People communicate for a wide range of reasons and its all to portray across a message of one form or another: Information transmitted in different ways to different means.People in general will communicate to have a conversation and socialise, to maintain a relationship of some sort. This also includes asking questions, sharing thoughts and ideas, emotions and reactions to put it simply. When working with people, personal care for instance, a simple question of how the service user would like their hair to be washed, their hair to be brushed and then they then answer with an instruction. Communication is vital for people to interact with each other. We wouldn’t be able to care for the service user with the best of our ability if we don’t use the best of our communication skills. In the time we spend with the service user, with other people, we build an emotional rapport with them and this can enable us to build trust which is a form of communication in itself. If there is no trust, then the person will not fully communicate. The body language of a person says a lot about how a person is in that moment of time and in that moment they could be wanting to tell you something or unable to tell you something and it is then your job to open up the leads to communication if that trust has been built, or you feel that it is right to do so and the person is wanting you to: by means of a question. Their body language may communicate to us but our body language also. If we use negative body language whilst with said person then we have broken down communication straight away. A slumped manner in how we stand, hand on our hips etc. slouching while we sit with the service user, are we really going to communicate well with them? We might as well just walk back out of their door. Questions and answers. That’s all it is. When working with other carers, there is an instruction given for instance when working with a service user but sitting down speaking with colleagues about how each service user has been in the day – it is an answer to that question. We need to be able to think about how we communicate throughout our work whilst we work with others and service users as we need to be able to convey across to the next team and each other, that vital information on the service user, important dates, appointments -how that person has been, to be able to convey that information across and converse with outside agencies such as district nurses , OTs etc. All this is very important and helps to ensure the continuity of the service users needs. We don’t just talk amongst ourselves but we record information also every time we see a service user, we document it, any and every concern, change etc, we document. The care plan itself is a piece of written communication from ourselves and the service user to the carers – instructions. All that vital information to be able to give the best person centred care possible. If we are not able to communicate effectively, then our care gets affected, then the service user will get affected negatively. Communication does not have to be verbal and with sound , this can be a challenge when you do not know the person and they just want help with their morning routine. Until you get to know that person, what are you supposed to do, how are you supposed to communicate? There are many ways to communicate with this person. You can start off by writing? But what if that person had a stroke and it has caused dysphasia(sometimes called Aphasia)? You do not want to just ask them to write down what they are wanting to say. You can’t ask them this or that? As a carer, you realise that there barriers everywhere to communication, this is when you take a small moment, a breath to think of a way to get a round that obstacle, put yourself in the other person’s shoes – relate to them and find a way. A picture can be a great communication aid for this person as this enables them to just point to what they want. Then if you introduce the word with the picture, they maybe could associate the word shower with having a shower for instance in the future. Not only can the service user use a picture to ask for something in a care call but they can portray across an emotion, how they really feel. A whole conversation can be had with the right pictures, photos and trust. All of this sounds good but if you are not listening fully then you won’t be able to manage this at all. If this service user is non verbal and has dysphasia then you need to be fully in the conversation, you need to be fully with that person. Watch the body language, see their facial expressions, with other service users, hearing the sub context of what they say and listen for what they actually say. It is no good just being with a person, a service user, outside agencies, colleagues and just hearing words, you need to Listen. This is Active listening.When listening and focusing on the service user, you can repeat back what they say in your own words what you think they meant. This shows that you are trying to understand them, fully comprehend the conversation on all sides, this shows that you are trying to empathise. This empathy could enable the service user to open up to a better communication next time, really communicate their thoughts and feelings. To actively listen, you need to comprehend, retain the information, but then again, our memory of a conversation could be different to the other person’s memory of the same conversation just due to how we or they are feeling, so we need to be aware of this when communicating and to end our actively listening, is the response – that is just what communication is. There are many technologies out there which can help and enable communication with all barriers, be it a different language, non verbal, deaf or blind, from the simple use of Google Translate to Cochlear Implants, symbol systems, sign language and braille. But to communicate effectively, needs the right environments and minimizing the distraction. This distraction though could be from one of their basic needs not being met: the service user might just be hungry. We as a carer need to ensure that the person we care for has all their basic needs met so communication between two or more people can happen effectively. The right environment from temperature to lighting needs to be ideal for the people trying to communicate. A service user who is deaf in one ear and uses a hearing aid in the other which doesn’t get cleaned very often, has a mild learning disability and you are trying to have a conversation with them whilst you are in the middle of the cafe at peak hour. Is it going to happen? Are you going to have a flowing conversation, get the information you need or get the information across. No. You wait until they have finished their lunch, or ask them to move into a quiet room so that your conversation can flow. They then not only can hear you one to one, but they can see you one to one also. They then feel that they are important, they are not just another person you see day in day out, you have made an effort – you have made the time – you care. Google Translate is a simple tool which is not 100% correct but it is free for when you speak a different language or maybe you are trying to help your colleague speak better english and they don’t quite understand the word you have used. They don’t necessarily understand the word you have used because you are using a slang word from the county, area you are from. In the uk, we have many different dialects, and subsequently, slang words or abbreviations to english words but all over the uk we are not just english, we come from all over the world and we work with those who come from different countries. I have experience myself of two spanish ladies who speak english but they have developed a new language between themselves – spanglish, which is crossing spanish and engish together, for when they are communicating about work. Sometimes they need to talk amongst themselves to fully understand as we all have different accents and use different terminologies. We all use different hand gestures also. Around the world, these gestures can mean different things. In the uk we use signs such as a thumbs up and the ok gesture as a positive but the thumbs up gesture in africa and the middle east is a negative sign and the ok gesture in europe can mean a vulgar gesture or “worthless”. We not only work with people from different countries but we work for them also, as service users. Those from a different country, even a different part of our own country, have a different background, a different culture, religion and we have to bare that in mind when communicating. We need to constantly analyse the people the people and situations around us to know how to communicate correctly. For those people with dementia, itself is a barrier to communication. We must not forget to use our non verbal communication. This is quite important. Non verbal such as body language, facial expressions, eye contact, touch when appropriate and even actions including hand gestures, again when appropriate. When communicating, the recipient needs to be able to receive the information and if they need aids such as hearing aids, this is to bare in mind and they need to be able to understand. Thinking about those with dementia though, they may not be able to communicate what is really going on. Sometimes they may feel they are hungry when in fact they in pain and vise versa, the behaviour of the person may change when they are ill. The body language of a person is very important when communicating and we need to always keep this in mind as it quite often tells us something they, the service user, either don’t or can’t. Negative body language like agitation, restlessness even aggression can be the service user communicating to us that their basic needs aren’t being met. A person who is unable to hear very well may need a hearing aid, but those with glasses, we need to ensure that those glasses are in fact clean. They need to be able to see our faces when we speak/communicate. This service user has dementia, a hearing aid, glasses – all of these factors need to be thought of. Does this person have their basic needs met. Do they have the correct aids in place. If it is a document we need to communicate with them, do they understand it? Do we need their family members with them or an advocate? Are we considering the service users emotional needs? All of these questions. Most often than not, just speaking to the service user alone in their own home, as they sit in their favorite chair, I sit by them or crouch to their level and use the skills that I have, turning any noise distractions down or off and it just the service user and myself, face to face. I then will ask permission to speak to family if needed and convey across to them what we have spoken about, then document so not only did the conversation take place but the rest of the care team can know what communication took place. The hardest communication I have found is talking to someone with dementia about their mobility and having to change the way they just get themselves up from a chair and going through this with them physically and explaining, let alone the rest of their mobility. It isn’t because I can’t find the right skill set with communication, it is because I as a senior, am now explaining to the service user that they have to change the way they have always done something even something as basic as getting up off a chair. That communication will change the way the person feels, changes the emotions and you know it won’t change it for the better, so during the process, it will be difficult and it may take a long time, but at the end of the communication, the service user is not only safer and us as carers going to see the service user are safer, but they will find emotionally they won’t feel such negative emotions as they have been. It is just the process you have to go through. Communication can take all parties through a vast range of emotions, even the service user who is non verbal, had a stroke and is just wanting to ask for support with a shower and a blow dry of her hair after. You may find through assessment of a service users communication needs that you need some extra advice or they need extra support. When needing to access extra support, the first protocol is always the family. They know the person better than anyone or you hope they do. They might have already sort out the extra support for communication. Then speaking with family,care manager and other carers to get as much information and advice as possible you may need to contact social workers or getting them appointed, occupational therapists. The person may need a SALT referral so speaking with the GP may be needed. Local government authorities have this information for how to contact the right places such as adult services,on the internet but speaking with GPs, they might be able to help also. If the service user has a language barrier though, you need an interpreter of some kind. You may be able to find a personal interpreter or a technological interpreter/translator. In care, the carer needs to go through training and is trained in various skills but may be trained in a specific skill – you may need to learn BSL or Makaton if you work with a service user on a regular basis.
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