1. Be able to address the range of communication requirements in own role.
1:2 – Explain how to support effective communication within own job role.
Everyone in a managerial role is responsible for establishing the communication needs of the service users, providing appropriate support and ensuring any equipment needed to communicate is available. The Managerial role is to empower and promote the rights of every person taking into account individual needs, wants and rights.
Before any support can be given, the individual’s ability, needs and most importantly preferences should be considered and taken into account. When an individual enters any care setting they should have their needs and preferences assessed and a base line established with regard to communication abilities. Effective methods of communication should be established. This is the initial assessment.
Every organisation will have their own forms where these details should be recorded. Establishing a baseline by observing ways in which the individual communicates and the method they use is essential. Everyone, regardless of whether they have a Learning Difficulty or health need has the right to communicate using their chosen method and their choice should be acknowledged and respected. During an initial assessment, an individual’s ability and communication methods will be established. Everyone involved in the care of the individual should be made aware of their baseline, needs and preferences regarding communication and any changes that are recognised during reviews. This information should be recorded and shared with the team to ensure the individual’s needs are met.
Within any job role communication is initiated with a variety of people including Service Users, relatives and carers, employees and colleagues, Health Care Professionals (i.e. GP, Consultants, Community mental Health Team), Social Services and Safeguarding Teams. Effective communication is vital.
Key people that should be included in partnership working are listed below. These people should be included in the initial assessments and any reviews in order to access information and support and to ensure you get the best from an individual’s communication abilities.
Family and friends – are important to the individual. The individual must be supported to communicate with their loved ones using the appropriate method. Sometimes close family members do what they think is best for the individual rather than asking what the individual wants. The family may need to be educated and supported to ensure they allow the individual to make choices and use their preferred method of communication. Speech Therapists – assess and support the individual’s speech development. They may work with individuals who have difficulty in swallowing which will have an effect on an individual’s communication needs. The therapist works closely with other professionals and the family of the individual to ensure the communication methods are used correctly to maximise effectiveness.
GP’s are consulted to ensure there are no unknown health needs that could affect communication and to access important information. Psychologists – are involved in assessing patterns of behaviour associated with certain conditions. These could include depressions or anxiety. Psychologists also offer support to carers in the best ways of working with individuals to ensure the highest rate of success and therefore the best results for the individual. Psychiatrists – assess and treat people with mental health problems, learning disabilities, behaviour disorders, dementia and epilepsy. They can be informative in supporting the individual’s communication needs.
Occupational Therapists – support the individual to develop fine motor skills. Some methods of communication require the use of fine motor skills, including the use of keyboards (e.g. the lightwriter). Care staff are often the first port of call for Health Care Professionals and usually spend the greatest amount of time with the individual if they are in long-term residential care or need a high level of support in their own home. Often the care staff will know an individual extremely well and can recognise and interpret the intricacies of the individuals communication. Behavioural Support Service Workers – work with individuals and their carers in developing appropriate methods for the individual to express themself in non-challenging ways.
Through regular staff, relative/carer and Service User meetings and/or reviews, information can be shared, efficient and effective health care and support given and decisions reached regarding assessed needs and outcomes/achieved outcomes. Effective communication means that the Individual is at the centre of every decision.
When planning such meetings the use of a planned agenda which is distributed to the relevant parties and requests for suggestions and additions to the agenda are beneficial in opening the lines of communication. When planning review,s the last review should be researched and any outcomes achieved should be noted and shared at the meeting. Any changes to the review information should be checked and changes made accordingly. Minutes of meetings should be taken and distributed to relevant parties following the meeting. This is also a valid way to communicate with parties who could not attend. Those who attended the meeting will be reassured to have written testimony of what was covered in the meeting and an accurate and factual account for future reference.
Informal communication in the form of one to one chats with both staff and service users is also vital in maintaining the line of communication. When in a managerial role it is necessary to make yourself available to staff and Service Users in order to build relationships and maintain an open line of communication.
The use of handover sheets, daily diaries, care plans, supervisions and appraisals are all forms of communication used within the Day Care setting.
The use of an electronic diary system is also invaluable as a quick and efficient way of sharing information with colleagues This enables one to one interviews, meetings, reviews and supervisions to be pre-booked and others to have access to this information. This communication system is used very effectively within our management team; all members have an electronic diary in place via a central server and share information with others allowing the smooth running of diary entries.
One of the most important and valuable forms of effective communication is an ‘open door policy’, ensuring that staff, relatives/carers and Service Users are aware that you are available to discuss matters at their convenience. This form of communication instils confidence in the day care setting ensuring that everyone feels ‘listened to’ and that communication is paramount in the day to day running of the centre.
Effective communication improves the quality of life of people. It is essential that efforts are made to enhance communication, time is made to listen and to understand. In a managerial role best practice is essential. This includes ensuring that:
Staff are aware of the different communication needs of different individuals including taking account of any hearing or visual problems or where English is a second language. Staff are trained to understand the importance of verbal and non-verbal communication ad barriers to effective communication. A multi-disciplinary approach is used to implement communication strategies Staff are able to access specialist advice and information
Advocacy services are utilised
1:3 – Analyse the barriers and challenges to communication within own job role.
Communication is a fundamental relationship-building skill in the workplace. If people don’t communicate well they limit their ability to connect on any meaningful level and in extreme cases this can create conflict. Depending on your position and role within your workplace, others will have expectations of how you should communicate. It is important that respect is shown to those you work with.
The General Social Care Council’s Code of Practice states that communication should be conducted in an appropriate, open, accurate and straightforward way. By communicating in this manner others will have trust and confidence in you and your abilities. Workplace relationships become a lot stronger when people can clearly and effectively communicate what they need and allow others to do the same.
There are many barriers to effective communication. Anything which blocks the meaning of a communication is a barrier. The first barriers to check out are those that you could be creating. You may think that you are doing everything possible to assist communication, but be sure that you are not making it difficult for people to understand what you say for instance using acronyms another person does not understand. Avoid professional jargon and terminology. Not listening effectively is another barrier that could affect communication, both when making requests and receiving them. Noise is a constant barrier to communication in the care environment. Sharing an office with other people, telephone conversations, background noise or people talking and playing music.
Physical barriers – these are due to the nature of the environment where you are trying to communicate. It could be that there are distractions and/or noise, such as the TV on, an inappropriate temperature, making the room too hot or cold. Is the room light enough? Are you positioned so that you are close enough to be heard but not invading the individual’s personal space?
Physiological barriers – personal problems and worries can lead to lack of concentration. Memory loss (dementia) can also create significant issues with communication. Distress – When someone is distressed, they might find it hard to communicate. They may not listen properly and not understand what is being said and may also be tearful or have difficulty speaking Emotional Difficulties – can cause the individual to be unable to listen to what is being said and can lead to misunderstandings. When someone is feeling ill, they may not be able to communicate as effectively as when they are feeling well. .
Language differences – this could be due to the choice of words used. Others linguistic abilities may differ from your own, leading to poor explanations and misunderstandings. Do they speak the same language as you?
Lack of subject knowledge – leading to poor explanations or answers to questions.
Stereotyping – When an individual has a preconception about another individual, to makes it difficult for the individual not to view the other individuals communication with prejudice.
Sensory Loss – When someone has an impairment to one or more of their senses, most commonly a visual or a hearing disability, they may have a problem receiving, retaining or passing on information.
One of the main barriers in communication that are faced within my job role is that of clinical barriers. Many of the Service Users who attend the centre have a diagnosis of a learning difficulty and/or cognitive impairment. The use of body language, gestures and pictures are often used as alternative forms of effective communication when supporting this client group. Other individuals may be non-verbal, have a loss of speech or impairments in speech, sight or hearing, all having an effect on communication and making effective communication more challenging.
Equipment such as picture boards (PECS) can be a useful tool in minimising these barriers along with touch and written word and Etran boards or computer systems such as Eye Gaze. In my experience emotional barriers are often detrimental in the line of communication between staff and relatives. It can be very distressing for relatives to witness their loved ones either contract a long-term or life altering illness from disease or accident especially if this results in altered behaviour or through a learning difficulty or altered diagnosis if a physical/learning difficult deteriorates over time. Ensuring relatives have sufficient time to understand information or supplying them with information leaflets gives time to take the information away with them, to their own environment, which may help them understand what you are trying to communicate.
Giving relatives/carers clear contact details is beneficial ensuring that they are confident with communication links between them and the centre/carer. Giving links to other lines of communication and help, such as voluntary organisations or support groups can also be effective. These strategies can help overcome emotional barriers to communication they may be facing. Different means of communication are used to meet differing needs. Care Plans, handover sheets, notice boards and staff meetings are used to ensure staff are kept updated.
2. Be able to improve communication systems and practices that support positive outcomes as individuals.
2:2 – Evaluate the effectiveness of existing communication systems and practices.
Once you have established and agreed the methods of communication and support which you are to provide the individual with, it is important that you evaluate the effectiveness of that support. The agreed method of communication and support are only effective for as long as the individual’s communication skills remain the same. If their skills change then so do their support needs.
As a manager you will be expected to recognise and act on changes to the individual’s communication skills. This can be done by monitoring feedback from staff, the individual, the individual’s family and other professionals involved in the individual’s care and by observing the individual when they are communicating with you, carers, friends and relatives. In this way you are able to evaluate if the communication method is working and also recognise any changes as they occur. The most obvious changes are when an individual is not able to of what they used to do. For example you notice that you are having to repeat things more often or they request that their TV/radio is louder than before.
As well as the individuals communication skills becoming worse, an individual’s circumstances and abilities could improve. This could be in the case of an individual who had suffered a stroke. With therapy and encouragement their speech could improve so that they are able to gradually express their needs through speech. These changes need to be collated, discussed and available to everyone in the acre team so all are aware and can add their views and opinions.
With regards evaluation of the effectiveness of existing communication systems and practices between individuals, staff and management, it is important that you have established a system in the workplace where regular meeting take place and everyone’s view and opinions are discussed and valued. Other communication methods in the workplace could include:
Staff communication books – daily notes which are not confidential Staff notice boards – details off personal development, training opportunities, staff rotas Staff handover – discuss recent events re individuals
Complaints procedure – everyone should be aware of the process and how to complain Care plan records – confidential daily records
Supervision – staff can discuss any issues.
2:3 –Propose improvements to communication systems and practices to address any shortcomings
It is important that everyone involved in care of the individual works as part of a team to establish the best support for that person. This is known as multidisciplinary working.
When changes occur it is important that the correct help and support is obtained immediately so that the individual does not feel frustrated or isolated by being unable to communicate effectively. You will need to access appropriate support and have access to sources of information and resources in able to do this. It is therefore important to immediately deal with any changes to the individuals communication skills. Encouraging carers, family and friends to monitor an individual for change will lead to positive outcomes. If changes are identified, carers should record this stating the date, with a factual entry of what was observed or how you identified the change followed by a signature and status. These should then be formally reported to you as the manager and any required actions taken immediately.
Significant changes in an individual’s ability to communicate should be referred to the speech therapist or GP involved in the individual care for professional investigation and monitoring. If no changes have been reported, reassessment should be undertaken on a yearly basis and should involve both the individual and key people in their lives, including their family, friends, partner, speech therapist, GP, psychologist, psychiatrist, occupational therapists, care staff and any other significant person involved in the individual’s life. This is known as a multidisciplinary review. This ensures the continued development of the individual’s communication.
With regards staff communication systems and practice it is important to evaluate these on a regular basis in order to address any shortcomings. To avoid any shortcomings;
All staff should attend training regarding completion of communication records and confidentiality and should be aware of the workplace policies and procedures regarding these areas. All staff should be aware of the complaints procedure in the workplace and have the knowledge of who/where they should complain for themselves and also on behalf of an individual. All staff should have regular supervision where they are able to voice their concerns Regular hand over and team meetings where everyone can discuss concerns and feedback on all areas of problem.
3. Be able to improve communication systems to support partnership working.
3;2 – Compare the effectiveness of different communication systems
Effective communication between partners is essential to good partnership working. Without effective communications staff can feel very isolated. Interaction needs to be on-going and partners needed to be mindful of the need to reduce jargon to promote clarity of understanding. Inclusion of the views of service users and their carer are also important to the communication process, both as a means of helping staff to look at things in new ways and to bring diversity and creativity to the process.
There are many different communication systems which can be used in partnership working. Computerised systems with shared records and access for example hospitals and GP’s now share some computerised information and medical records. This ensures continuity of care and service with immediate access to records. It avoids the need for paper records which increases the need to secure storage and accurate filing systems. This also allows for faster retrieval of information and an increased frequency with which information is collected and shared. It also ensures a standardised system across the partnership working. Any system used has to be available, effective and efficient in order to benefit all partners involved.
3:3 – Propose improvements to communication systems for partnership working.
If you feel there is room for improvement to communication systems for internal partnership working this could be proposed by calling a meeting in your workplace and discussing your proposals or, proposals could be made through written communication. By liaising with external partners at regular meetings and discussing, listening and hearing ideas and problems, solutions will be able to be found to any communication improvements which need to be made. Sometimes this may mean reaching compromises or it may just involve alleviating the anxieties of others in the partnership.
The use of effective communication systems with our partners is essential in ensuring a close link is maintained. Our communication needs to take into account the differing relationships we have with these partners. The needs of the partnership we have with relatives will be very different from that of our regulators. However, there are also many similarities. All communication should be accurate, timely and courteous. It is merely the way in which we communicate that may vary. Most communication with family may be informal, day to day nature with all parties keeping each other informed. Care reviews and relatives meetings also play a vital part in the effective communication between the two.
4. Be able to use systems for effective information management.
4:1 – Explain legal and ethical; tensions between maintaining confidentiality and sharing information.
The Data Protection Act 1988 – governs the storage and use of information collected but your organisation. In order to keep personal records the organisation must be registered with the Data Protection Register. Some of the relevant aspects of the Act are: The information should only be used for the purposes explained when it was collected The information should not be disclosed to anyone who has no right to see it The information collected should be relevant and contain no more than is necessary for its purpose The information should be accurate when collected and where necessary kept up to date Individuals should have access to the data held about them
Appropriate security measures should be taken to prevent unauthorised access to data
1. Justify the purpose for which the information is needed. 2. Only use personally identifiable information when absolutely necessary. 3. Use the minimum personal identifiable information possible – if possible use an identifier number rather than a name. 4. Access to the information should be on a strict need to know basis. 5. Everyone should be aware of his/her responsibilities to respect client confidentiality. 6. Understand and comply with the law. The most relevant legislation is the Data Protection Act 1988, the Police and Criminal evidence Act 1984 and the human Rights Act 1988.
Essential standards for quality and safety Complance Criteria
5. You can expect you care provider to constantly check the quality of its services.
Your care provider will continuously monitor the quality of its service to make sure you are safe. If you or someone acting on your behalf makes a complaint, you will be listened to and it will be acted upon properly. Your personal records, including medical records will be accurate and kept safe and confidential.
The Human Rights Act 1988 – Article 8 stated “The right to respect for private and family life, home and correspondence”
Public Interest Disclosure Act (1999) – This act, sometimes called the “whistle blowing act” is not solely for people working in the caring professions but for any employee in any sector of employment. It has its place in considering other perspectives of confidentiality and relates more to corporate consideration than perhaps individual or personal confidences shared. It allows people at work to raise genuine concerns about crime, negligence, miscarriages of justice, dangers to health and safety and applies whether the information is confidential or not. The Act seeks to protect “Whistleblowers” from dismissal and victimisation and thus promotes the public interest and potential extra protection for vulnerable people in society.
Generally confidential information can only be disclosed if it is in the Individual’s best interests, for the protection of others, in their interest of public health, during an official or legal investigation, or if there has been or there is a risk of a serious crime committed. Individuals using care services need to feel that their personal information is kept confidential, even from family members. This builds trust between you and the individual. In formal relationships such as in a carer/service user, trust is based on the assumption that because the carer is in a professional role they are governed by laws and legislations, ethics and principles which protect their confidentiality. These laws, ethics and principles give individuals the confidence to give confidential information to others in the knowledge that if that information was to be divulged to another, they would face serious consequences.
Sharing information is kept to effective communication but this should be balanced alongside the need to maintain a service users rights to confidentiality. This is often complex relationship. Service users should be involved in decisions as to whether sensitive information can be shared with the wider network of care providers and staff should reflect on balance whether sharing the information will benefit the client and whether the benefits out-weigh the risks of sharing the information. Supervision should be used to support staff in reaching these decisions.
In certain circumstances you may be faced with ethical issues regarding the disclosure of confidential information to a third party. Any professional has a “duty of care” which means as previously stated a confidence can only be broken if it is in the Individual’s best interests, for the protection of others, in the interest of public health, during an official or legal investigation or if there has been or there is a risk of serious crime committed. This can place the individual in a dilemma between the law and their professions and personal ethics.
4:2 – Analyse the essential features of information sharing agreements whitin and between organisations.
Certain information will need to be shared within your workplace and also between your and other organisation. As discussed in the last outcome information can only be disclose if it in the individuals best interests, for the protection of others, in the interest of public health, during an official or legal investigation or if there has been or there is a risk of a serious crime committed. Information should only ever be shared on a need to know basis. For example, if a service used had a fall, you may need to pass on details of the individuals medication to the paramedics as this would be in the individuals best interest but you would not need to pass them details regarding the individuals financial affairs as this is not relevant and the paramedics do not have a “need to know”.
Other examples could include an outbreak of an infection disease in your workplace which by law has to be reported (RIDDOR). You should also consider your workplace “Whistleblowing policy” which allows people at work to raise concerns and report areas such as negligence, dangers to health and safety or crimes whilst being protected from dismissal or victimisation. Your workplace will have policies and procedures in place for the sharing of information with others. In order to analyse your workplace agreements regarding the sharing of information you will need to look at the circumstance you are allowed to divulge information and who to and analyse why this is acceptable in certain circumstances.
Establishing clear boundaries around confidentiality in our service is vital. Confidentiality enables people who receive care services to have a sense of trust in professionals and a sense of control over their life and the service they receive. The data protection act 1998 concerns the recording of personal and sensitive information. It also covers confidentiality and access to records. It is important that we consider the principles that the data protection act sets out, these include, ensuring the information that we record is used fairly and lawfully, that it is used for a particular and lawful reason, that it is not excessive , that it is accurate and up to date, it is kept no longer than necessary, that it is used in line with the rights of the individuals, that it is kept securely and information must not be transferred between countries which do not have adequate protection for personal information. The act also gives people the right to access all information held about them, this includes all care records and incident forms.
We should, as professionals. Be aware of this at all time when recording sensitive information about our Service Users. It is easy for information to be misinterpreted especially by someone with limited medical knowledge or someone who is emotionally involved with issues surrounding the information being documented. Records should always be non-judgemental, factual, clear, concise, legible and objective. Not only does the individual have the rights to see care records but, we also have to share Service User’s information with other organisations such as Safeguarding and CQC. In this instance, it is ideal if Service Users can consent to this information being shared, however this is not always possible.
All parties need to be clear on the purpose of information sharing and that only necessary information about the individual is shared. In my role it is essential that I act as a role model for my staff ensuring that I emphasise care recording as an essential part of our service and ensure policies and procedures are established and that I instil confidentiality into the culture of our service. I do this by taking immediate action if staff breach confidentiality. In dealing with confidentiality issues as they arise I hope to instil the correct culture in the work place. Having an open and honest approach and discussing issues at staff meetings and in supervision ensures staff fully understand the importance of confidentially for Service Users.
Courtney from Study Moose