

? touch
? gestures
? speech
? drawing
? facial expression
? sign language
? style of dress
? body movements and posture
? writing
? telephone
? electronically (eg. text messaging and email).

The three Vs of communication

There are 3 Vs involved in the giving and receiving of a message:

Visual cues – body language such as eye contact.

Vocal cues – the tone and pitch of the voice.

Verbal cues – the choice of language.

All the different types of communication can be categorised into three main areas:

? verbal communication
? non-verbal communication
? written communication.

Verbal communication

When thinking about verbal communication, people tend to focus on the words they use. However, research indicates that the words we use are less important than other aspects of communication in conveying or understanding our needs. Only a small proportion of communication is conveyed in the words we use with more being communicated by the tone, volume and pitch of the voice, and even more being communicated in the form of body language. Therefore, in using verbal communication you not only need to think about using words that treat people with respect and using words that people can understand, but you also need to think about the following areas:

Speed

The speed at which someone talks is very significant. It might indicate someone’s emotional state – for example, fast speech is associated with anger or excitement while slow speech can be associated with tiredness or a low mood. The speed at which someone speaks can be interpreted in a range of ways – for example, slow speech can be interpreted as showing a lack of interest.

Tone

People are often not aware of the tone of their own voice. However, it is important for health and social care staff to develop this awareness as tone of voice has such a significant impact on communication.

Volume

How loud or softly we speak has a very significant impact on communication. For example, loud speech can indicate anger or aggression and yet many health and social care staff raise the volume of their voice when talking to service users.

Register

The ‘register’ of speech refers to how formal or informal it is. You will be aware that people often change the formality of their speech depending on their situation.

Non-verbal communication

Non-verbal communication (also referred to as body language) refers to the messages given out by body actions and movements rather than words. Body language is an important part of the communication process. As the saying goes, ‘actions speak louder than words’. Usually verbal and non-verbal communications are in agreement (eg someone saying ‘I’m happy’ and smiling) but at times they may contradict each other (eg someone saying ‘I’m happy’ while they look positively sad). There are some key guidelines in terms of body language.

When considering body language (and communication as a whole) try to remember the three Rs: Communication should always be:

? respectful
? receptive
? relaxed.

UNDERSTANDING HOW PEOPLE COMMUNICATE

Respectful, relaxed, receptive ? Disrespectful, tense, not receptive ?
Resting and/or still hands

Relaxed face

Relaxed shoulders

Posture is upright, able to breathe easily

Slow and deep breathing

General position comfortable and easy to retain when either sitting or standing

Mouth visible

Feet and legs still and comfortable

Appear interested in what is being said
Fidgeting and/or clenched hands

Creased brow, a drawn mouth

Raised and tense shoulders

Posture is strained or hunched

Rapid and/or shallow breathing

Requires lots of fidgeting and movement to remain comfortable

Mouth covered up or chewing finger nails

Feet and legs fidgeting or tapping

Doodle, sigh, look away, look at the watch, etc

These descriptions can also act as indicators of how someone is feeling. Sensitive observation provides insight into how the exchange is progressing. This is an important point because communication depends upon responding to the verbal and non-verbal messages provided by others within the exchange. Therefore, if a person’s body language becomes tense, the situation may be causing anxiety.

The use of touch in communication

Touch is a very powerful form of non-verbal communication. Think about the way that you might experience touch yourself – when someone you know well touches you, you might feel comforted and safe, but when someone you don’t know touches you, you might feel vulnerable and threatened.

When used appropriately, touch can be a very positive form of communication in that it can:

? provide comfort and reassurance when someone is distressed, making them feel safe and secure
? show respect
? calm someone who is agitated.

However, when used indiscriminately, touch can:
? invade privacy, making people feel vulnerable
? embarrass people
? undermine trust
? be seen as harassment.

So, this is a sensitive area. The best approach is to keep touch to a minimum, because it can easily be experienced as threatening, inappropriate or uncomfortable, especially for a service user who may already be feeling vulnerable. If a health and social care worker needs to touch someone as part of the care process, they should explain what they are doing and always ask permission. Failure to ask permission and obtain consent is an intrusion on that person and an abuse of power.

Alternative methods of communication

Where people experience barriers to the more common forms of communication they may use alternative methods of communication (sometimes referred to as augmentative and alternative communication). This might include communication methods as follows.

Objects of reference

Using an object or a picture to indicate what someone wants. They could pick up a cup to indicate that he or she would like a hot drink or could use a picture or symbol to indicate this. A particular object or picture may have a specific meaning for that individual which may not be immediately apparent, which is where observations, together with feedback from others, will be especially helpful.

Touch

Perhaps using a tap on the arm to obtain your attention or guiding you to indicate what the person requires. In this way, someone might guide you to a room where they want to be or show you something of interest.

Behaviour, gestures and movement

These can be used by many people as a communication method. Behaviour that may be labelled as challenging or difficult may in fact be much more about a person communicating some aspect of their needs.

Sounds

If people have relatively few or no words, they may use other sounds to indicate what they want. The meaning of some sounds may well be obvious, such as laughter or shouts of joy or pleasure. As with the use of objects of reference and touch, the association made with some sounds will be specific to that individual.

Smell

Where other senses are impaired, the sense of smell may take on added significance and some people may, for example, sniff different types of foods and toiletries to make their choice.

Drawing

Some people may prefer you to make a drawing to indicate what choices are available or what may be taking place. Symbols are often used in communicating with people to help understanding.

Writing

Some people may prefer to write rather than to speak. This may be the case if someone’s speech is temporarily impaired due to illness or it may help them to clarify what they mean.