Promote effective communication for and about individualsExercise HSC031A) What are the legal requirements on equality, diversity, discrimination and rights, relating to: individuals language and communication preferences?Equal treatment for language and communication.
When completing records?As I work within the NHS, the ICU follows the National Institute for Clinical Excellence Equal Opportunities (2000) policy it states thatIt is the policy of the Institute to work towards ensuring that no recipient of its services, present or future employee or job applicant receives less favourable treatment on the grounds of:- age, colour, creed, disability, ethnic origin, marital status, nationality, race, religion, sex, sexual orientation, social status, trade union membership (NICE 2000)This affects communication as it states that we must do everything in our power to provide equal service levels to everyone. For example if a patient speaks a foreign language, there is a communication barrier, so we must provide any information to them in their native language, whether that be through an interpreter or translated leaflets.
The trust recognises that promotion and regular communication of the policy is important to ensure that individuals understand their commitment to equal opportunity and are aware of their own responsibility regarding equal opportunities and know how to raise concerns or make complaints and are confident that these will be handled effectively.
E) What is the code of practice and standards and guidance relevant to your role, responsibilities and accountability, and duties of others when communicating difficult, complex and sensitive issues and reporting and recording?As a health care assistant the official code of practice and standard that I should follow and understand are laid down by the General Social Care Council in the Codes of practice: for social care workers and employers (2002) this covers most of the core standards which as a care worker I must follow. But I am also under the guidelines set down by the Nursing and Midwifery Council (NMC 2005). To ensure that I gain the trust of my patients, I should recognise them as equal partners, use language that is familiar to them and make sure that they understand the information you are giving.
As far as record keeping goes, I should make sure that any records I make must be clear, legible and accessible to the patient or client, as outlined by the NMCs document Standards for Records and Record Keeping (NMC 89346) and under the terms of the Data Protection Act (1984) and the Access to Health Records Act (1990).
Both these documents state that all communication about patients whether written or verbal are completely confidential.
F) Where can you seek advice from regarding an individuals communication and language needs, wishes and preferences?When a patient has communication and language needs the first person I would ask would be the patient, to access for myself the communication needs. I would then look at the patients notes and finally I would ask the staff nurse looking after the patient or the district nurse if they are in the community. If I still need more advice or there are still communication difficulties, I could refer the patient to the speech and language therapy department. If the difficulty is a language barrier I could try to contact a language and interpretation service. It is vital to understand that wherever possible the patients wishes should take priority in the decision taking over communication needs.
G) How can you and were can you access information and support to update your knowledge and gain further assistance to meet the individuals communication needs.
There are several places that you can access information to update your knowledge both on a personal level and on an individual client basis. You can update your communication knowledge by keeping up to date with all the guidelines surrounding communication, such as the journals on new communication methods and studies or spend time with the speech and language therapy unit to improve your communication skills.
On an individual client basis, the first place to look for information on improving your communication with the client is from the client themselves. By checking for responses and reactions, both verbal and non verbal you can judge whether your communication methods are effective. Then to further gain knowledge and understanding, you can refer them to a specialised service to meet their needs depending on what the communication need is. For example there may be a language barrier, in this instance, first see if there are members of family who could translate (where appropriate with patients understanding) as patients often feel more comfortable with a relative translating for them, if this was not available or inappropriate, I would track down the translators service and refer the case to them.
H) What are the theories relevant to the following:-Specific conditions in your area of practice that can affect communication skills, abilities.
In Intensive care effective communication can be difficult for a number of reasons, they can be environmental problems, physical or mental problems, like the patients consciousness levels could be effected, either drug induced or pathologically based, there may be visual and hearing problems and environmental problems, such as poor lighting or a noisy situation. The patient may not be able to make sense of the communication, they may use a different language or dialect or may not understand the jargon or professional terms used.
Many of the patients on Intensive care are heavily sedated, so effective two way communication with then is almost impossible, also most of the patients that are not sedated are on high levels of medication, which can cause drowsiness and confusion. Of the patients that are lucid enough to communicate coherently, the most common communication problems are the problems of those who have ventilation support, either they have a tracheotomy tube in place, which means that air does not pass through the voice box so they have no voice, or they have a BiPAP mask to assist with breathing, which restricts the ability to speak and be heard.
How can communication and language differences affect the identity, self esteem and self image of those you work with?Self-esteem means ‘appreciating your own worth and importance’ – and it helps you to cope better with the challenges of life (Tracy Turner BBC)In ICU patients that have a Glasgow coma score (GCS) of 14 or 15 and are on little or no sedation, in other words able to understand where they are and what is happening to them. Communication problems can have a huge influence on identity, self esteem and self image. Especially in ICU as the communication difficulties are usually new problems for the patient due to illness and the treatment.
For example a person has a tracheotomy, firstly they loose their voice, which many people feel is part of them, it make who they are, so this detracts from self image and identity. But the main factor is that they loose the ability to express themselves with ease, so they can loose self-esteem. One of the major thing is, as they cant express themselves in the way they are used to, so a person whose self-esteem is low, will tend to feel that what happens to them is beyond their control. Studies have suggests that self-esteem is likely to have a major effect on their mental and physical health.
How can power be used to abuse people when communicating on difficult, sensitive and complex issues?One major thing that people with communication difficulties experience, is loss of power. The person/carer who is looking after someone with communication difficulties, whether they be sensory deficits or other difficulties, is that they ( the carer ) is acting as interpreter and has the power to interpret the patients needs and wishes in their own way, even ignoring the persons wishes and carry out tasks that they want to. This is why training is essential for effective two-way communication.
An example of this would be the situation of a stroke patient with paralysis down one side, so was unable to feed themselves and has mild dysphasia. In a lot of cases the care giver thinks they know what is best for the patient, with no consideration for the patients wishes, In many cases all the carer wants to do is feed the patient so they have a full diet but the patient may not like the mashed carrot but because time is tight and the carer just wants to get the plate cleared, they pretend not to understand the patients attempts to communicate that they would prefer the mushy peas.
A lot of abuse is not actually intentional, much of this comes from lack of proper communication skills and the carer not taking the time to listen or try to understand the patient. They have a job to do and a set amount of time to do that job in and in most cases think they know what is best for the patient. Often when patients do try to communicate their unhappiness the are treated to a barrage of patronizing awws and come on dears you need to do this, or arent you being silly today almost treating patients like children, they can even be labelled as trouble makers.
It is much different for the patient who can communicate fully, they state their discomfort in a clear and concise way, it is much harder to make somebody do something if they say straight out no I dont like that.
On ICU the situation is slightly different as a lot of our patients are on medications which will affect their mental capacity and perception so their communication difficulties are harder to resolve. So to determine if someone is of sound mind we use assessment tools to determine how able a patient is to make there own decisions (GCS & Sedation score).
I) What factors can affect communication skills, abilities and development of those you support?In the ward environment there are many factors that can affect communication with the patient, they can be broken down into two main categories, environmental factors and personal factors.
Trying to talk to someone in a noisy environment where there are continual interruptions leads to frustration, lack of understanding and poor concentration. Similarly individuals are often disinclined to discuss personal information or express strong emotions if they can be overheard or seen. Other environmental factors may relate to time available to talk. Carers often feel under pressure to ‘get the job done’ and their workloads may either inhibit clients ‘I don’t want to bother the nurses they’re so busy’ or result in the carer communicating poorly because of pressure of work.
VanCott (1993), Identified some of the personal factors that can effect patient communicationIndividual Carers may lack the knowledge, experience and skills to promote effective communication. Also in health care medical jargon is common, but can appear as a foreign language to someone receiving care. Use of words that are not within the client’s own vocabulary generally results in misunderstandings and poor communication. There is also a tendency to use vague, ambiguous or unclear questions or statements along with failing to verify their own understanding of the other person’s statements. A communication failure that often occurs is completing tasks with little or no explanation behind purpose behind actionsM)
What conflicts and dilemmas may be created by difficulties in communication in your workplace?Moving away from patient/career conflict, one of the main sources of conflict in ICU it that of conflict between families and friends and ICU staff. As with any ward and care situation the next of kin debate comes up regularly and what is best for the patient. The law around patient consent and advocacy is a massive topic and very hazy in some areas as to whether the doctor has the right to decide treatment or whether a next of kin should be involved. Also there is visitation rights who can come in and who cant and who decides.
N) What procedures do you follow when dealing with conflict?In most of the cases where conflict arises there are strict procedures to follow this usually means reporting the problem to a higher level of responsibility. A good example of this it the case of Luke Winston-Jones (BBC 2004) there was direct conflict between the doctors and parents over the best case of action for the child. In the end the problem was passed to the highest responsibility the courts.
This would be the same in my workplace so far I have only had to report minor conflict up to my line manager.
R) What is the difference between factual, opinionated and judgement? Why is this important when completing records?It is important when completing records to only fill in what actually happened or what your clinical judgement was, not what your opinion is. An example of this would be when documenting what dressing you applied, you would state that in your clinical judgement what the best dressing would be and a factual account of applying that dressing. It is not good practice to document opinions unless your opinion clashed with that of somebody else, then you would state in the records that that was your opinion.
A Factual account is something that is known to have happened or to exist, especially something for which proof exists, or about which there is information.
Opinionated means having and expressing very strong feelings and beliefs, and believing that your own ideas are the only correct ones.
Whereas an opinion is a person’s ideas and thoughts about something. It is an assessment, judgement or evaluation of something. An opinion is not a fact, because it is not possible to prove (or disprove) an opinionJudgement is the act or process of judging; the formation of an opinion after consideration and deliberation especially a formal or authoritative decision