Learning outcome 1: Be able to address the range of communication requirements in own role. 1.1 Review the range of groups and individuals whose communication needs must be addressed in own job role.
Common groups and individuals that are present in the workplace that may have communication support needs could include: Resident’s with DEMENTIA - Dementia is a progressive illness that over time will affect a person's ability to remember and understand basic everyday facts, such as names, dates and places. Dementia will gradually affect the way the person communicates. Their ability to present rational ideas and to reason clearly will change. Resident’s suffered from STROKE - A stroke is an injury to the brain. The brain controls everything we do including everything we interpret and understand. A stroke can cause problems with communicating if there is damage to the parts of the brain responsible for language. These functions are controlled by the left side of the brain in most people. As the brain controls the opposite side of our body, many people who have communication problems after stroke also have weakness or paralysis on the right side of their body. Stroke can also cause communication problems if muscles of the face, tongue or throat are affected. It may result into communication problems like aphasia/dysphasia (difficulty in speaking), dysarthria (happens when a stroke causes weakness of the muscles you use to speak), and dyspraxia (condition that affects movement and co-ordination. Dyspraxia of speech happens when you cannot move muscles in the correct order and sequence to make the sounds needed for clear speech).
1.2 Explain how to support effective communication within own job role. To the staff:
Ask people how they prefer to be addressed and respect their wishes. Give people information about the service in advance and in a suitable format Don't assume you know what people want because of their culture, ability or any other factor – always ask. Ensure people are offered 'time to talk', and a chance to voice any concerns or simply have a chat. If a person using the service does not speak English, translation services should be provided in the short term and culturally appropriate services provided in the long term. Staff should have acceptable levels of both spoken and written English. Overseas staff should understand the cultural needs and communication requirements of the people they are caring for. Staff should be properly trained to communicate with people who have cognitive or communication difficulties. Schedules should include enough time for staff to properly hand over information between shifts. Involve people in the production of information resources to ensure the information is clear and answers the right questions Provide information material in an accessible format (in large print or on DVD, for example) and wherever possible, provide it in advance. Find ways to get the views of people using the service (for example, through residentsʼ meetings) and respect individuals’ contributions by acting on their ideas and suggestions.
1.3 Analyse the barriers and challenges to communication within own job role.
Barriers in effective communication can become the hurdle in progress of professional life as well as in the personal life. There are various points where the message is misinterpreted in which some are as follows: Material or Physical Barrier: This is the main hurdle or barrier in effective communication at workplace. This barrier in the company comprises large working area which is physically estranged from each other. Other things due to which physical barrier rises may be the organizational environment or noise coming from back. Various things can be included in physical barrier like large working place or working in one section which is physically separate from each other, closed office doors, separate place for people of different rank etc. These points can be concluded in physical barriers to effective communication: Environmental cause: Too much humidity in atmosphere, light in excess, lofty temperature or bad ventilation are some of the environmental barriers in effective communication. Challenging Stimulus: If there is loud music or noise in the background and there is distance between sender and receiver then it becomes very difficult to send the correct message by the sender to the receiver. Subjective strain: Due to bad health, too much mental stress, lack of proper sleep or consumption of medicines, the receiver can never understand the message appropriately. Linguistic Barrier: Different language and vocabulary is another barrier in communication. Language is vague in nature and its words are symbols which hardly represent only one meaning. The meanings of these symbols or words are understood by the sender and receiver in their own way which can result in misinterpretation. If communicator uses difficult or inappropriate words or if message is not explained in proper manner then it can result in misinterpretation. It is the language only that plays vital role in every field so it should be kept in mind that proper language and words are used. In today’s world if you send your message to another person in his language then it will be more effective and in this way the communication can be made effectively.
Cultural Barrier: You will find diverse culture barrier to effective communication in this world. This communication barrier arise when two people of any organization belongs to different culture, place or religion. There are many other factors of cultural barrier like age, social position, mental difference or thinking behavior, economic status, political views, values and rules, ethics or standards, motives and priorities. The communication done without mixing any culture will not miss its meaning, but once a culture is mixed up with the communication then it may lose its exact meaning. Emotional barrier: Every person takes the situations and affair in his own way as everyone differs from each other. Many times thoughts of the person become strong base for communication. There are many emotions which can be the cause of effective communication barrier. Examples include anger, fear, or hostility. Apart from these some barriers to effective communication are mentioned below: Sudden reactions: Many times while communicating, a listener makes comment or criticizes the message sender without waiting for the sentence to be completed. So it’s very necessary to be keep patience and speak once the communicator completes his speech. Unfair assumptions: Never make wrong assumptions of the message as it creates great confusion. For example, you incorrectly assumed that your subordinate have understood the thing you have explained regarding any issue. Terror: This emotion makes the person to think slowly. He becomes narrow minded. This makes the negative impact on effective communication skill. Person becomes defensive: Man who cannot communicate effectively just tries to justify himself every time because he thinks that accepting the mistake means degradation. This kind of attitude is a great obstacle in the effective communication. Being overconfident about self-knowledge: There are number of persons existing in this world that are overconfident about themselves that they have enough knowledge about any subject. But when you talk to such people, you will discover that they don’t have enough knowledge nor such people accept that they can be wrong. This is another hurdle in effective communication.
1.4 Implement a strategy to overcome communication barriers. In our care practice we have a significant number of service users who have communication difficulties due to dementia and post-stroke. The following strategies are identified in order to have an effective communication and be able to understand and meet their needs.
1. Residents with dementia.
speaking clearly and slowly, using short sentences
making eye contact with the person when they're talking, asking questions or having other conversations giving them time to respond, because they may feel pressured if you try to speed up their answers encouraging them to join in conversations with others where possible letting them speak for themselves during discussions about their welfare or health issues, as they may not speak up for themselves in other situations trying not patronise them, or ridiculing what they say
acknowledging what they have said, even if they don't answer your question, or what they say seems out of context – show that you've heard them and encourage them to say more about their answer giving them simple choices – avoid creating complicated choices for them using other ways to communicate – such as rephrasing questions because they can't answer in the way they used to 2. Residents suffered from stroke with communication problems. Keep your own language clear and simple.
Speak in a normal tone of voice.
Don’t rush the conversation. Give the person time to take in what you say and to respond. Assume the person can hear and understand well, in spite of any difficulties responding, unless you learn otherwise. Stick to one topic at a time using short sentences. For example, instead of saying, “Your wife called and she will be here at 4pm to pick you up and take you home”, say: “Your wife called.” (pause) “She will be here at 4pm.” (pause) “You can go home then.” Use all forms of communication to help reinforce what you are saying, such as clear gestures, drawing, communication aids. Use adult language and don’t “talk down” to the person with aphasia. Even if someone understands little or nothing, remember they are not a child. Don’t interrupt them. Watch out for when they are finished, or when they are looking for help. Ask if your help is needed before giving it. If it helps them to remember things, make use of a diary, calendar or photos. Lists of words or options to select from can help. If they can’t think of a word, ask how it is spelt. Write down the first letter or syllable as a prompt. Write down key words with a marker pen. Write clearly in lower case and don’t underline. Keep the lists of words to refer back to. If they prefer, guess the word they can’t find and ask if it’s correct. If they are keen to find the right word, give them more time to respond, or guess their meaning and check out if you’re correct. Otherwise, if they prefer and you’ve understood the message, just carry on the conversation. If easier for them, establish the general topic of their message by asking careful questions that only require a ‘Yes’ or ‘No’ answer. Give them plenty of time to respond. Don’t ask too many questions too quickly, as they may feel overwhelmed and become frustrated.
1.5 Use different means of communication to meet different needs. Members of the health care staff use different ways of communication in order to meet the needs and preferences of the service users. Staff should be familiar with the difficulties of communication that a certain resident may have in consideration to their medical condition. They used verbal and non-verbal communication that varies depending on the individual’s needs and difficulties. Below are examples of different ways of communication to meet the different needs of clients. Verbal communication uses words to present ideas, thoughts and feelings. Good verbal communication is the ability to both explain and present your ideas clearly through the spoken word, and to listen carefully to other people. This will involve using a variety of approaches and styles appropriate to the client you are addressing. Non-verbal communication - This refers to the messages we send out to express ideas and opinions without talking. This might be through the use of body language, facial expressions, gestures, tone of voice, touch or contact, signs, symbols, pictures, objects and other visual aids. It is very important to be able to recognise what a person’s body language is saying, especially when as a health or social care worker you are dealing with someone who is in pain, worried or upset. You must also be able to understand the messages you send with your own body when working with other people. Written communication -This is central to the work of any person providing a service in a health and social care environment when keeping records and in writing reports. Different types of communication need different styles of writing but all require literacy skills. A more formal style of writing is needed when recording information about a patient. Technological aids- Technology is moving so quickly now that we have many electronic aids to help us communicate. For example, we have computers on which we can record, store and communicate information very quickly and efficiently over long distances.
Learning outcome 2: Be able to improve communication systems and practices that support positive outcomes for individuals. 2.1 Monitor the effectiveness of communication systems and practices. To the staff – Two monthly supervisions are being practice in our workplace in order to address the needs and concerns of the members of the health care staff. Work schedules, preferences, relationship with other staff and continuing professional development (trainings, study days, etc) are some of the topics being discussed during supervisions. Meeting are also held on a regular basis. To the service users – Part of the care plan of each client is their communication needs. Changes or difficulties in communication are being monitored or evaluated monthly. This file is accessible to members of the health care staff to familiarize themselves to the mode of communication effective to a particular resident. To families of service users – regular meetings with families of residents is being practiced. Management of the health care staff are approachable to address their needs or concerns with regards to the care being provided to their family member. 2.2 Evaluate the effectiveness of existing communication systems and practices 2.3 Propose improvements to communication systems and practices to address any shortcomings
Evaluation of existing communication system is very important in order to meet the needs of the service users, maintain the high morale of the staff and satisfy the relatives of the residents. The following are the existing communication systems and practices in my workplace. Communication System Scores: 1-5 (1=very poor; 2=poor; 3=adequate; 4=good; 5=very good) Staff Handover (4) – Staff should be provided with adequate information to changes happened to a particular resident in a particular shift. Staff Supervision (4) – Management should not take it personally when providing constructive criticisms. Care plan recording (4) – staff should ensure that files are updated on a regular basis. All staff should be familiarise to the different needs of each resident. Complaints Procedure (4) – Ensure that all service users and family members are aware of the procedure in making a complaint. Call Bell System (4) – Service users to differentiate the normal call button from the emergency button. Telephone Log (4) – Staff should be trained in confidentiality regarding sharing of patient’s information. 2.4 Lead the implementation of revised communication systems and practices
Learning outcome 3: Be able to improve communication systems to support partnership working. 3.1 Use communication systems to promote partnership working. 3.2 Compare the effectiveness of different communication systems for partnership working. 3.3 Propose improvements to communication systems for partnership working.
In a Nursing Home you communicate with different agencies and departments of the health care in order to meet the optimum level of care that the services users deserved. Liaise with GP’s, dietician, Occupational Therapist, Pharmacist, Clinics and other members of the health care setting contributes in the effectiveness of communication for partnership working. These are the list of problems that are identified with the current system and proposed improvements in order for partnership working to be effective. GP Visits – Doctors should trust the decision making of healthcare staff because they are more familiar with the behaviour and changes of service users. Medication Ordering – Pharmacists should delete the medications that were stopped from the repeat prescriptions in order to prevent medication errors. Electronic ordering should be considered to Nursing Homes in order to save time and effort. Referral to dieticians, podiatrist, SALT and OT – Preferably nurses should directly refer to these departments in order to save time and decrease the actual waiting time for visits of service users. Learning outcome 4: Be able to use systems for effective information management 4.1 Explain legal and ethical tensions between maintaining confidentiality and sharing information. Confidentiality is an important value within the healthcare setting for clients, their families and employees. Important confidentiality issues are trust and client safety. Personal and private information such as health diagnosis, feelings, emotions and financial status must be restricted to people who have an accepted need to know. NMC [online] 2002 confirms that confidentiality is the respect for the privacy of any information about a client/patient. The Value Base ( a system of values to guide the care profession) states that confidentiality of records and information should be discussed with clients if possible, however some information can be kept from a client if it were to cause them to self-harm (physically or mentally). If clients/patients know that personal details and conversations are private it will enable them to feel safe and that trust is present. Clients/patients should be told that other health professionals involved in the care of them have a need to know of some confidential issues to enable better recovery for themselves. It sets rules for and applies to personal information, paper records and computer held records. It covers data held in the respect of any individual including financial and credit information, membership of organisation, medical, health and social services records. Nolan Y, (2001). Good record keeping helps to protect patients and clients by promoting: - High standards of clinical care and continuity of care - Better communication between health care professionals regarding information of clients/patients. - An accurate account of treatment, care planning and delivery. Confidentiality arises when service uses keep information about themselves off the record and determine how recorded information about themselves is shared and used. Users of services can control information about themselves by refusing to disclose it at all and this is the most obvious way to do so. Whatever service it is, there will be always a minimum amount of information which the client has to disclose as a condition for receiving the service, hence would- be users of services don't have a real choice about keeping information. However confidentiality policies are important in carework. Most records in health and care are made with a view to the information being shared. This is so that continuity of care is not vulnerable to individual practitioners becoming sick, going on holiday or changing their jobs. Records are an important facility for co-ordinating care. However sharing the information in records raises issues about whom the information should be shared with, what they may or may not do with, and what rights clients have to know how and with whom information about themselves is likely to be shared. The code: Standards of conduct, performance and ethics for nurses and midwives’ (2008) states: "You must respect people's right to confidentiality."
"You must ensure people are informed about how and why information is shared by those who will be providing their care." "You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising." Confidentiality is a duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence. This duty of confidence is derived from:
common law – the decisions of the Courts
statute law which is passed by Parliament.
Confidentiality is a fundamental part of professional practice that protects human rights. This is identified in Article 8 (Right to respect for private and family life) of the European Convention of Human Rights which states: Everyone has the right to respect for his private and family life, his home and his correspondence. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it was given and will not be disclosed without permission. This covers situations where information is disclosed directly to the nurse or midwife and also to information that the nurse or midwife obtains from others. One aspect of privacy is that individuals have the right to control access to their own personal health information. It is not acceptable for nurses and midwives to:
discuss matters related to the people in their care outside the clinical setting discuss a case with colleagues in public where they may be overheard leave records unattended where they may be read by unauthorised persons. Legislation
All nurses and midwives need to be aware of the following pieces of legislation relating to confidentiality: The Data Protection Act 1998 - This Act governs the processing of information that identifies living individuals. Processing includes holding, obtaining, recording, using and disclosing of information and the Act applies to all forms of media, including paper and electronic. The Human Fertilisation and Embryology Act 1990 - Regulates the provision of new reproductive technology services and places a statutory ban upon the disclosure of information concerning gamete donors and people receiving treatment under the Act. Unauthorised disclosure of such information by healthcare professionals and others has been made a criminal offence. The National Health Service Venereal Disease Regulations (SI 1974 No.29) - This states that health authorities should take all necessary steps to ensure that identifiable information relating to persons being treated for sexually transmitted diseases should not be disclosed. The Mental Capacity Act (2005) - This provides a legal framework to empower and protect people who may lack capacity to make some decisions for themselves. The assessor of an “individual’s capacity to make a decision will usually be the person who is directly concerned with the individual at the time the decision needs to be made” this means that different health and social care workers will be involved in different capacity decisions at different times. The Freedom of Information Act 2000 and Freedom of Information (Scotland) Act 2002 - These Acts grant people rights of access to information that is not covered by the Data Protection Act 1998, e.g. information which does not contain a person’s identifiable details. The Computer Misuse Act 1990 - This Act secures computer programmes and data against unauthorised access or alteration. Authorised users have permission to use certain programmes and data. If the users go beyond what is permitted, this is a criminal offence. Disclosure
Disclosure means the giving of information. Disclosure is only lawful and ethical if the individual has given consent to the information being passed on. Such consent must be freely and fully given. Consent to disclosure of confidential information may be: Explicit consent is obtained when the person in the care of a nurse or midwife agrees to disclosure having been informed of the reason for that disclosure and with whom the information may or will be shared. Explicit consent can be written or spoken. Implied consent is obtained when it is assumed that the person in the care of a nurse or midwife understands that their information may be shared within the healthcare team. Nurses and midwives should make the people in their care aware of this routine sharing of information, and clearly record any objections. Disclosure without consent - The term ‘public interest’ describes the exceptional circumstances that justify overruling the right of an individual to confidentiality in order to serve a broader social concern. Under common law, staff are permitted to disclose personal information in order to prevent and support detection, investigation and punishment of serious crime and/or to prevent abuse or serious harm to others. Each case must be judged on its merits. Examples could include disclosing information in relation to crimes against the person e.g. rape, child abuse, murder, kidnapping, or as a result of injuries sustained from knife or gun shot wounds. These decisions are complex and must take account of both the public interest in ensuring confidentiality against the public interest in disclosure. Disclosures should be proportionate and limited to relevant details.Nurses and midwives should be aware that it may be necessary to justify disclosures to the courts or to the Nursing & Midwifery Council and must keep a clear record of the decision making process and advice sought. Courts tend to require disclosure in the public interest where the information concerns misconduct, illegality and gross immorality. Disclosure to third parties - This is where information is shared with other people and/or organisations not directly involved in a person’s care. Nurses and midwives must ensure that the people in their care are aware that information about them may be disclosed to third parties involved in their care. People in the care of a nurse or midwife generally have a right to object to the use and disclosure of confidential information. They need to be made aware of this right and understand its implications. Information that can identify individual people in the care of a nurse or midwife must not be used or disclosed for purposes other than healthcare without the individuals’ explicit consent, some other legal basis, or where there is a wider public interest. Information Sharing Protocols - These are documented rules and procedures for the disclosure and use of patient information between two or more organisations or agencies, in relation to security, confidentiality and data destruction. All organisations should have these in place and nurses and midwives should follow any established information sharing protocols. Confidentiality after death - The duty of confidentiality does continue after death of an individual to whom that duty is owed. Information disclosure to the police - In English law there is no obligation placed upon any citizen to answer questions put to them by the police. However, there are some exceptional situations in which disclosure is required by statute. These include: the duty to report notifiable diseases in accordance with the Public Health Act 1984 duty to inform the Police, when asked, of the name and address of drivers who are allegedly guilty of an offence contrary to the Road Traffic Act 1998 the duty not to withhold information relating to the commission of acts of terrorism contrary to the Terrorism Act 2000 the duty to report relevant infectious diseases in accordance with the Public Health (Infectious Diseases) Regulations 1998. The Police and Criminal Evidence Act (1984) - This Act allows nurses and midwives to pass on information to the police if they believe that someone may be seriously harmed or death may occur if the police are not informed. Before any disclosure is made nurses and midwives should always discuss the matter fully with other professional colleagues and, if appropriate consult the NMC or their professional body or trade union. It is important that nurses and midwives are aware of their organisational policies and how to implement them. Wherever possible the issue of disclosure should be discussed with the individual concerned and consent sought. If disclosure takes place without the person’s consent they should be told of the decision to disclose and a clear record of the discussion and decision should be made as stated above. 4.2 Analyse the essential features of information-sharing agreements within the and between organisations.
These are the usual subjects that are applicable in sharing information within and between organizations: Complaint Procedure – Service users and relatives are informed regarding the proper procedure in filing a complaint. This guideline is posted and accessible in the nursing home. Infectious Disease - The care home should produce a written policy that details the roles and responsibilities of the staff during an outbreak of communicable disease or episode of infection. The plan should include details of the roles and responsibilities of senior personnel as follows. The owner of a home is responsible under health and safety legislation for maintaining an environment which is safe for residents, visitors and staff alike. Suitable arrangements and procedures for control of infection would form part of the health and safety requirements. The registered manager should have 24-hour access to advice on infection prevention and control from a suitably qualified and competent individual. It is good practice for the registered manager to produce an annual report on the systems in place for the prevention and control of infection and how these are monitored. The report should contain information on incidents and outbreaks of infection, risk assessment, training and education of staff, and infection control audit and the actions that have been taken to rectify any problems. The person in charge should ensure that appropriate infection control policies and procedures exist, are readily available, are understood by all members of staff and are used within the home. Health and Safety - We complete all of the necessary risk assessments and procedures (Fire, COSHH, Premises, Administration of Medicines, Clinical Waste Disposal & Handling, Food-Personal Hygiene, Infection Control, Use of Stairs, Use of Wheelchairs, Use of Bathrooms, Maintenance of Showers, Lone Working, Manual Handling, Expectant Mother, Office Safety, Passenger Lifts and many more). We write Health and Safety policies, review and provide staff training (Specialist Training and Safety Training). Medical Records - The Health Insurance Portability and Accountability Act produced the Standards for Privacy of Individually Identifiable Health Information rule which requires health care providers to make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose for which the information is being used, disclosed, or requested. This means the authorized entity requesting the information may not use, disclose, or request the entire medical record for a particular reason unless it can justify the whole record as the amount of information reasonably needed for that purpose. 4.3 Demonstrate use of information management systems that meet legal and ethical requirements.