Chapter 25 – Shauna O’Regan (D2SOP2)

Communication Methods and Styles 

When many people think of communication and communicating with others, they think of the most common form of communicating, speaking. People forget that there are many more forms of communicating through language than just spoken communication. Language can be spoken or written but can also be signed. Sign language is a skill mostly taught to people who have impaired hearing and those in their immediate circle, i.e. their family. As a social care worker who may be working with service users with hearing impairments it would be useful to learn basic signs that would allow you to open up a line of communication with the service user. This is just one simple way of how you can adapt your communication style within the social care environment. Although this is a great way to open up lines of communication with service users, it is important to further develop your professional skills by going to courses and seeking training in this style of communication. The many different areas of social care will affect how as a practitioner you will adapt and change your method of communicating; for example, an office-based position will involve using written and technological methods of communicating. It will also change depending on the demographic you are communicating with, i.e. clinicians, floor staff, families of the service users or the service users themselves. Floor staff will be in direct contact with the service users, which will entail face-to-face communication. Below I will detail the different methods and styles of communication that can be used in the social care setting. I will then go into detail about the key terms highlighted above; language, culture, beliefs, and health and social care needs.

Verbal Communication 

Service users who communicate verbally to staff and to others will do so in their own way and to the best of their ability. Some service users may use their own way of speaking. Verbal communication involves more than just speaking to someone and them responding. The communication cycle demonstrates this (see diagram). Effective verbal communication involves six steps; however, when working within a social care setting it is important to recognise that this process may take longer for some people that for others. If you are working in the disability sector, it is evident that the decoding stage may take longer to process. Thus, it is vital as a social care worker to allow the service user time to decode the message before they respond. In practice you must not rush service users or overload them with more information than necessary, as this may impact on their ability to decode and understand the verbal cues. It is important to give service users time to complete the communication cycle before they are expected to respond.

Non-verbal Communication 

Non-verbal communication includes a multitude of different ways in which someone communicates, for example body language, eye contact and gestures. It is necessary for a social care worker to familiarise themselves with service users’ non-verbal communication methods in order to maintain a pathway to communication. An example of this would be that if you are to sit down and discuss with a service user what they would like to do for the day, depending on their communication style the conversation might be you suggesting activities, allowing time for them to process the verbal prompt and then respond. This may be by how they position themselves – if they don’t want to do the activity, they may move away, turn their back on you or simply shake their head; if they do want to do the activity they may nod their head in approval or even move towards where the activity is happening.

Signs and Symbols 

Service users may associate certain objects with different things, i.e. a lunch box may indicate it’s time for lunch or a picture of a bus may mean that it is time to go home. These are objects of reference. These are signs and symbols that service users use as visual aids to communication. Another example of this form of communication is a visual schedule designed around a service user’s day so that they understand what is going to be happening throughout the day and they will always have a visual representation to refer back to so that they do not have to remember everything. A visual schedule can also be used alongside a ‘now and then’ chart to help with transitioning between activities.

Picture Exchange Communication System (PECS) is a form of communication using signs and symbols. ‘PECS is a type of augmentative and alternative communication that use visual symbols to teach the learner to communicate with parents, carers, teachers and peers. The aim is to teach intentional, functional communication and to allow users to communicate their wants and needs’ (Integrated Treatment Services 2021).

Technological Aids 

‘Technological aids, such as electronic communicators, hearing aids and videophones are designed to help people who have difficulty sending or receiving ‘messages’ as part of the communication cycle’ (Collins Resources 2010). Service users may also use their mobile phones as a method of communication; they can use them to text their parents/guardians, family, carers or friends.

When working in a social care setting it is important to have patience and understanding when communicating with service users while they communicate with you. Rushing a service user or ignoring them because you ‘don’t have time’ simply because you may be in the middle of another task is one way to make a service user feel you are not providing an adequate service that suits their needs. A simple conversation may take time as the method used by the service user may involve typing out words and sentences on electrical devices. This should never be an ‘inconvenience’ to you as a staff member as it will most likely break down any relationship with the service user as they feel you do not care about their thoughts and needs.

Language 

As a social are worker it is vital to know that your use of language will need to be altered and edited depending on the group of people or specific individual you are communicating with. An example of this is that you will likely talk to a clinician in a different manner than you would to a service user. A multi-disciplinary team is a different cultural group from the service users you support. At meetings about the needs of service users’ personal plans there may be pages upon pages of information that might be too complicated or overwhelming for a service user to understand. This can be adapted and modified for them by transcribing the most important information into an easy-to-read copy that might include pictures for reference.

Ireland is home to people of many different nationalities and cultures, so as social care workers we will meet service users and families who use different languages. We must be equipped with resources to facilitate adequate lines of communication. Service users under the age of 18 and who are residing at home will be advocated on their behalf by both their parents/guardians and their service staff. In order to successfully fulfil this the family and staff must have an equal understanding of each other, language barrier included. If necessary staff may need to use an independent translator if the family do not have fluent English. It is important to not make the family feel excluded at meetings or in decision-making when it comes to care plans. Staff might learn simple and useful words and terms that are in the first language of the service user and their family. This will open up lines of communication and will build a rapport with the family so that they will understand that the staff team are putting effort into co-operating with and including the family.

In social care, language and culture are closely interlinked: ‘when you learn a new language, it may not only involve learning its alphabet, the word arrangement and the rules of grammar but also learning about a specific society’s customs and behaviour. When learning or teaching a language, it is important that the culture where the language belongs be referenced, because language is very much ingrained in the culture’ (Day Translations 2018).

Culture 

‘Every time you interact with another person, you do so in relation to patterns of communication that you have learned from the many different cultural groups of which you are a member. The vast majority of those patterns will be invisible to you, and that lack of knowledge means that whilst you and others like you may judge your communication to be good, some of the most vulnerable people in health and social care settings may find it to be poor’ (Roebuck 2017: 30). This may mean that when you are communicating with service users you will need to adapt your language for them to understand. ‘Language and culture are intertwined. A particular language usually points out to a specific group of people. When you interact with another language, it means that you are also interacting with the culture that speaks the language. You cannot understand one’s culture without accessing its language directly’ (Day Translations 2018: np). An example of this would be that you may have to learn certain words of the language in which your service user is fluent or recognises primarily.

It is important to know that culture can define a person’s level and understanding of communication. A service user may not understand certain jargon if they are from a different cultural background from staff. When dealing with someone who may be new to a service it is beneficial to assess their level of comprehension and understanding so as to provide them with a service person-centred to them, and using jargon-free language can aid this. Involving a service user in devising and implementing any support plans can make them feel as though not all control has been taken away from them. In order to do this, it is important that staff understand the way in which the service user communicates, and adapt their way of communicating to support the service user. As mentioned above, this may mean changing the language you use and being mindful of not using colloquial speech that you may use in another cultural group. You must also be able to read the service user’s body language and facial expressions to determine whether or not they are following you or if they are afraid to disclose that they are having trouble understanding you. In this case, you may have to modify your language or the way you are explaining things, such as using more visual ways of communicating.

Beliefs 

‘Beliefs are things in life that you feel strongly about, that guide you in your daily life and are linked closely to your morals and values, beliefs might not necessarily be based on facts but our opinions and beliefs are not just formal ones, such as, what we regard as right or wrong’ (Active Social Care 2010: np). Being able to communicate your beliefs with others is important and as social care workers it is important to be non-judgemental when a service user is expressing theirs.

In many ways, it can be difficult to support a service user as the staff may have no knowledge about, for example, their religious faith. If a service user wishes to actively practise their faith, staff should ensure that they have an appropriate knowledge in order to facilitate an open thread of communication with the service users around their religion. Staff may need to adapt religious literature for service users, and if staff do not have adequate knowledge it may make the service user feel that they are not being supported. Many religions are taught through a language other than English, and this can be an additional barrier that staff need to work through to be able to give the service user access to material. Staff may have to use online resources, translate them and then adapt them to the communication style of the service user. It is important to exhaust every option to solve any problems that exist due to a communication difference.

Being able to communicate right and wrong with a service user can be challenging. A non-verbal service user may use aggressive or destructive behaviour to try to communicate how they are feeling. This behaviour can all too quickly be labelled as behaviours that challenge, and plans implemented to manage these behaviours may be useless if the real cause of the behaviour is frustration because staff are not able to recognise what they are trying to communicate. In this case staff need to know the service user well and be able to correlate certain behaviours with an outcome of a demand or request. If a service user is trying to say they want a drink or they are in pain and staff do not understand, this may lead to a service user displaying certain behaviours. Staff may see this as challenging but to the service user it is their way of communicating a need or want. An ABC chart or scatter plot may be implemented to try to identify the cause of the behaviour and through this staff can identify a pattern, e.g. when the service user bangs on the counter, it is after they have held their hand out towards the press with the cups in it. This could be their way of saying they would like a drink. Work can then be done to open up a better level of communication, but the main thing to take from this is that something you see as challenging and unnecessary may be the only way a service user has to communicate.

Health and Social Care Needs 

Through working within the health and social care sector it will become evident that each service user will use a different form of communication. As a professional working in these sectors it is important to familiarise yourself with each form of communication. As a key worker to service users it is important to create a communication passport for them so that no matter who they wish to communicate with, be it relief staff, new staff or family and friends, that person will have an understanding of their preferred way of communicating and also will allow the person to adapt their communication in a manner that will open the lines of communication with that service user.

A communication passport is a folder devised by the service user and their key worker.