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.