In this article
After reading this Care Certificate Standard 6 – Communication, you should be able to:
- Understand the importance of effective communication at work.
- Understand how to meet the communication and language needs, wishes and preferences of individuals.
- Understand how to promote effective communication.
- Understand the principles and practices relating to confidentiality.
- Use appropriate verbal and non-verbal communication.
- Support the use of appropriate communication aids/technologies.
The Care Certificate Standards detail what you must achieve and be assessed against to meet these learning outcomes.
If you have any concerns or queries, you should discuss these with your employer and/or assessor.
Why is good communication essential in health and social care?
Good communication is essential in health and social care. It increases your knowledge and understanding of:
- The individuals who are being cared for and supported, and;
- The part played by other workers.
Good communication helps workers provide the best possible care and support. It also helps develop working relationships, so that everyone’s views are valued and taken into account.
The 6Cs and communication
The 6Cs are values that apply to all health and social care workers. They are:
Communication is one of the 6Cs and it:
- Is an essential part of a caring relationship.
- Helps to encourage trusting relationships with the individuals you care for and with families and other workers.
- Means having the ability to speak and act in a way so the person can understand and also listening carefully.
Verbal and non-verbal communication
It is often believed that talking is the most common type, or method, of communication.
However, most communication is silent, for example:
- Tone of voice.
- Moving away or closer.
- Crossing arms and legs.
Silent communication can often tell us far more than words.
To achieve the best outcomes for the individual’s care and support, you should learn to take these reactions into account. Understanding them is a vital part of developing your communication skills.
Using the phone, texting or emailing can make communicating difficult, as you cannot see the person and are therefore unable to see these signs.
The different types of communication
There are many different ways of communicating. The individuals who you are caring for and supporting will communicate in ways that work best for them.
Some examples of the different types of communication are:
- Verbal communication.
- Written communication.
- Body language.
- Sign language.
- Facial expressions.
- Eye contact.
You will now look at each of these types in further detail.
Verbal and written communication
When you communicate verbally, you must consider that differences in how you speak (including the tone, pitch and volume of your voice) can influence how your message is interpreted.
- Try to avoid jargon, abbreviations, complex words and terminology.
- Ensure that you always speak in a respectful manner.
- Adjust your speech to suit the individual.
This method of communication is used to:
- Send messages;
- Keep records, or;
- Provide evidence.
Body language and gestures
This type of communication is non-verbal, and there are many different aspects, for example:
- Facial expressions (showing reactions and feeling).
- Eye contact.
- Body positioning.
- Body movements.
People will often not realise that using these different aspects can communicate information about an individual or worker. It can give others clues to how we feel and our attitudes and emotions, i.e. by the way we stand, sit or hold our arms when we are talking.
This type of communication uses hand or arm movements as:
- An alternative to speaking, or;
- To emphasise what is said.
Sign language and Makaton
This type of communication is:
- A language that is recognised worldwide.
- Used by individuals in the United Kingdom (UK), which is known as British Sign Language (BSL). There are variations of sign language in different regions.
- Used by many individuals, but mainly by those who are deaf or have hearing impairments.
This is a unique language programme that uses a large collection of symbols, signs and speech to enable people to communicate.
It is often used by those who have:
- Learning and physical disabilities, or;
- Hearing impairments.
Braille and facial expressions
This type of communication is:
- A tactile system that is used to support reading and writing.
- A code of raised dots that are ‘read’ using touch.
- Used by people who are visually impaired or those who are blind.
We use facial expressions to show our reactions, or feelings, to things and to support what we are saying. This communication type provides you with valuable clues, so you can gauge how a person is feeling.
Eye contact and position
Health and social care workers should maintain good eye contact when communicating with individuals, workers and others. It is a vital part of communication, as it shows others you are engaged and listening to what they have to say.
The way we position ourselves can give others clues about our feelings, attitudes and emotions, e.g. how we stand, sit or hold our arms when we are talking.
Communication with other workers and individuals
Health and social care workers will form various relationships. Some of these will be formal and some informal. Having a relationship based on understanding and trust from the start will provide the basis for good care and support; regardless of whether it is short or long-term.
Successful two-way communication is essential in:
- Identifying and understanding individuals’ care and support needs.
- Effective team working with carers and other workers providing care.
- Ensuring clarity and trust.
If communication is poor, it can quickly lead to:
- Misunderstanding individuals’ care and support needs.
- Ineffective team working.
- Confusion and distress.
The processing of exchanging information through communication is not always straightforward. Mistakes can happen due to sharing inaccurate, unclear or misleading information and can lead to a poor standard of care.
Formal and informal communication
As you have learned, communication can be good or poor. It can also be formal or informal.
- Formal communication – is likely to be used between you and other workers in the working environment.
- Informal communication – is likely to be used with family and friends using slang or familiar words.
You must ensure that you always use the most appropriate communication method for the person and situation.
Understanding and observing non-verbal clues and signs
As a health and social care worker, you should look for non-verbal communication clues, which are unspoken messages that come from an individual’s:
- Body language;
- Facial expressions, or;
Observing non-verbal signs
Being observant of the non-verbal communication signs will help you notice when an individual (without them telling you) is becoming:
- Stressed, or;
Looking out for these signs will then allow you to:
- Take action to help stop this from happening, or;
- Help the individual to express their feelings in the best way they can.
Responding to non-verbal signs
By noticing an individual’s reactions, you can ask yourself the following questions:
- Do I need to alter the type of communication I am using to help the individual understand?
- Do I need to have an awareness of how the conversation is affecting them?
- Is there something the individual is not communicating to me that may help?
To help you ask good questions, and develop supportive relationships, you should learn to recognise the unspoken messages, i.e. non-verbal communication cues.
It will also improve trust, as the individual will see that you are:
- Taking an interest in them, and;
- Trying to understand and meet their needs.
Communication needs, wishes and preferences
The individuals who you care for and support will have a range of different needs and preferences.
They will have unique communication needs, which will differ depending on their:
- Condition, and;
- Personal preferences.
You will have to connect with an individual to discover what their needs and wants are, so your work can be centred on them as a person. You will also need to find out the best ways of communicating with them and their needs from the outset. If you can’t communicate with them by talking, you will need to use other methods, so they can pass information to you in a way that works best for them.
Sources of information
The best source of information regarding communication needs and preferences is the individual. Where it isn’t possible, to acquire this information from the individual, their family, friends or carer can also be useful sources. They may be able to share their experiences regarding the most effective communication methods. However, you must not rely on this method alone, as others may not communicate well with the individual being supported.
The most effective ways of communicating, with the individual, should be included in their care plan.
Communicating by touch or physical contact
When using touch, as part of non-verbal communication, the individual’s preferences are extremely important and must be taken into account.
- Be carried out as a form of communication, such as shaking hands or kissing.
- Communicate something to them, for example:
– What they experience when they are physically assisted to stand, sit or turned over in bed.
– Their experience of being touched during intimate personal care, such as washing.
In all situations, how you touch a person must be well thought out and carried out in a person-centred way.
Your use of touch may have to differ from one individual to the next, and you will need to:
- Talk with each individual you are caring for and supporting to know what their particular preferences are.
- Talk with your manager and colleagues, particularly if you have a situation where an individual cannot clearly communicate their preferences to you.
Touch and consent
In all circumstances, consent must be given by both people where any form of touch or physical contact is used.
You may have a situation where it may be necessary to touch an individual who doesn’t want to be touched, e.g. if they need to physically restrained for their own and other’s safety.
To be prepared for these types of situations, you must:
- Speak to your manager about the agreed ways of working in your workplace, so you know what actions to take.
- Be aware of the rules for infection control in your workplace, as they will need to be followed when using touch. You can read about infection control in the Care Certificate Standard 15 – Infection Prevention and Control.
Different methods of communication
As you have learned, individuals have unique communication needs. Talking may not be the best communication method for all individuals, and you may have to use other methods.
- Technological aids.
- Word or symbol boards.
- Speech synthesisers.
Touch and technological aids
This method is used to communicate with individuals who are deaf and visually impaired. Health and social care workers sign information onto the individual’s hands as a way of passing on information.
For those who have limited or impaired communication skills, technological aids can be used, for example:
- Hearing aids.
- Hearing loops.
- Text phones.
- Text messaging on mobile phones.
These are all forms of technological communication devices.
Word or symbol boards and speech synthesisers
Word or symbol boards
Some individuals may support their speech by using word or symbol boards. Using this method, the listener can associate the word or picture with the verbal communication to understand what is said.
Speech synthesisers replace speech either by producing:
- A visual display of written text, or;
- Synthesised speech that relays the information verbally.
Voice recognition software is available and can be purchased for any computer. This translates speech to written text.
Checking and reporting
Where communication aids or technology are being used, you must always:
- Check that they are:
– Functioning properly.
– In good working order.
- Report to a senior member of staff, or the individual’s carer or family member, if you have any worries about them not working properly or being unclean.
What are communication barriers?
Barriers to effective communication
Anything that will get in the way of effective communication, and can make it difficult, is known as a barrier.
There are many examples of barriers, such as:
- Limited use of technology.
- Body positioning.
- Not enough time.
- Poor or negative body language.
- Lack of privacy.
- Sensory impairments.
- Environmental factors.
- Substance misuse.
Attitude and limited use of technology
There may be situations where health and social care workers may be abrupt due to:
- Time limits.
- A lack of resources.
- Their mood.
Being abrupt when speaking to an individual may make them feel intimidated and frustrated. It may result in them not wanting to communicate.
Enough time should be allowed for each meeting, and workers must never let a bad mood affect the standard of care and support they provide.
Limited use of technology
Communication barriers can occur when technology aids, which are known to be the best way for the individual to communicate, are unavailable.
If this type of situation arises, you should find alternative ways of supporting communication. If necessary, raise the issue with a manager or supervisor.
Body positioning and emotions
When communicating with an individual, the way you position your body can be a barrier, for example:
- Sitting too close – may be intimidating for the individual and would possibly make them feel uncomfortable.
- Sitting too far away – may show a lack of interest or concern.
You must always respect people’s personal space but be close enough for them to be able to see and hear you.
An individual’s ability to think and communicate sensibly can be affected by their emotions, i.e. if they are depressed, angry or upset.
In these types of situations, it may be best to:
- Consider communicating with them at another time that is better for them.
- Leave information, in a different format, for them to look at when they are less emotional.
Physical and not enough time
Some physical conditions can make it difficult for an individual to communicate, for example:
- Not having any teeth.
- Being in pain.
To ensure that an individual’s care and support needs are met, so they can alleviate pain and manage their condition, you should:
- Communicate in ways that enable them to express themselves.
- Allow plenty of time for them to communicate.
- Find out if they feel better at a particular time of day.
Not enough time
If individuals are not given enough time to say what they want or are unable to use their preferred communication method, this can make them:
- Feel rushed.
- Reluctant to express their true feelings.
Allow sufficient time for the individual to say what they want. You should arrange another meeting if you run out of time rather than rush.
Poor or negative body language and lack of privacy
Poor or negative body language
People are less likely to communicate if your body language is poor or negative, for example:
- Crossed arms or legs.
- Poor facial expressions.
- Poor body positioning.
- Constant fidgeting.
- Looking at a watch or mobile phone.
Be mindful of the above when communicating with the individual.
Lack of privacy
Individuals may be reluctant to openly communicate where there is a lack of privacy, particularly where personal or sensitive issues are involved. You should think carefully where and when private and confidential conversations should take place.
When you are discussing personal or sensitive issues with the individual, you should find a private location. It is important to remember that those with hearing impairments can face communication barriers if you speak too quietly.
Stereotyping and sensory impairments
Stereotyping is making generalisations about a group of people that are wrong and misleading. This can result in unnecessary barriers. An example is assuming that all older people are hard of hearing.
You should always work in ways that meet the individual’s communication needs. This will be detailed in their care plan and will tell you the most effective methods of communicating with them.
A barrier to effective communication can occur when an individual is unable to see a person or hear them speaking. You should consider whether the individual can see or hear you when you are communicating.
To overcome these barriers, you should ensure that when you are communicating with someone who is hearing impaired, you:
- Face the individual;
- Speak clearly, and;
- Provide written information to help them understand.
For those who have a visual impairment, consider using documents with large text.
Barriers can be created by environmental factors, for example:
- Noise – can make it difficult to hear what the other person is saying.
- Lighting – lighting that is poor or too bright can make it difficult for the individual to see the communicator’s face. It can affect those who lip-read, as they will be unable to read facial expressions.
You should make sure that the lighting is sufficient and not right behind you when communicating with the individual. Where noise is an issue, you should move to a quieter area.
Language and substance misuse
The style of language you use can create communication barriers, particularly if you use technical terminology and jargon. Barriers can also be created if you and the individual have different preferred languages.
You should avoid using technical terminology and jargon when communicating with the individual. You may also have to consider using interpreters and translators where an individual prefers to speak a different language.
If an individual is misusing substances, this can affect their ability to understand and retain information. In these types of situations, you should provide them with information they can access when they are not affected by substances. You could also reschedule meetings with them when they are less affected.
How to reduce communication barriers
As a health and social care worker, you should try to reduce any barriers to communication wherever possible.
Knowing as much as you can about the individual is the most effective way of ensuring that you are:
- Meeting their communication needs, and;
- Providing them with person-centred care.
A communication passport might also be used to reduce communication barriers and this:
- Provides crucial information regarding an individual’s needs, wishes and preferences.
- Pulls together information into an easy to read format, and often includes pictures and photographs
Gathering information with the individual will provide you with a good opportunity to get to know them well and understand their needs.
You may be required to use your organisation’s suggested format. Alternatively, at a simple level, you can put a communication passport together with the individual to suit them.
Obtaining regular feedback
To improve your communication skills continually, it is vital to receive regular feedback regarding your communication style and methods from the people you are caring for and supporting.
Being open to, and taking up, learning opportunities can enhance your awareness of different communication needs and methods.
As you become more experienced in your role, this will help you to:
- Develop a variety of new communication methods, and;
- Select the best one in each situation.
To further help you reduce communication barriers, you should:
- Be creative;
- Use open body language, and;
- Have a positive and non-judgemental attitude.
Think of your communication skills as a toolbox. You should use the correct tool for the right job and choose a different one if it is not working well.
An essential part of the process is checking that communication has been understood. A crucial skill that checks understanding is summarising.
A summary should:
- Bring together the main points of an exchange of information.
- Shorten or simplify the points to repeat them back to the individual.
- Allow the individual to correct you where necessary.
- Help you to check that you and the individual have understood correctly.
You can check whether a message has been received and understood by the individual by also asking questions. You should ensure that you ask open questions that require a detailed response, rather than asking closed questions, i.e. those with yes or no answers.
Examples of open questions would be:
- Tell me what you understand about what we’ve just discussed?
- What do you like to do in your spare time?
Closed questions are useful and can be more suitable in certain situations. However, if you want to check understanding, it is best to use open questions.
There is a wealth of information and support available to assist with communication barriers.
Information can be found from:
- Specialist charities and associations.
- Websites, which can provide material on online forums.
- Services or local groups that you could attend or use to find out more.
- Your manager or supervisor.
Further learning can come from your manager and other workers, and a wide range of courses and qualifications.
Support can be found from:
- Local charities, which offer specific human aids such as befrienders, advocates or mentors.
– Befrienders – can provide support to an individual to overcome emotional difficulties that are a communication barrier.
– Advocates – can communicate on behalf of an individual if they have limited skills.
- Additional key experts who are available to support individuals with their communication needs, for example:
– Speech and language therapists.
– Clinical psychologists or counsellors.
What important is confidentiality in health and social care?
In health and social care, confidentiality is a vital principle that forms the basis of codes of practice and all ways of working. An individual should feel confident that their personal information is going to be treated confidentially. Whether this is the case will depend on whether there is a good working relationship built on trust.
When you are handling an individual’s personal and sensitive information, you must remember the following:
- Information must only be shared with others involved in their care and support and on a need-to-know basis.
- Information should not usually be disclosed without the person’s informed consent.
- There are circumstances when information must be shared, even if the individual does not give their consent.
For an individual to give their informed consent, they must have all of the required information to make a considered decision.
An individual has rights regarding the confidentiality of their personal and sensitive information, which also means:
- An individual’s notes or details must not be left where they can be seen by unauthorised people. They must always be stored in locked filing cabinets and cupboards.
- Electronic files, on computers or mobile devices such as electronic tablets, must be password and firewall-protected.
- Ensuring that others cannot overhear you when discussing an individual.
When it comes to individuals’ confidentiality, you must abide by the principles of the following laws:
The Data Protection Act 2018
- Is the UK’s implementation of the General Data Protection Regulation (GDPR)
- Applies to any public service provider.
- All individuals have the right to confidentiality, to know which information is collected and that this data is up-to-date.
- Data should not be held for longer than necessary.
- Everyone has the right to refuse to give information.
- Further information can be found here.
General Data Protection Regulation (GDPR)
- A regulation in EU law on data protection and privacy in the European Union (EU) and the European Economic Area (EEA). Now the UK has left the EU it has become UK GDPR.
- Further information can be found here.
The Human Rights Act 1998
- Determines a number of basic rights for any UK citizen.
- All individuals have the right to respect for private and family life, home and correspondence.
- Further information can be found here.
As you have learned, information should not usually be disclosed without the individual’s informed consent. However, there may be instances where information that is normally considered to be confidential needs to be shared.
Confidentiality may have to be broken in the following circumstances:
- A person is likely to harm themselves.
- A person has been, or is likely to be, involved in a serious crime.
- A person is likely to harm others.
- Your safety is placed at risk.
- A child or vulnerable adult has suffered, or is at risk of suffering, significant harm.
In these examples, information can be shared without consent.
You may have situations where you are faced with dilemmas regarding an individual’s confidentiality. You may not know what you should do or whether you should discuss the information you have with anyone else.
In these situations, you should:
- Speak to your manager about your concerns.
- Follow the agreed ways of working for your organisation.
- Ask for assistance from a senior staff member of another worker if your manager is unavailable.
Communication in practice
Communication can be:
- By telephone or text.
- By email, internet or social networks.
- By written reports or letters.
Regardless of how you are communicating with an individual, you should:
- Always be respectful.
- Try to match the communication method to the needs of the individual.
- Be aware of confidentiality.