Recognise the effects of barriers, and influences on communication

In care settings it is very important for care workers to be able to communicate effectively with the service users they are responsible for, and for this to be done they need to be aware of the barriers to communication which can hinder successful interactions. According to Fisher (2006) the barriers to communication can include:

* Environmental factors

* Social factors

* Emotional instability

* Inappropriate language or behaviour

* Lack of skills

* Cultural barriers

* Use of gestures

* Failure to maintain confidentiality

* Incorrect positioning

Environmental factors

Before engaging in a conversation with a service user, the care worker should consider where would be the most appropriate place for the interaction to take place. Factors such as temperature, lighting and ventilation should be taken in to consideration to make sure that the service user is comfortable enough to actively engage in the conversation.

Care workers should also remember that what is comfortable for them may be less so for the service user; for example, a care worker in a residential home may have been on their feet and moving around a lot throughout the day before the conversation, and so may feel quite hot, but the older resident they will be speaking with may well feel cooler as they have not had the same level of physical exertion. In such a situation the carer should not assume that the service user is also feeling hot and say, open a window, but instead should ask the service user if they are either too hot or cold, and act accordingly.

If it is too bright in the room where the carer and service user are sitting, they may have to squint; making them unable to see each other properly and communication can also be hindered if the room is too dull.

Noise can be another hindering factor; if there is too much loud noise in the background one of the participants in the conversation may misunderstand what has been said, and if it is too quiet the service user may feel awkward speaking; therefore some quiet background music may help to relax the service user when speaking. The service user may also misinterpret what has been said if he or she has a hearing impairment; if the service user has a hearing impairment the carer will have to take this into account; they may have to speak much louder in which case the conversation may have to be held in a private room so not to disturb any other residents and so that others will not be able to overhear.

Care workers should be careful however, not to assume that all older people have difficulty hearing, as a service user may feel patronised and offended if a carer speaks very loudly to them when there is no need to do so. To avoid situations such as this, care workers should read the care plans of those they are responsible for so that they learn the service users’ individual needs, and any physical or mental impairment that they may have, as this may affect the communication process.

Social barriers

Social barriers to communication arise when the service user feels inferior due to a lack in confidence or self esteem. Therefore it is important that care workers always aim to promote independence and self esteem amongst service users. Care workers should be careful not to put forward the impression that they are superior to, and ‘looking down’ on the service user when speaking with them, but rather the service user should feel valued and that they have unconditional positive regard from the care worker.

In order to make a service user feel valued, the care worker will need to build a positive working relationship with them. To do so often takes time and the care worker will need to examine any prejudices they may have to make sure that their practice is not adversely influenced by them, as it is very important that service users do not feel that they are judged by their care worker. It is likely to inhibit a conversation if the carer and service user do not have a positive working relationship and especially if the service user feels that they are being judged.

Group interactions/conversations within care settings should be led carefully to prevent divisions forming between service users; which is very important as being social can help to improve service users’ well being, and those who are more isolated are likely to have lower self esteem.

According to Bruce Tuckman (cited in Fisher, 2006) the four stages in group interactions are:

* Forming – where there is quietness within the group as participants are reluctant to speak

* Storming – where individuals begin to put forward their views and opinions, and where clashed between personalities may therefore become apparent

* Norming – where the participants become more comfortable around each other and feel they can further share their knowledge and experiences

* Performing – individuals begin to work independently

This process put forward by Tuckman can certainly be seen in many group interactions whether in a school, nursery or residential home; speaking in a group can be quite difficult so people are often shy until they get to know the others better. Once everyone has started to talk a little bit the atmosphere then becomes more comfortable, and from first impressions we often decide who we like better than others. Once everyone is quite well known to each other the awkwardness of speaking tends to go.

The first stage in group interactions (forming) is probably the most noticeable; for example in a primary school during a group interaction (such as ‘circle time’) the teacher is likely to notice who the quieter and shy children are, and in turn encourage them to speak and interact with the others. A good way to do this would be to ask the quieter child what they think about what another child has just mentioned, or ask them something about themselves. Getting them involved early on is important as it can help to prevent future social exclusion, which in turn has detrimental effects on self esteem.

Emotional barriers

Emotional barriers to communication can emerge when a service user become upset; this could happen in situations where there has been a disagreement between a service user and someone else, they may have lost a loved one, or could feel upset if a relative is unable to visit. To help prevent emotional barriers from forming, the care worker will need to make the service user feel safe and secure during their interactions; if they feel that they are being ignored or misunderstood, they are likely to withdraw and become quiet, or on the other hand they may become aggressive and lash out (Fisher, 2006).

The discussions care workers hold with service users should be handled differently to the sort of conversation held with a friend; the carer must remember to maintain the professional relationship and should be thinking of the needs of the service user. For example, if an elderly women who lives at home and receives home care tells her carer that she has been very upset because her pet cat has died, the carer should remember to keep the conversation focussed on the service user; they should not, for example, say something like: ‘oh I know how you feel, when my dog died I was so upset and felt…’ they should instead sensitively use open questions to help the service user express their feelings about the situation.

According to Fisher (2006) it is important that a service user:

* Feels that the care worker has empathy and empathetic understanding – care workers should try to imagine what it would be like to be in the others shoes so that they can better understand how the service user is feeling

* Considers that they are being offered unconditional positive regard – it would greatly hinder a conversation if the service user felt they may be being judged on what they tell their care worker; they should feel accepted just the way they are

* Knows that the person or persons with whom they are talking is genuine or congruent – this means showing a genuine interest as the service user is likely to withdraw if they feel that the care worker is not really interested in what they have to say

These factors help service users to feel emotionally safe and are important for helping them to discuss how they really feel, and therefore helps to prevent emotional barriers to communication from forming.

Inappropriate language

In health care a lot of technical language is used by doctors, nurses and other professionals, but it is important to remember that service users quite often will not understand what these technical terms mean; therefore if having a discussion with a service user about things such as a health condition they suffer from, any technical language should be explained a way that the service user will understand. When explaining what technical terms mean, the age and ability of the service user should be taken in to account as well as the situation under discussion.

Styles of speech can also prove to be problematic when communicating with service users, for example different people may expect differing degrees of formality when greeting someone and having a conversation. For example, an elderly person may feel uncomfortable if their younger carer greeted them in the morning with: ‘morning, you alright? When do ya wanna get up?’ And instead prefer a more formal greeting such as ‘good morning Mrs Smith, how are you today? When would you like to get up?’ The degree of formality carers should use will depend on the situation, how well the service user is known to them and their background, for example an elderly upper class woman is likely to expect a more formal style of speaking whereas a lower class man from London may prefer a more casual style of speaking; however, assumptions should not be made on the basis of such little information about people, and it is usually better to adopt a more formal tone, at least until the service user is better known to the carer. In any case, the style of speech used by carers to communicate with service users should become overly informal as carer workers must maintain a professional working relationship with them.

Lack of skills

Skills, such as using open and closed questions when appropriate, summarising and using prompts are important for effectively conversing with service users and a lack of these skills can therefore hinder communication between service users and care workers. For example care workers should remember to be patient if there are long pauses before a service user answers a question, as they often need longer to think about it and decide how to respond. A care worker without effective communication skills might think the long pause is unusual and repeat the question or ask another, which could confuse the service user as they would not know which question to answer first and they would also feel rushed and so not give full or fully thought through responses.

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