Credit value: 10

1 Developing
effective
communication
in health and
social care
This unit is designed to help you develop your communication skills.
You will explore ways of overcoming barriers to communication and
develop your own skills in one-to-one and group interactions.
In order to work with people you must be good at communicating with them.
Effective communication requires advanced practical skills in much the same way as
driving a car does. Driving a car involves responding to changes in the road ahead,
as well as responding to other road users. Effective communication in care involves
being sensitive to feedback from others. Sometimes the people you meet may be
happy but often they may feel sad, afraid, upset or anxious. You need to be able to
recognise and respond appropriately to many different emotional situations. Different
contexts will require you to communicate in different ways. Skilled communication
requires you to make decisions as to what response would be most effective in the
situation you find yourself in. Effective communication involves much more than just
giving or receiving information.

Learning outcomes
After completing this unit you should:
1 understand effective communication and interpersonal interaction in health
and social care
2 understand factors that influence communication and interpersonal interaction
in health and social care environments
3 understand ways to overcome barriers in a health and social care environment
4 be able to communicate and interact effectively in a health or care
environment.
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Assessment and grading criteria

This table shows you what you must do in order to achieve a pass, merit or distinction grade,
and where you can find activities in this book to help you.

To achieve a pass grade, the To achieve a merit grade, the To achieve a distinction grade,
evidence must show that you are evidence must show that, in the evidence must show that, in
able to: addition to the pass criteria, you are addition to the pass and merit
able to: criteria, you are able to:

P1 Explain the role of effective M1 Assess the role of effective

communication and interpersonal communication and interpersonal
interaction in a health and social interaction in health and social
care context. care with a reference to theories of
See Assessment activity 1.1, communication.
page 17 See Assessment activity 1.2,
page 21
P2 Discuss theories of communication. D1 Evaluate strategies used in health
See Assessment activity 1.2, and social care environments to
page 21 overcome barriers to effective
communication and interpersonal
P3 Explain factors that may influence M2 Review strategies used in health interactions.
communication and interpersonal and social care environments to See Assessment activity 1.4,
interactions in health and social overcome barriers to effective page 40
care environments. communication and interpersonal
See Assessment activity 1.3, interactions.
page 28 See Assessment activity 1.4,
page 40
P4 Explain strategies used in health
and social care environments to
overcome barriers to effective
communication and interpersonal
interactions.
See Assessment activity 1.4,
page 40

P5 Participate in a one-to-one M3 Assess your communication and D2 Evaluate factors that influence the
interaction in a health and social interpersonal skills in relation to effectiveness of each interaction.
care context. each interaction. See Assessment activity 1.5,
See Assessment activity 1.5, See Assessment activity 1.5, page 42
page 42 page 42

P6 Participate in a group interaction in

a health and social care context.
See Assessment activity 1.5,
page 42

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 Unit 1 Developing effective communication in health and social care

How you will be assessed

You will need to produce written evidence of examples of the role of communication and
interpersonal interaction in health and social care. You will also need to explain theories
of one-to-one and group communication. You will need to demonstrate your own skills
both in one-to-one and in group interaction situations. Varied assessment tasks are
included throughout this unit to help you prepare your work.

Daniel, 17 years old

This is a very practical unit. Although there’s quite a lot of theory, I
found that I ‘sort of knew’ some of the ideas, although I had never
put them into words before.
The great thing about studying this unit is that it enables you to
explain what’s going on in one-to-one and group situations. The
unit changes the way you understand conversations and the way
people behave when they are in groups. Whenever I see people talking,
I start to work out what their body language might mean. I now realise that there are
special communication skills that you can use in care work. Sometimes the way you say
something can be more important than what you say. There are a lot of barriers in care
situations that can stop people from understanding each other. But the unit explains
ways of overcoming these problems.
The assignment work is all very practical. To begin with, I had to set up a logbook to
record examples of the theory we were studying. We had to study practical examples
of the communication cycle and group formation. I went on to explore barriers to
communication and how to overcome barriers. I found my supervisor at my practice
placement was very helpful in getting me to understand how to overcome barriers.
Finally, I had to explore my own skills in one-to-one communication and group
situations. I tried analysing several situations that I had experienced before going on to
complete my final assignment work.

Over to you!
1 Why is skilled communication so important in health and social care work?
2 Do you think effective group or effective one-to-one communication will be the
hardest to demonstrate?
3 What part of the practical work for this unit do you think will be most enjoyable?

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1 Understanding effective communication

and interpersonal interaction in health and
social care

Changing the way you communicate

Get Imagine that you have to interview people in a youth club in a distant city as part of
started a project. You do not know the members of this club. The members speak English
but they are very different from your friends in your local area. The people you are
interviewing don’t have to answer your questions.
How would you act to get these people to like you and listen to you?
The way you communicate with other people always depends on the situation
or the context you find yourself in. You will have developed effective ways of
communicating and interacting with your friends. But if you find yourself in a
different context you will need to be able to change the way you act in order to get
a good response from people.

1.1 Contexts of communication Reflect

One-to-one communication Imagine a care worker in a day centre for older
people walking around and sharply asking
When you start a conversation with someone you
each person: ‘You want tea or coffee?’ Without
don’t know well, you should always try to create the any other conversation, this behaviour would
right kind of feeling. It is important to create a positive probably come across as ‘mechanical’. The care
emotional atmosphere before you go on to discuss worker would just be carrying out a practical task
complicated issues or give people information. The – getting fluid into the bodies of these people.
other person needs to feel relaxed and happy to talk to However, some older people might find this
behaviour disrespectful, and others might find it
you. Very often people will start with a greeting such as
cold and unfriendly.
‘Good morning’. You can help other people to relax by
showing that you are friendly and relaxed. How would you offer a choice of drinks to people
in a warm and friendly way?

1. Greeting 2. Conversation
or warm-up 3. Farewells or
or information
winding-down
exchange

Fig 1.1: Interaction often involves a three-stage process

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 Unit 1 Developing effective communication in health and social care

Once you have created a good feeling, you can move about to finish speaking they usually signal this by
on to the business – the things you want to talk about. lowering their voice tone, slowing their pace of talking
When it is time to finish the conversation, you want to and looking around at other people in the group.
leave the other person with the right kind of emotions The next person to talk knows that it is their turn by
so you might say something like ‘See you soon’ to watching the eyes of other group members. If people
show that you value them. Formal conversations often fail to notice these patterns then too many people may
follow a three-stage model, with an emotional ‘warm- try to speak at the same time. If everybody is talking
up stage’ at the beginning, a ‘business’ or ‘exchange then nobody is listening!
of information’ stage in the middle, and a ‘winding
Can everybody see each other clearly?
down stage’ at the end.
If people sit in a circle then everyone can see everyone
Group communication else’s face. This is very important because positive
Taking part in a group discussion involves the same group feeling and successful turn-taking often depend
issues as one-to-one communication as well as some on people being able to understand the messages in
additional issues. other people’s faces. If people sit behind each other
or in rows, then some of the group cannot see others’
How does it feel to be in the group?
faces. Bad seating or standing positions can make
Group discussion only works well if people want to group communication harder.
be involved. Sometimes people feel threatened if
they have to speak within a formal group of people,
or they might stay quiet because they are worried
Activity 1: Record eye
about other people’s reactions. It is important that the contact and turn-taking
group has the right emotional atmosphere. People in group discussion
in groups often use humour or other friendly ways
of behaving to create the right group feeling, which Get together with five or six colleagues and agree
encourages people to talk. Creating the right group on a current news topic that you would all enjoy
discussing for four or five minutes. One of you
atmosphere involves ‘maintaining’ the group so this
should use a camcorder to record the eye contact
aspect of group communication is often called group and speech of other group members. Analyse your
maintenance. recording and work out how good people were at
Is there a group leader? taking turns in group discussion.

Some groups, such as team meetings or classroom

discussions, have a leader or chairperson. Having a
leader is very useful because the leader can encourage PLTS
people to express their ideas and help them to take
Independent enquirer: This activity will help you
turns when talking. Group leaders often encourage
demonstrate that you can analyse and evaluate
people to focus on a particular task within a group. information, judging its relevance and value. The
Have you prepared what you are going to say? activity may also help to develop team working and
participation skills.
When talking in a formal group you will need to think
through your points before sharing them with the
whole group. Because of this extra preparation, talking Informal communication
to a group can feel very different from talking in a one-
We often use informal communication when we know
to-one situation.
people well – for example, with friends and family.
Are you good at taking turns? Some friends or family members may use terms that
Group communication fails if everybody speaks at other people would not understand. Local groups
the same time. It is harder to work out who should from particular places might also have their own ways
be speaking in a group discussion than in a one-to- of speaking. For example, some people in southern
one conversation. The skill of taking turns involves England might say things like ‘Hiya, mate. How’s it
identifying the following pattern. When a person is goin’?’ If you belong to this group, you will appreciate

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this as a warm, friendly greeting. But different groups interpret this as not being treated seriously, or ‘not
of people use different informal language so it can being respected’.
sometimes be hard to understand the informal So is there a correct way to speak to people when
communication of people from different social groups. you first introduce yourself? After all, if you are too
Formal communication formal you may come across as pretentious or ‘posh’.
Usually care workers will adjust the way they speak in
Health and social care work often involves formal
order to communicate respect for different ‘speech
communication. For example, if you went to a local
communities’.
authority social services reception desk you might
expect to be greeted with the phrase ‘Good morning. Communication between colleagues
How can I help you?’ This formal communication Family and friends know you well and will usually
is understood by a wide range of people. Formal understand you, even if you communicate poorly or
communication also shows respect for others. very informally. Communicating with people at work is
The degree of formality or informality is called the different because:
language ‘register’.
• It is important that care workers communicate
Imagine going to the reception desk and being respect for each other. Colleagues who do not show
greeted with the phrase ‘What you after then?’ Some respect for each other may fail to show respect to
people might actually prefer such an informal greeting. the people who use care services.
It might put them at ease, making them feel that the
• You may often have to greet colleagues by asking
other person is like them. But in many situations, such
if they are well and spend time on ‘warm-up talk’ in
informal language could make people feel that they
order to show that you value them.
are not being respected. Being ‘after something’ could
be a ‘put down’; you might assume that you are being • You will need to demonstrate that you are a good
seen as a scrounger. So it is often risky to use informal listener and can remember details of conversations
language unless you are sure that other people expect with your colleagues.
you to do so. If you are treated informally, you may • Colleagues have to develop trust in each other. It
is important to demonstrate that you respect the
Hiya, confidentiality of conversation with colleagues.
I’m ’ere to assess • Work settings may have their own social
some geezer who lives
’ere – that you? expectations about the correct way to communicate
thoughts and feelings. These may differ from social
expectations when communicating with your friends
and family.
Although communication between colleagues may
often be informal it is important that care workers use
skilled communication in order to develop respect and
trust.

PLTS
Independent enquirer: The following activity will
help you demonstrate that you can identify questions to
answer, and explore issues from different perspectives.
Creative thinker: You may also be able to demonstrate
that you can connect your own and other people’s
experiences in inventive ways.
Fig 1.2: Informality can be seen as a sign of disrespect

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 Unit 1 Developing effective communication in health and social care

Activity 2: Formal and well aware of the need to translate technical language
into everyday language when they work with people
informal communication from other professions or people who use services.
It is important that professionals check that they are
Get together with a small group of colleagues
and imagine an introductory meeting between not being misunderstood (see section 2 on the role of
a student and a care manager as part of a work feedback).
practice placement. One person should act as the
manager and another as the student. Work out Communication with professionals
how the manager would welcome the student and When people who use services communicate with
explain the work of the care centre. Then work out professionals there is always a risk of misunderstanding
what questions the student should ask. After you between people from different language communities.
have performed this simulation or role-play, two
It is important that people check that they are being
other students should undertake exactly the same
task, but this time they should pretend that they are understood correctly. Professional health and social
close friends chatting about the situation. care staff need to check their understanding of issues
with people who are communicating with them.
The whole group should then discuss the
differences between these two simulations. Multi-agency working
Health and social care professionals often have to
communicate with colleagues who work for different
organisations. For example, a home care organiser
Functional skills
might have to communicate not only with people who
English: Your discussion activity may also contribute use services and care workers but also with community
towards English speaking and listening skills. nurses, GPs’ surgeries, hospital services, occupational
therapists, voluntary groups, day care groups and
Communication between professional many other organisations. It is important not to assume
people and people using services that people from different agencies will understand

Professional people, such as doctors and nurses, often

work within their own specialised language community. Key term
A language community is a community of people that Language community – A social community of people
has developed its own special words, phrases, social that has its own special ways of using language in order to
expectations and ways of interacting that set it apart communicate between group members.
from other groups of people. Professionals are usually

Case study: Amber

The following conversation took place between 1 If Amber had spoken to her colleagues
members of the same family: like this, would they have assumed that Amber
respected and valued them?
Mother: How was your day at work?
2 Can you explain why a conversation like this
Amber: OK, didn’t do much, walked about a bit. might be acceptable within a family context but
Have to learn where everything is – like. not within a work context?
Mother: Did you enjoy it there? 3 Can you explain how Amber should change her
Amber: Suppose it was all right. I had to listen comments if she was describing her first day at
to a guy going on about stuff but it was boring. work to a professional colleague?
Might be better tomorrow. I am going to ‘do’ the
residents tomorrow – they should be more fun!

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 BTEC’s own resources

the same terminology. Formal communication may

Reflect
help to convey respect and avoid misunderstandings
when interacting with unfamiliar professionals in other No one has ever written a rule book defining how
agencies. health and social care workers should behave in
all the different contexts listed above. One of the
Multi-professional working reasons this has not been attempted is that every
interaction involves a feedback cycle (see section
Professionals from different backgrounds often have
2 in this unit). There may not be a single correct
to work together in order to assess and meet the way of handling each interaction.
needs of people who use services. Multi-professional
working happens when many different professionals
work together. Communication will often need to be
formal and carefully planned in order to avoid barriers
to understanding.

Table 1.1: Degrees of formality in different contexts

Context Degree of formality Key issues
Between colleagues Often informal. Must demonstrate respect for each
other.
Between professionals and people Usually informal. Professionals must adapt their
using services language (not use technical terms or
jargon) in order to be understood.
With professionals People using services may Professionals must take
communicate informally. responsibility for checking their
Professionals may respond formally. understanding.
Multi-agency working Usually formal – unless workers Important not to make assumptions
know each other well. or use technical terminology.
Multi-professional working Usually formal – may need formal Different professional people must
planning to produce ‘agendas’ for be careful to check that they are
business. understood.

Case study: Karen

Karen is a home care worker. ‘She makes you feel special – not just one of
Here are some statements the crowd.’
that people have made about ‘She is very kind and considerate. There aren’t very
the way she works: many people like her – it’s a sort of magical touch –
‘I always feel better when she you feel different when she is around.’
visits – she always smiles and Karen has excellent interpersonal skills – a ‘magical
cheers me up if I feel down.’ touch’. Karen’s skills enrich her own life and the lives
‘She makes you feel important of other people.
– she always listens to you, 1 Why do some people get on so well with other
even when she is very busy.’ people?
‘She is so easy to talk to – she takes an interest in 2 What makes someone good at interpersonal
you. She is never ‘bossy’ or ‘posh’ – she’s like one of work?
my family’.

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 Unit 1 Developing effective communication in health and social care

1.2 Forms of communication 1.3 Types of interpersonal

Communication between people enables us to interaction
exchange ideas and information but it involves
much more than simply passing on information to Speech
others. Communication helps people to feel safe, to Different localities, ethnic groups, professions and work
form relationships and to develop self-esteem. Poor cultures all have their own special words, phrases and
communication can make an individual feel vulnerable, speech patterns. These localities and groups may be
worthless or emotionally threatened. referred to as different speech communities. Some
There are many different types of communication as people may feel threatened or excluded by the kind of
shown in Fig. 1.3 below. language they encounter in these speech communities.
However, just using formal language will not solve
this problem. The technical terminology used by care
Activity 3: Communicating workers (often called jargon) can also create barriers for
emotion people who are not a part of that ‘speech community’.
When people from different geographical areas use
Get together with a small group of colleagues and different words and pronounce words differently they
discuss the relative importance of all the different are often using a different dialect. Some social groups
types of communication in Fig. 1.3 when you try use slang – non-standard words that are understood
to communicate emotions such as feeling happy by other members of a speech community but which
or sad. Discuss whether or not spoken words are
usually the best way to communicate emotion.
cannot usually be found in a dictionary.

Key terms
Jargon – Words used by a particular profession or group that
are hard for others to understand.
PLTS
Dialect – Words and their pronunciation, which are specific to
Creative thinker: This activity will help you a geographical community. For example, people who live in
demonstrate that you can generate ideas and explore the north west of England might use a different dialect from
possibilities. Londoners.
Independent enquirer: The activity may also lead you Slang – Informal words and phrases that are not usually found
to identify questions and problems to resolve. in standard dictionaries but which are used within specific
social groups and communities.

Artwork, paintings,
photographs,
sculptures, architecture,
One-to-one spoken Unspoken ornaments and other
Text messaging using
communication communication using objects communicate
mobile phones
between individuals facial expressions messages and
emotions

Music and drama Communication

have been called the using information
language of emotion. Types of technology, e.g.
Mime and drama communication emails and other
provide powerful ways technological aids to
of communicating communication

Braille communication
Spoken (oral) using raised marks
communication within Written The use of signed
communication (visual) languages on paper that can be
groups of people touched
Fig 1.3: Forms of communication
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Case study: Professional jargon

The following conversation involves speech from for guidance that must be followed by all
different speech communities. PCTs to result in a national assessment process
supported by a checklist tool, decision support
Relative: If my mother needed care who would pay
tool, and fast track tool which are used to provide
for it?
clarity, transparency and consistency in the
Professional: Well the national framework for NHS decision-making process for eligibility.
continuing health care and NHS funded nursing 1 Can you work out what the professional is talking
care provides principles and processes for an about?
assessment process that will establish eligibility for
NHS continuing health care. 2 Can you see how technical and legal terminology
can exclude people?
Relative: So the NHS would pay for care?
3 Will the relative feel helped and respected by
Professional: No, as I said, the framework provides such a technical answer?

Did you know?

Non-verbal communication
Within a few seconds of meeting an individual you will
Teenagers can be thought of as a speech community usually be able to tell what they are feeling. You will
with their own slang. Lucy Tobin has published a book know whether the person is tired, happy, angry, sad,
called Pimp your vocab, which acts as a dictionary for frightened – even before they say anything. You can
‘teek people’ – people who are outside the teenage
usually guess what a person feels by studying their
speech community. This ‘teenglish dictionary’ enables
others to understand teenage terminology. non-verbal communication.

Many people think the book is great fun, but some

Non-verbal means ‘without words’, so non-verbal
critics argue that adolescent language changes so communication refers to the messages that we send
rapidly that it is hard to keep up to date and to be without using words. We send these messages using
sensitive to local variations. our eyes, the tone of our voice, our facial expression,
our hands and arms, gestures with our hands and arms,
First language the angle of our head, the way we sit or stand (known
The author and psychologist Steven Pinker (1994) as body posture) and the tension in our muscles.
estimated that there may be about 600 languages Posture
in the world that are spoken by more than 100,000 The way you sit or stand can send messages. Sitting
people. There are many more minority languages. with crossed arms can mean ‘I’m not taking any notice’.
Some people grow up in multilingual communities, Leaning back can send the message that you are
where they learn several languages from birth. But relaxed or bored. Leaning forward can show interest or
many people in the UK have grown up using only one intense involvement.
language to think and communicate. People who learn
a second language later in life often find that they
cannot communicate their thoughts as effectively as
they might have done using their first language. The
first language that people have learned to think in
usually becomes their preferred language.

Key term
First language – The first language that a person learns to
speak is often the language that they will think in. Working Person 2 Person 1
with later languages can be difficult, as mental translation
between languages may be required. Fig 1.4: You can see that person 2 is rejecting what person 1 is
communicating

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 Unit 1 Developing effective communication in health and social care

The way you move

As well as posture, your body movements will
communicate messages. For example, the way you
walk, move your head, sit, cross your legs and so
on will send messages about whether you are tired,
happy, sad, or bored.
Facing other people
The way in which you face other people can also
communicate emotional messages. Standing or sitting
face-to-face may send a message that you are being
formal or angry. A slight angle can create a more
relaxed and friendly feeling.

Fig 1.5: Square-on orientation can communicate aggression Can you see how a person’s emotions
can often be interpreted from their facial
expression?
Gestures
Gestures are hand and arm movements that can
help us to understand what a person is saying.
Facial expression
Some gestures carry a common meaning in most
communities in the UK. Your face often indicates your emotional state. When a
person is sad they may signal this emotion by looking
down – there may be tension in their face and their
mouth will be closed. The muscles in the person’s
shoulders are likely to be relaxed but their face and
neck may show tension. A happy person will have
‘wide eyes’ that make contact with you – and they will
probably smile. When people are excited they move
their arms and hands to signal this.
We can guess another person’s feelings and thoughts
by looking at their eyes, using eye-to-eye contact. Our
eyes get wider when we are excited, attracted to, or
interested in someone else. A fixed stare may send the
message that someone is angry. In European culture,
looking away is often interpreted as being bored or
Fig 1.6: Common gestures for ‘good’ and ‘perfect’ not interested.

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Most people can recognise emotions in the non-verbal touch, or gesture in a way that allows another person
behaviour of others. You will also need to understand to refuse your touch, before proceeding.
how your own non-verbal behaviour may influence People may also look at, or feel, the degree of muscle
other people. tension that you show when you communicate with
Touch them. The tension in your feet, hands and fingers can
tell others how relaxed or tense you are. If someone
Touch is another way of communicating without words.
is very tense their shoulders might stiffen, their face
Touching another person can send messages of care,
muscles might tighten and they might sit or stand
affection, power over them or sexual interest. The
rigidly. A tense person may have a firmly closed mouth,
social setting and a person’s body language will usually
with lips and jaws clenched tight, and they might
help you to understand what their touch might mean.
breathe quickly.
But touch can easily be misinterpreted. You might try
to comfort someone by holding their hand but they Silence
may interpret this touch as an attempt to dominate.
One definition of friends is ‘people who can sit
Sometimes it can be a good idea to ask if you may
together and feel comfortable in silence’. Sometimes
a pause in conversation can make people feel
embarrassed – it looks as if you weren’t listening or
Case study: Tonya you weren’t interested. Sometimes a silent pause can
Tonya is 15 years old and attends meetings
mean ‘let’s think’ or ‘I need time to think’. Silent pauses
of a youth group. She often sits with her arms can be OK, as long as non-verbal messages that show
crossed and her head turned away, looking out of respect and interest are given. Silence doesn’t always
the window. She avoids making eye contact with stop the conversation.
people who are speaking to the group. When
asked if she feels OK, she does make eye contact, Voice tone
changes her body posture and says she is happy to When you speak to other people, your tone of voice
be in the group.
is important. If you talk quickly in a loud voice with a
1 What messages would crossed arms and fixed tone, people may think you are angry. A calm,
avoidance of eye contact normally send?
slow voice with a varying tone may send a message of
2 How many reasons can you think of to explain being friendly.
why someone might sit with their arms crossed,
looking out of the window, while other people Proximity
are speaking?
The space between people can sometimes show how
3 How can you find out what an individual’s body
friendly or ‘intimate’ the conversation is. Different
language means?
cultures have different customs regarding the space
between people when they are talking.
In Britain there are expectations or ‘norms’ as to how
close you should be when you talk to others. When
.
talking to strangers we usually keep ‘an arm’s length’
apart. The ritual of shaking hands indicates that you
have been introduced – you may come closer. When
you are friendly with someone you may accept them
being closer to you. Relatives and partners might not
be restricted at all in how close they can come.
Proximity is a very important issue in health and care
work. Many people have a sense of personal space.
A care worker who assumes it is fine to enter the
personal space of a person who uses services, without
asking or explaining why, may be seen as dominating
Fig 1.7: Gestures and words give a person the option of
refusing touch or aggressive.

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 Unit 1 Developing effective communication in health and social care

Reflective listening • checking your understanding with the person who

We can often understand other people’s emotions just was speaking to you.
by watching their non-verbal communication. However, We can learn about people who are different from
we can’t always understand someone’s thoughts us by checking our understanding of what we have
without good listening skills. heard. Checking understanding can involve listening to
Listening skills involve hearing another person’s what the other person says and then asking questions.
words, then thinking about what their words mean, Reflection may also involve putting what a person has
then thinking about how to reply to the other person. just said into our own words (paraphrasing) and saying
Sometimes this process is called ‘active listening’ and it back to them, to check that we have understood
sometimes ‘reflective listening.’ The word ‘reflective’ what they were saying.
is used because the person’s conversation is reflected When we listen to complicated details of other
back (like the reflection in a mirror) in order to check people’s lives, we often begin to form mental pictures
understanding. As well as remembering what a person based on what they tell us. The skill of listening
says, good listeners will make sure that their non-verbal involves checking these mental pictures. Good
behaviour shows interest. listening involves thinking about what we hear while
Skilled listening involves: we are listening and checking our understanding as
the conversation goes along – we reflect on the other
• looking interested and communicating that you are
person’s ideas.
ready to listen
Good listening can feel like really hard work. Instead
• hearing what is said to you of just being around when people speak, we have to
• remembering what was said to you, together with build an understanding of the people we communicate
non-verbal messages with.

Message sent

Message is ‘reflected’
back like an image
in a mirror

Personal space

Close relationships
Fig 1.9: Why is it important to see our understanding reflected
Personal space
with friends back to us?

Public space

Fig 1.8: There are different expectations about personal space

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Case study: Sarah

Sarah is unemployed and is looking for work in a • Repeating what was said, e.g. ‘You never
specialised field. She looks worried and says ‘I don’t get a job offer.’
know what to do. I keep looking for work and going Parroting some phrases back to a person may
for interviews but I never get a job offer.’ Given that sound mechanical. The person might say: ‘That’s
you know nothing about the kind of job she is looking what I just said – didn’t you hear me?’
for, how can you respond in a skilled way? Consider • Reflecting the other person’s message, e.g. ‘It must
some of the possibilities below: be worrying when you can’t get a job.’
• Try to be reassuring, e.g. ‘I’m sure you will get a job This shows that you have listened and it may be
eventually.’ seen as an invitation to keep talking. Being able to
Unless you are an expert with detailed knowledge talk to someone who is actively involved may make
of the job market, reassurance is likely to sound the other person feel that they are being taken
false. You may come across as trying to avoid the seriously.
topic or trick the person. 1 What is the difference between saying things such
• Offer advice, e.g. ‘Why don’t you see a careers as ‘Why don’t you see an adviser’ or ‘I’m sure you
adviser?’ will get a job eventually’ and just saying ‘I don’t
Receiving unwanted advice can sometimes be very want to talk to you about it’?
irritating. The person may have already thought of 2 Can you explain the difference between just
seeing an adviser. You might come across as trying repeating or parroting the words you have heard
to sound clever and superior to Sarah. You might and the idea of reflective listening?
be seen as trying to avoid the issue, i.e. ‘This is all I
can think to say, please don’t talk to me about this 3 Why might another person feel that you care
any more.’ about them because you can reflect back what
they have said?

1.4 Communication and community should be identified as ‘culturally Deaf’ by

using a capital ‘D’ for Deaf. This emphasises that ‘Deaf’
language needs and preferences people use another language system, as opposed to
Spoken and written English are not the preferred ‘Deaf’ people who are perceived to be impaired.
system of communication for everyone. The first (or Further details of BSL can be found at
main) language of many Deaf people may be a signed www.bda.org.uk
language. People who are registered blind may use
Details of signs and a finger spelling alphabet
Braille, as opposed to written text, in order to read
can be found at www.british-sign.co.uk and at
information.
www.royaldeaf.org.uk

British Sign Language Makaton

British Sign Language is a language in its own right Makaton is a system for developing language that
– not simply a signed version of spoken English. The uses speech, signs and symbols to help people with
British Deaf Association explains that British Sign learning difficulties to communicate and to develop
Language is the first or preferred language of many their language skills. People who communicate using
Deaf people in the United Kingdom. The British Deaf Makaton may speak a word and perform a sign using
Association also explains that BSL was recognised as hands and body language. There is a large range of
an official British language in 2003 and the Association symbols to help people with learning difficulties to
campaigns for the right of Deaf people to be educated recognise an idea or to communicate with others.
in BSL and to access information and services Further information on Makaton can be found at
through BSL. Many Deaf people argue that the Deaf www.makaton.org

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 Unit 1 Developing effective communication in health and social care

Activity 4: Research Written communication

people’s understanding There is a Chinese saying that ‘the faintest ink is
stronger than the strongest memory’! Written records
of BSL are essential for communicating formal information
Do people understand what British Sign Language that needs to be reviewed at a future date. When
is? Plan a short series of questions and ask people people remember conversations they have had, they
who are not studying this course if they have will probably miss out or change some details. Written
ever heard of British Sign Language and what statements are much more permanent and, if they are
kind of language it might be? You may find that accurate when they are written, they may be useful
the majority of people think that BSL is a way of
later on.
signing English words – in other words that to
sign in BSL you would first have to know English. Pictures and objects of reference
Only a few people might understand that BSL is
a separate language developed within the Deaf Paintings, photographs, sculptures, architecture,
community. Discuss what consequences your ornaments and other household objects can
research might have for both Deaf and hearing communicate messages and emotions to people.
people. People often take photographs or buy souvenirs to
remind them of happy experiences and emotions.
Sometimes an object – such as a cuddly toy – can
PLTS symbolise important personal issues and provide a
source of meaning and comfort for an individual.
Independent enquirer: This activity will help you
demonstrate that you can plan and carry out research
and appreciate its consequences.

Key term
Braille Object of reference – An object of reference is a physical
object or picture that has become associated with an activity,
Braille (a system of raised marks that can be felt person or other special meaning.
with the fingers) provides a means of written
communication, based on the sense of touch, for
people who have limited vision. The communication Objects can sometimes be used to communicate
system known as Braille was first published by Louis with people who do not use much signed or spoken
Braille, a blind 20-year-old, in 1829. This system is now language. A child or adult with a learning disability
widely used, for reading and writing, by people who might understand that a cup stands for ‘would you like
cannot see written script. a drink’. An object like a spoon tied to a card might
Modern computer software can translate written communicate that it is time for dinner when the spoon
material into Braille, which can be printed out using is presented. A person without language might use
special printers. Further details on Braille can be found a patch of cloth to communicate that they wish to
at www.brailleplus.net sit in a favourite chair covered in that type of cloth.
Sometimes a person might learn a symbol, perhaps
Use of signs and symbols a symbol like a horseshoe that can be used to label
Gestures made with hands or arms, written symbols possessions or identify his or her room.
or diagrams (such as traffic signs) all communicate
messages to people.
Finger spelling
People who use a signed language, such as British
Sign Language, also use finger spelling. Finger spelling
enables signers to spell out words that do not have
a general sign, or words that may be misunderstood
such as the names of people and places.

Fig 1.10: What meanings do these signs communicate?

15
 BTEC’s own resources

speech into writing. Some electronic communication

Reflect
systems can be activated by air pressure, so that a
Imagine that you had to spell every word in person can communicate via an oral tube connected
a phone conversation – it would take a long
to computerised equipment. At a simpler level, aids
time and the conversation would not be very
such as flash cards or picture books can also improve
enjoyable. For this reason, people who use
signed languages do not generally use finger communication with people who do not use a spoken
spelling to communicate, other than for specific or signed language. Text messaging, using a mobile
terms. phone, provides an effective way of staying in touch for
many people. For people with a hearing disability, text
Communication passports messaging may provide a major form of communication.

Communication passports are usually small personalised

books containing straightforward practical information
about a person and their style of communication. Did you know?
The passport may help health and care workers to
understand the needs of a person with communication In August 2009 a Roman Catholic Archbishop, Vincent
Nichols, was reported as saying that ‘too much
difficulties. Communication passports often include
exclusive use of electronic information dehumanises
photographs or drawings that may help care workers what is a very, very important part of community life
to gain a better understanding of the person who owns and living together... We’re losing social skills, the
the passport. They are put together by working with human interaction skills, how to read a person’s mood,
the person with communication difficulties and his or to read their body language.’
her carers; the person tells their own story of their likes, How far do you think email and text messages may
dislikes and communication styles. spoil or improve relationships between people?

Technological aids to communication

Information technology offers a wide range of facilities When you send text messages to friends, do you
to help with communication. It is possible to provide use symbols and shortened words that would not be
enlarged visual displays or voice description for acceptable in more formal academic work? If you send
people with visual impairment. Electronic aids – such emails, do you use abbreviations, symbols and special
as the minicom for people with a hearing disability terms or do you only use formal English? Do you think
or voice typing for people with dyslexia – can turn it should be acceptable to use ‘texting’ symbols and
abbreviations for academic work? How formal should
English be?

Human aids to communication

Think about the way children communicate
Many people have specific communication needs. It
through play using objects
may be important to employ an interpreter if a person
uses a different language such as BSL. Some carers
learn to use communication systems, such as Makaton,
in order to help them communicate with people.
If you are communicating with a person with a hearing
impairment you should make sure that the person
can see your face clearly so that they can see your
expressions and the way your lips move. Sometimes
people use clues from facial expression and lip
movement to interpret what you might be saying. It
is also important to speak in a clear, normal voice. If
you raise your voice, your face and lips will become
distorted. A person with a hearing impairment may
realise that you are shouting and may assume that you

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 Unit 1 Developing effective communication in health and social care

are angry! It is also important to try and speak in an No one can learn every possible system of cultural
environment with little background noise. variation in non-verbal behaviour but it is possible
If people have limited vision, it may be important to learn about the ones that are used by the people
to use language to describe issues that a sighted you are with! You can do this by first noticing and
person might take for granted, such as non-verbal remembering what others do – in other words, what
communication or the context of certain comments. non-verbal messages they are sending. The next step
Touch may be an important aspect of communication. is to make a guess as to what messages the person is
For instance, some registered blind people can work trying to give you. Finally, check your understanding
out what you look like if they can touch your face in (your guesses) with the person. This involves reflective
order to build an understanding of your features. listening and thinking carefully about the person’s
responses.
It is always important to choose the right style of
language in order to communicate with people from
different language communities.
Key term
Variation between cultures Cultural variation – Communication is always influenced
Skilled carers use a range of conversational techniques by cultural systems of meaning. Different cultures interpret
when working with others. These include being verbal and non-verbal communication behaviours as having
sensitive to variations in culture. different meanings.

Culture means the history, customs and ways of

behaving that people learn as they grow up. People Care workers must be careful not to assume that
from different regions of Britain use different statements and signs always have the same meaning.
expressions. Non-verbal signs vary from culture to Cultural differences and different settings can alter
culture. White middle-class people often expect what things mean. A vast range of meanings can be
people to ‘look them in the eye’ while talking. If a given to any type of eye contact, facial expression,
person looks down or away a lot, they think it is a sign posture or gesture. Every culture, and even small
that the person may be dishonest, or perhaps sad groups of people, can develop their own system of
or depressed. In some other cultures – for example, meanings. Care workers have to respect differences
among some black communities – looking down or but it is impossible to learn all the possible meanings
away when talking is a sign of respect. that phrases, words and signs may have.

Assessment activity 1.1 P1

Explain, using examples you have observed, the role the anonymity of individuals and any details
of communication and interpersonal interactions in that might enable individuals or settings to be
health and social care. identified.

Grading tip Consider what is meant by ‘effective’ when

discussing communication and interpersonal
P1 Maintain a logbook to record notes of interactions in health and social care.
interactions you have observed in class role
plays, informally with your peers, with others at Consider formal and informal communication,
work and in school/college or in public spaces differences between different language
and particularly in health and social care settings communities and cultures and the role of verbal
when visiting or in placements. Note behaviours, and non-verbal communication in interpersonal
non-verbal communication skills and how the interactions.
communication cycle is/is not demonstrated. Include examples of different language needs
Remember that your notes should maintain and preferences in your explanation.

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 BTEC’s own resources

2 Understand factors that influence

communication and interpersonal interaction in
health and social care environments
2.1 Theories of communication
The communication cycle Key term
Communication cycle – Most important communication in
Effective communication involves a two-way process in care work involves a cycle of building understanding using an
which each person tries to understand the viewpoint active process of reflecting on, and checking out, what the
of the other person. Communication is a cycle other person is trying to communicate.
because when two people communicate they need to
check that their ideas have been understood. Good
communication involves the process of checking One way of looking at this cycle might be:
understanding, using reflective or active listening.
1 An idea occurs: You have an idea that you want to
Michael Argyle (1972) argued that interpersonal communicate.
communication was a skill that could be learned and
2 Message coded: You think through how you are
developed in much the same way as learning to drive
going to say what you are thinking. You put your
a car. Argyle emphasised the importance of feedback
thoughts into language or into some other code
in skilled activities. When you drive a car you have
such as sign language.
to change your behaviour depending on what is
3 Message sent: You speak, or perhaps you sign or
happening on the road. Driving involves a constant
write, or send your message in some other way.
cycle of watching what is happening, working out how
to respond, making responses and then repeating this 4 Message received: The other person has to sense
cycle until you reach your destination. your message – they hear your words or see your
symbols.
According to Argyle, skilled interpersonal interaction
(social skills) involves a cycle in which you have 5 Message decoded: The other person has to
to translate or ‘decode’ what other people are interpret or ‘decode’ your message (i.e. what you
communicating and constantly adapt your own have said). This is not always easy, as the other
behaviour in order to communicate effectively. person will make assumptions about your words
Verbal and non-verbal communication is not always and body language.
straightforward. The communication cycle involves a 6 Message understood: If all goes well then your
kind of code that has to be translated. You have to work ideas will be understood but this does not always
out what another person’s behaviour really means. happen first time!
2. Message coded 4. Message perceived

1. Ideas
occur
3. Message sent 5. Message
decoded

6. Feedback –
what was
understood
Fig 1.11: What are the stages in the communication cycle?

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 Unit 1 Developing effective communication in health and social care

Case study: Karen

Karen is talking to Jasmin, In this brief example, there is no helpful advice or
whose partner has died. information that Karen can offer. Karen is careful to
reflect back what Jasmin has said. This results in a
Jasmin: I can’t believe it.
communication cycle in which Jasmin can begin to
I don’t know how I’m going
share her feelings.
to cope on my own, I can’t
sleep or eat. 1 Can you explain why it is so important for care
workers to say back what they understand?
Karen: You must feel awful,
it must have been a terrible 2 What might have happened if Karen had
shock. responded with ‘Don’t worry, you’ll feel better as
time goes by’?
Jasmin: I’ll say it was – I just feel so anxious. I know I
won’t be able to cope. 3 How can understanding the communication
cycle help care professionals to develop skilled
Karen: Can you tell me a little about your life communication?
together?

Activity 5: Observe the through a process of group formation. Many groups

may experience some sort of struggle before people
communication cycle unite and communicate effectively. One of the best-
known theorists to explain group formation stages is
Work in a small group and plan how to record the
speech and faces of two people talking. Agree on Tuckman (1965). Tuckman suggested that most groups
a topic of conversation and record pairs of people go through a process involving four stages. These are:
talking to each other for up to five minutes. Analyse 1 forming
your recordings in terms of the six stages of the
communication cycle.
2 storming
3 norming
4 performing.
The first stage (forming) refers to people meeting for
PLTS the first time and sharing information. The second
Independent enquirer: This activity may help you stage (storming) involves tension, struggle and
demonstrate that you can analyse and evaluate sometimes arguments about the way the group might
information. function. The third stage (norming) sees the group
coming together and consciously or unconsciously
agreeing on their group values. Once they have
Functional skills established common expectations and values, the
group will reach the fourth stage of being an effectively
ICT: Discussing this activity may help you demonstrate performing group.
that you can evaluate the selection and use of ICT
tools and facilities used to present information.

Key term
Group values – Group members need to share a common
Tuckman’s stages of group interaction system of beliefs or values in order for the group to
Communication in groups can also be influenced by communicate and perform effectively. You may be able to
the degree to which people feel they belong together. identify these values when you watch a group at work.
When people first meet in a group they often go

19
WorkSpace Jea Black
Day centre team leader

Pinewoods
is a day centre for adult people
with learning disabilities. Jenna is the team leader
for a new group of care workers who have only been working
together for the past two weeks. They have regular team meetings
and this is an extract from their third meeting in which they are
discussing the activities that they lead with day centre members.
Jenna: Let’s talk about the cookery sessions. I think that members are
really enjoying learning to cook.
Carly: Maybe, but I worry about what we’re doing. We don’t
watch people carefully enough. For example, Drew nearly
burned himself last Tuesday because nobody was
watching what he was doing.

André: Yes, but he didn’t burn

himself and he is learning to become independent. I
think it’s important to let people take risks. I could never have become
independent if my parents hadn’t let me take risks!
Deja: So it’s all right for Drew to burn himself, is it? Is that what you’re saying?
Shanice: I can’t believe you just said that! André is talking about the importance of independence
and you turn that round to saying he doesn’t care about people burning themselves. That’s not what he
said – you didn’t listen!
Deja: Now you listen to me! What I am saying is that we don’t take safety seriously enough. These
people are vulnerable, they can hurt themselves if we don’t take proper care.
Jenna: OK, we all know that both safety and independence are central to our work here. So why are
we talking as if we can’t have both?
Deja: Well, I agree that both are important, but safety comes first as far as I’m concerned.
Shanice: Well I don’t think things are that simple. It is possible to concentrate
too much on safety and then we might stop people from reaching their
potential of independence. It’s a matter of getting the
balance right.

Think about it!

1 Using Tuckman’s theory, can you identify which stage of group formation this group is at?
2 Can you identify different norms that are being argued about in the group?
3 Can you identify the different ‘sides’ being taken in the discussion and how Jenna is starting to use
her group leader role to get the team to focus on common values?
4 If this group is to succeed in working they will have to share common ‘norms’. Can you guess on
what norms the group might eventually agree?
5 If you were in Jenna’s position, how would you lead the conversation on from Shanice’s last
comment in order to reach the ‘norming stage’ of team working?

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 Unit 1 Developing effective communication in health and social care

Assessment activity 1.2 P2 M1

Using examples from your experience, discuss Participation in a series of group tasks with
theories of communication. This assessment could be the same group of individuals over a period
integrated with Assessment Activity 1.1. of several weeks and an analysis of how your
For M1, you should also include an assessment of the work with each other changes over time could
role of effective communication and interpersonal provide useful understanding of Tuckman’s
interaction in health and social care. theory. This could involve group work in class
with your peers or how you settle into working
Grading tips with a group of individuals in a work experience
placement or any employment.
P2 Consider how communication theory helps to
explain effective communication in health and M1 Integrate your assessment by using the
social care contexts. examples explained for P1 and discussed in P2.
Consider one-to-one and group interactions, The assessment should consider strengths
formal and informal communication, different and weaknesses of communication and
types of communication and different forms of interpersonal interactions you have observed
interpersonal interaction in your discussion. in relation to theories relating to the
communication cycle and group formation
Reviews of filmed class role-plays in which
you and your peers have participated would Remember to consider a range of health
be helpful to gain understanding of the and social care contexts, different forms
communication cycle. of communication and different types of
interpersonal interaction in your assessment.

2.2 Environmental factors that Activity 6: Plan a good

influence communication environment for group
It is very hard to hear what someone is saying if there communication
is a lot of background noise. It is also very difficult
to make sense of other people’s facial expressions Get together with a group of colleagues and make
a list of what an ideal environment for videoing a
if you can’t see their faces properly due to poor
group discussion would involve. Work out what
lighting. Rooms with awkward seating positions might practical changes you may be able to introduce
mean that a group of people cannot see each other into your own working environment.
comfortably. People sometimes feel uncomfortable if
they are trying to communicate with a person who is PLTS
too close or at a distance. A room that is too hot, stuffy
Creative thinker: This activity will help you
or cold may inhibit communication if it makes people
demonstrate that you can generate ideas and explore
feel tired or stressed. possibilities and perhaps try out alternatives.
The environment also plays an important role in the
effectiveness of communication aids. For instance,
hearing aids will amplify background noise as well as
2.3 Barriers to communication
A barrier blocks things and stops them ‘getting
the voice of the speaker. A noisy environment may
through’. There are different types of communication
therefore be difficult and unpleasant for someone who
barrier that stop communication from being effective.
is using a hearing aid. Good lighting will be critical for
Three types are shown in Table 1.2 on page 22.
someone who supports their understanding of speech
with lip reading. Time limits on how long you can use a Where the first and second types of barriers exist, it
room can also interfere with communication. will usually be obvious that communication has failed.
However, distorted understanding is not always easy
to identify. Skilled use of the communication cycle may
help you to check what has been understood or what
communication barriers may exist. 21
 BTEC’s own resources

Table 1.2: Communication barriers

Type of barrier Examples

1 Communication is not Not responding to language needs or preferences. Not understanding sensory
received impairment or disability.
Examples: Speaking to a Deaf person who uses a signed language. The sounds are
not received.
Environmental barriers:
Background noise can stop you from hearing a message. You can’t receive full
non-verbal communication if you can’t see a person’s face or body.
2 Communication is received A person using slang, jargon or complex technical terminology can be heard, but
but not understood their message may not be understood.
3 Understanding is distorted A wide range of emotional and psychological factors can act as barriers, resulting
in distorted understanding of communication.

Key term
Communication barrier – Anything that stops the
development of understanding when people interact.

Fig 1.12: Consider why barriers can mean that no information Fig 1.13: How can psychological factors create communication
is communicated barriers by distorting perception of a message?

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 Unit 1 Developing effective communication in health and social care

Case study: Karen

Interviewer: Some people who need care have ‘Can you remember what I told you?’
problems with understanding and memory. How do If I did that, the person might feel I was treating
you know if a person has understood what you are them like a child. So instead I asked them about
talking about? what they would be doing on the day that I had
changed from. They said that I would be coming
Karen: It’s not easy but sometimes you can tell from
to see them – and that was wrong – and so I was
a person’s face. When a person looks puzzled, or if
able to remind them of the change. One way
they don’t respond, then you know you’ve got to try
of preventing misunderstanding is to just keep
and explain something in a different way.
somebody talking.
But some people will nod 1 Can you explain why Karen does not like to ask
and smile although they direct questions such as ‘What did I just tell you?’
haven’t really understood or ‘When am I coming next then?’
you. So I try to keep
the conversation going 2 Can you think of some reasons why people
and find a way to check might nod and smile as if they understand, even
understanding. For example, if they don’t understand what you have tried to
I had to explain I would communicate?
come on a different day. 3 In the example above, how is Karen using the
Now, I couldn’t ask the communication cycle?
person a direct question like

Types of communication: difficult, Reflect

complex or sensitive
What can you say to a person who is upset and
Some communication between people is simply crying because they can’t cope, following the
about sharing or ‘transmitting’ information. For death of their partner?
example, someone might want to know what number
bus to catch, or they might ask for a drink of water.
should focus on emotional needs, rather than giving
Sometimes communication will be complex. For
out information.
example, a relative may want to know about funding
arrangements for care. A communication about Engebretson (2003) uses the idea of a caring presence
funding might involve a great deal of complex to explain what is needed in these situations. Creating
information. In this situation it would be important a caring presence is about sharing an understanding
to check what the relative already knew, and whether of the feelings that other people may be experiencing.
or not the individual understood the information you Sometimes simply being with a person who is lonely,
were providing. anxious or depressed can provide comfort. If you
believe that your carer understands your needs and
A great deal of communication in care work involves
is concerned about you, then just knowing that they
building an understanding of another person and
are near you can help you to feel supported. Non-
providing emotional support. Burnard and Morrison
verbal communication may sometimes communicate
(1997) argue that caring and communicating are
emotions and feelings more effectively than words.
inseparably linked. Communication that involves
emotional issues is often experienced as being difficult
or sensitive.
There is no advice or information that is likely to be Key term
very useful to a person who is overwhelmed by grief, Caring presence – Being open to the experience of another
but many people do want someone to be with them. person through a ‘two-way’ encounter with that person.
Communication in this difficult or sensitive situation

23
 BTEC’s own resources

If you can support people just by the way you are

‘present with them’ this may be because you are
Key terms
developing empathy with them.
Empathy – The ability to develop a deep level of
Empathy understanding of another person’s experience.
Communication disability – Difference that may create
Empathy involves a caring attitude where someone
barriers between people with different systems of
can see beyond his or her own assumptions about communication.
the world and can imagine the thoughts and feelings Sensory impairment – Damage to sense organs such as eyes
of someone else. A professional care worker who and ears.
can empathise will be able to imagine the emotions
associated with the pain and grief that another person
However, in this case, the disability is a social issue (to
is experiencing.
do with needing an interpreter), rather than a sensory
impairment issue.
Did you know? Barriers associated with personality, self-
Empathy is often regarded as a skill that can be esteem, anxiety and depression
developed through training but Carl Rogers, a famous Sometimes care workers can create their own barriers
counsellor, argued that empathy was a state of being. because they feel stressed by the emotional needs
This means that you have to experience your self of the people they work with. Listening to others can
and other people in a special empathetic way. In
involve hearing about frightening and depressing
Rogers’ view you couldn’t simply use empathy as a
communication tool or technique – you had to ‘live’ situations. Carers sometimes stop listening in order
empathy. to avoid painful emotions. Tiredness, lack of time or a
desire to avoid emotional stress can create a barrier to
providing caring communication.
Language needs/preferences Building an understanding of another person and
Most people will have a preferred first language. And establishing a ‘caring presence’ can be very difficult
this preferred language will sometimes be obvious when their personality or self-esteem needs create a
to you. But language needs go beyond the choice of barrier. Many people who are depressed or anxious
a preferred language. Different communities use a experience negative thoughts that ‘just come to them’.
given language in different ways. People use different Attempting to understand these thoughts and feelings
degrees of formality and informality, depending on the can feel like trying to find a way through a brick wall. It
context. For example, people may use jargon, dialect may feel as if there is an emotional barrier preventing
or slang to communicate effectively with people in the person from experiencing any positive emotions.
their own speech community. These differences can The case study on the next page illustrates this type of
create barriers to understanding. situation.
Sensory impairment and disability The carer in the case study opposite is not ‘just
talking’ – she is trying to steer the conversation
A sensory impairment means that a person’s senses
round to positive memories. The worker is using
do not work effectively. Impairments create the first
her understanding of Liam’s past to try and lead the
kind of communication barrier, where information is
conversation around the barrier of negative and
not fully received.
depressed thoughts. If the worker is successful, the
Disability is not the same as impairment. Some people
conversation might lead to Liam having positive
experiencing barriers because of their difference
thoughts and feelings and increasing his level of self-
may have a communication disability. For example,
esteem.
a ‘Deaf’ person, whose preferred language is BSL,
experiences no problems communicating with another Asking questions
person who is good at signing with BSL. This person Talking through difficult, complex or sensitive issues
may not be able to communicate with people who will involve the verbal skills of asking open questions
use spoken English without the aid of an interpreter. and using probes and prompts within the conversation.

24
 Unit 1 Developing effective communication in health and social care

Case study: Liam

Liam: You can’t possibly understand what it feels Carer: So when you ran your own taxi business
like to be me. Absolutely everything is wrong with you were on top of everything – nothing could get
my life, I’ve got no reason to be alive and you can’t you down?
help me – what’s the point of talking?
Liam: Yeah – but I’ve got health problems now, I’m
Carer: But perhaps I could be useful if I knew more finished, that time is all gone.
about your life?
Carer: Yes, I know it feels terrible, but tell me about
Liam: What do you want to know? I’ve got no the good times. You dealt with problems then. I’d
money, no job, no future, no one cares about me – like to understand how you made it all work back
there’s no point in going on. then.
Carer: Right, so it feels really terrible, really bad, but Read the information on probes and prompts below
was there a time before things went wrong – a time and answer the following questions.
when you were happy? 1 Can you identify how the carer has used
Liam: Yes, a few years back everything was good – questions, probes and prompts in order to keep
but now I feel even more miserable because you the conversation going?
are reminding me of how much I’ve lost! 2 Can you explain how the carer may have
There is no simple way of removing this emotional used reflective listening in order to build an
barrier but some skilled workers might try to keep understanding of Liam’s situation?
the conversation going so that they could continue 3 Can you explain the importance of building an
to learn about the person. It might be possible to understanding of another person during a difficult
positively influence the person’s self-esteem as the and sensitive interaction?
conversation continues.

• Open questions: These cannot be answered with a Barriers associated with assumptions
yes or no response – they require a person to think Building an understanding of other people’s needs
about their answer. Open questions are likely to takes time and effort. Jumping to conclusions and
involve a complex communication cycle in order to making assumptions can save mental effort and time,
discuss issues. They include questions such as ‘How but assumptions may cause us to misinterpret what
would you describe your quality of life?’ another person is trying to communicate. For example,
• Probes: These are very short questions such as ‘Can you might believe that you don’t need to listen to a
you tell me more?’ Probes are used to dig deeper person because you already know what their needs
into the person’s answer – they probe or investigate are. But care workers who use the communication
what the other person has just said. cycle are less likely to make assumptions because they
• Prompts: These are short questions, which you check their understanding. Assumptions can create a
offer to the other person in order to prompt them barrier because people stop listening and checking
to answer. Prompts are questions such as ‘Would their understanding of other people’s communication.
you do it again?’ Some people make assumptions that people who
have a disability are damaged ‘normal’ people. When
Barriers associated with aggression and disabled people are seen in this way, they might
submissiveness be pitied or ignored. People with communication
When a person experiences strong emotions or
their self-esteem is threatened, that person may
become aggressive or withdrawn, creating barriers to
communication.
Key term
Assumption – An idea that people think is true or correct
See pages 30–33 for further information on aggression without bothering to check.
and submissiveness.

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differences are sometimes assumed to be mentally Barriers associated with cultural variation
impaired. Older people are sometimes seen as Culture refers to the different customs and
demented or confused if they do not answer questions assumptions that communities of people adopt.
quickly, correctly and clearly. If care workers do not Different ethnic and religious groups may have
bother to check their assumptions about people, these different cultures, but different age, occupational
assumptions can turn into prejudices. And a prejudice and geographical groups also make different cultural
or pre-judgement can result in discrimination. assumptions.
Barriers associated with values and belief Words and non-verbal communication can be
systems interpreted differently depending on the context
and on the culture of the person using them. For
People have different belief systems – about what is
example, the word ‘hot’ can have different meanings
important in life and how people should live their lives.
depending on the context in which it is used and the
Values are the principles that we think of as being
culture of the person using it. In a formal context,
important or valuable, in terms of how we live our lives.
‘hot’ refers to having a high temperature. But in other
speech communities an object might be ‘hot’ if it has
been ‘stolen’ or if it is perceived as ‘very desirable’.
Key terms A hot person might be very good at something, or
Belief systems – The assumptions we use to make sense of
be someone who is overcome with sexual desire! If
our lives. Our belief systems often include our values.
communication is interpreted only from a fixed cultural
Values – What we think of as being important or valuable in
terms of how we live our lives. standpoint, serious misunderstandings can arise. To
make sense of spoken and non-verbal language, you
need to understand the context of the interaction and
When people have different belief systems and the intentions of the person communicating.
values it is easy for them to misinterpret one another’s
intentions when attempting to communicate. Like
assumptions, belief systems and values can therefore
Reflect
create barriers to understanding. It is important to Think of some words that can mean different
try to learn about other people’s beliefs and values things depending on the cultural context in
in order to make sense of what they are trying to which they are used. ‘Chilling’ is one example.
communicate.

Fig 1.14: Why does learning about other people’s beliefs help to avoid barriers to
communication?

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 Unit 1 Developing effective communication in health and social care

An example of a non-verbal cultural variation might If you cannot control and make decisions about your
be the hand gesture in which the palm is held up and own life you may fail to develop, or you might lose
facing forward. In Britain this means ‘Stop, don’t do your sense of being a worthwhile person. If care
that’, whereas in Greece it can mean ‘You are dirt’ and workers control and manipulate you, your self-esteem
is considered a very offensive gesture. Why do the may be damaged.
same physical movements have different meanings? Care workers should seek to empower people who
One explanation could be that the British version of use services. Empowerment means giving power to
the palm-and-fingers gesture means, ‘I arrest you, you others. People who use services should be empowered
must not do it’, whereas the Greek interpretation goes to believe that they can make their own choices and
back to medieval times when criminals had dirt rubbed take control of their lives.
in their faces to show how much people despised
them.
It is important not to make assumptions about non- Key terms
verbal messages – they should always be checked. Empowerment – This enables a person who uses services to
Non-verbal messages can mean different things make choices and take control of their own life.
depending on the circumstances of the people who Power – In the context of interpersonal behaviour, ‘power’
are sending them. means the ability to influence and control what other people
do.

Case study: Gerard

In order to empower others, care workers need to
Gerard is a tall, muscular, middle-aged man understand and value each person’s unique story.
who regularly talks to staff about his son’s care. Care workers must support the people they work
He prefers to stand squarely face-to-face and with, in taking control of important decisions. Care
speaks quickly, using a loud voice. Staff say that
workers must also carry out their work on the basis that
they feel uncomfortable talking to Gerard because
he sometimes ‘stares at you’ with a fixed gaze. everyone is of equal status. The care worker does not
Staff say ‘He is in your face’ because they feel that have higher status than people who use services.
he stands too close to them. Some staff think that
Gerard is aggressive and demanding because of
the way he acts.
Fixed eye contact
1 Can you identify how ‘cultural variation’ might
be important when trying to understand this Difference in height
situation?
2 Can you think of possibilities, other than being Inappropriate use of touch
demanding and aggressive, that might explain
Worker ignores feedback
the non-verbal behaviours described above?
3 How could you check what certain non-verbal
behaviours might mean during a conversation?

Use and abuse of power

The General Social Care Council (GSCC) Code of
Practice for Social Care Workers (2002) requires all
workers to respect individuality and support people
who use services to control their own lives. However,
there is always a danger that, if a care worker is short of
Fig 1.15: How do these non-verbal messages express power
time, they will seek to control people who use services. and domination?
It is an abuse of power if care workers deliberately
control and manipulate others.

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Barriers associated with the effects of understood and also in distorted interpretations of the
alcohol/drugs message. Alcohol and drug abuse can therefore create
all the barriers to communication shown in Figure 1.16
Alcohol and drugs can influence a person’s ability to
on page 29. People with a distorted perception of
send clear verbal and non-verbal messages. Drugs that
other people’s communication may be more likely to
affect the functioning of the central nervous system
become frustrated or aggressive.
can easily result in messages not being received or

Case study: Karen

Interviewer: Why do a lot of meeting people and getting to know them.
people worry about having care I value everyone I work with; I think of them as
services? important. I am interested in their lives and I listen
Karen: Some people are afraid to what they tell me. I think values – what you
that you will come in and take believe in – are at the heart of how you work with
control of their lives, boss them people.
about, and make them feel stupid. Interviewer: So do you really need theories like
Interviewer: But care work is all about giving power to reflective listening and the communication cycle to
people who use services, making sure people are in be a good carer?
control of their own lives – so why do people worry? Karen: These ideas can help you to be more
Karen: Well, I am always short of time and it is sensitive and to understand what might be going
tempting to just take over and do everything my on. But care work is really about values, attitudes
way to get it done quickly. It’s easy to think you and feelings. Technical knowledge on its own,
know best – but if you make that assumption, you without the right values, isn't enough if you want
upset people and make them feel powerless. to enjoy caring for others and if they are going to
enjoy working with you.
Interviewer: Don’t some people like to sit back and
let you be in control? 1 Why should care workers not aim to control the
lives of the people they work with?
Karen: Some people say, ‘You do what you like,
buy me whatever you think I need – I don’t care.’ 2 Why does Karen try to encourage people to make
But that is a problem too. Sometimes people lose choices, even if they appear not to want to?
control of their lives and give up – they become 3 Can you explain what is meant by power in the
‘helpless’. They want you to make all the decisions context of interpersonal behaviour?
– have all the power. I still try to encourage them to 4 Can you identify what values Karen uses when she
make choices. talks to people who use care services?
Interviewer: There is so much to think about when 5 What does Karen mean when she says ‘If you’ve
you are working with people. How do you manage? got the right attitude then you tend to say and do
Karen: You have to have the right attitude – it’s a the right things anyway’?
sort of feeling. If you’ve got the right attitude you 6 Explain why Karen thinks technical knowledge,
tend to say and do the right things anyway. I enjoy without the right values, isn’t enough?

Assessment activity 1.3 P3

Again, use the examples used in Grading tip

the previous assessment activities
to explain the factors that influence P3 Integrate the evidence for this task with that for assessment
communication and interpersonal Activities 1.1 and 1.2.
interactions. Consider both positive and negative influences.
Consider one-to-one and group interactions, different forms of
communication and different types of interpersonal interaction.

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3 Understand ways to overcome barriers in a

health and social care environment
3.1 Communication and national standards, codes of practice and legislation.
People who use services may be seen as having the
interpersonal interaction following rights.
Staff training Confidentiality
Many skills, such as communicating effectively with Confidentiality is an important right for all people who
anxious, depressed or aggressive people, cannot be use services because:
developed simply by obtaining information. Instead, • People may feel confident about sharing
people often develop their skills by reflecting on their information if they know that their care worker won’t
own practice experience and discussing thoughts and pass things on. They may not trust a carer if the
experiences with colleagues. Formal training courses carer does not keep information to themselves.
usually provide opportunities to practise important
• Keeping information confidential demonstrates
skills as well as theories about how to overcome
respect for people who use services. A lack of
communication barriers.
confidentiality may threaten people’s self-esteem.
Assessment of need and using preferred • A professional service, which maintains respect
methods of communication for individuals, must keep private information
It is important to build an understanding of the needs confidential – in the same way that medical
of people you work with in health and social care. practitioners and lawyers have always maintained
Very often, people will make their preferred method confidentiality.
of communication obvious. Sometimes a professional • There are legal requirements (data protection) to
social work or medical assessment may be needed in keep personal records confidential.
order to clarify the person’s needs and their preferred • A person’s safety may be put at risk if details of
method of communication. their property and habits are shared publicly. For
example, if your home was empty and other people
Promoting rights
knew where you kept your money, someone might
As well as general human rights, people who use be tempted to break in.
services have a range of rights that are established in

To be treated as an To be treated To be protected

individual in a dignified way from danger or harm

To be cared for in a
A service way that meets their
To be respected user’s rights needs and takes
account of choices

To be allowed access To be treated equally To be able to

To be given privacy to information about and not discriminated communicate using their
themselves against preferred method

Fig 1.16: What are the rights of people who use services?

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Assertiveness To be assertive, a person usually has to:

Fear and aggression are two basic emotions that we • understand the situation they are in (including facts,
all experience. When we feel stressed, it is easy to details and other people’s perceptions)
give in to our basic emotions and be either submissive • be able to control personal emotions and stay calm
or aggressive. Assertion is an advanced skill, which • be able to act assertively, using the right non-verbal
involves controlling the basic emotions that usually behaviour
prompt you to run away or fight. It involves a mental
• be able to communicate assertively, using the right
attitude whereby you try to negotiate, and try to solve
words and statements.
problems rather than give in to emotional impulses.
Some of the emotions, attitudes and behaviours
During an argument, an aggressive person might
involved in assertion are summarised in Table 1.3 on
insist that they are right and other people are wrong.
page 31.
They will want to win, while others lose. The opposite
of aggression is submission. A submissive person Staying calm and in control of your emotions,
accepts that they will lose, get told off, or be put down displaying respect for others, using reflective listening
emotionally. Assertive behaviour is different from both and building an understanding of another person’s
these responses. In an argument, an assertive person viewpoint are all part of being assertive. Assertion
will try to find an answer that means no one has to lose is the skill of being able to understand another
or be ‘put down’. Assertion is a skill that helps create person’s viewpoint, while being able to help them to
‘win-win’ situations. understand your viewpoint. Assertion skills create a
situation where negotiation is possible.
Assertion does involve a special kind of attitude. You
are going to stick up for yourself – but you are not
Key term trying to dominate or get power over other people.
Assertion – Assertion is different from both submission and
You are trying to reach the best outcome for everyone.
aggression. It involves being able to negotiate a solution to a
problem.
It is very easy to be aggressive – it is in our ‘animal
nature’ to attack people who cause us problems.

Case study: Justin and Tyler

The manager of a care centre has asked that either 1 With a submissive response, Tyler will get
Justin or Tyler should stay for an extra half-hour at what he wants and Justin will lose. But what are
the end of their shift to complete some paper work. the likely consequences for their ability to work
Neither Justin nor Tyler want to do this work, so Justin together in the future?
could argue, using: 2 Justin will not necessarily win using aggression.
Aggression: Don’t think I’m going to do it. I need to Both people could become trapped in a cycle of
get away early and you’re not going to stand in my aggressive responses. If one person does force
way. I don’t care what you say – either you do it or the other to give in, will they be able to trust each
nobody does. other later?
Assertion: Look – neither of us wants to stay late, 3 Assertion is the most skilful response. Can you
but one of us has to stay. Let’s work out a fair way identify the skills that Justin would need in order
to decide which of us stays. to make this approach work?

Submission: I didn’t really want to stay late, but if

you don’t want to stay, then I suppose I’ll have to.

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 Unit 1 Developing effective communication in health and social care

Table 1.3: Differences between aggressive, assertive and submissive behaviours

Aggressive behaviour Assertive behaviour Submissive behaviour
Main emotions Anger Control of own behaviour Fear – wanting to please
Attitudes Trying to win Trying to create a situation in Accepting that you will lose
Wanting your own way which everyone wins Letting others dominate
Making demands Negotiating with others Agreeing with others
Trying to solve problems

Behaviours Not listening to other people Listening to other points of Not putting your own views
Putting other people down view across
Shouting or talking very Showing respect for others Withdrawing or showing fear
loudly Keeping a clear, calm voice Speaking quietly or not
speaking at all

Body language Fixed eye contact, tense Varied eye contact, relaxed Looking down, not looking
muscles, waving of hands and face muscles, looking ‘in at others, looking frightened,
arms, looking angry control’, keeping hands and tense muscles
arms at your side

Case study: Karen

Interviewer: You must have people to talk to you. You have to show that
to deal with some rude and you’re not going to try and dominate or threaten
aggressive people? them. But you can’t let yourself be pushed around
either. When people cross the line, I will talk firmly
Karen: Yes, the first thing I
about how they make me feel, and what the
do is to think to myself ‘stay
consequences might be for them. Services can be
calm – don’t feel threatened’.
withdrawn from really offensive people. Usually
Very often people are rude
I think you get respect if you can put yourself in
or aggressive because
other people’s shoes, but if you also stick up for
they feel threatened. They
yourself.
are upset that you are in
their home – they want to control you, to make 1 Do you think Karen has good assertiveness skills?
themselves feel safe. For many people the only way 2 If Karen did behave aggressively towards people
they know to defend themselves is to get angry. who use services, what would be the risks for her
Thinking this way helps me to stay calm. and the people she works with?
Interviewer: That’s a wonderful attitude – but don’t 3 Why does Karen believe it is important to ‘put
people take advantage of you if you think like that? herself in other people’s shoes’?
Karen: No, you have to have the right attitude,
you have to be patient, stay calm and try to get

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Defusing aggression and staying confident When people become aggressive, care workers are
People do not always plan or choose to be aggressive. likely to feel threatened. We all have a natural, animal
In health and social care contexts, a great deal response to run away or fight when we feel threatened.
of aggression is caused by stress, often because An unskilled response is to fight aggression with
people feel powerless and out of control. Aggression your own aggression – to ‘get your own back’ on
sometimes results from frustration; aggression can be a someone who is threatening you. Within health and
last-ditch emotional response when a person feels that social care, this is wrong because it can increase the
he or she is losing control. level of aggression or violence in someone who is
stressed. A care worker could be injured in a violent
outburst. Alternatively, your aggression could punish a
Reflect person so that he or she gives up and withdraws from
Have you ever seen a person shouting or contact with you or your services. Being aggressive
swearing at a computer, or hitting the keyboard towards a person who is vulnerable will increase his
because the machine was not doing what they or her problems and could result in helplessness and
wanted? Do they really think the computer will be depression.
impressed?
People can become frustrated when they cannot
control events, and aggressive behaviour is a
natural emotional response.
Key term
Helplessness – People can give up and become helpless
when they learn that they cannot control or influence
Activity 7: Discussing important personal events. Helpless people can become
sources of stress withdrawn and depressed.

Get together with a small group of colleagues and

make a list of some of the stresses that people
who receive care services might experience. Think
about situations in which people may feel that they Table 1.4: Skills for defusing aggression
are out of control. Think about ways in which illness 1 Stay calm Show that you are not going to
or pain might create stress. Think about barriers to
become aggressive. Avoid a tense
understanding and how these might create stress.
body posture, a tense face or
Work out ways in which care workers could prevent clenched fists. Avoid fixed, staring
the stresses from resulting in aggression. eye contact. Breathe normally.
2 Communicate Use your listening skills to show
respect that you are taking the other
person seriously. Use non-verbal
PLTS skills to communicate respect.
Independent enquirer: This activity will help you
demonstrate that you can identify questions to answer,
3 Create trust Try to meet the other person’s
and consider the influence of circumstances on events. self-esteem needs. Try to make
the other person feel valued and
important, without agreeing to
When people feel stressed, emotions and tension everything they say.
often build up. Just one little misunderstanding can 4 Try to solve You can only discuss issues or
be enough to cause this tension to explode into an problems problems in detail after the other
aggressive outburst. When a person becomes angry person responds to your listening
they may decide that it is someone else’s fault that and calming behaviour. You will
they have been made to be aggressive. Sometimes a note that the other person’s
person will have multiple aggressive outbursts as they non-verbal behaviour shows less
tension.
struggle with their emotions.

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 Unit 1 Developing effective communication in health and social care

Care workers are likely to break professional codes Building relationships and appropriate
of conduct if they allow themselves to become verbal and non-verbal communication
aggressive. Instead it is vital that care workers learn the
Building relationships with people who use care services
skills needed to defuse aggression.
involves skilled listening, together with appropriate
It is not easy to stay calm if someone is threatening verbal and non-verbal communication. It may be
you. You will need to feel confident that you know important to use warm, friendly non-verbal behaviour
how to work with the other person. If you have that expresses interest in another person such as:
already established a sense of trust, it may be easier
• making effective eye contact (varied and
to cope with their aggression than with aggressive
appropriate contact with another person’s eyes)
behaviour from a stranger. You will need to be sensitive
about possible misunderstandings and barriers to • adopting a relaxed and calm body posture
understanding when you start to work with an angry • smiling – looking friendly rather than ‘cold’ or frozen
person. You must avoid any spark that could light the in expression
fuse leading to an angry explosion. • using hand movements and gestures that show
All the skills of recognising and overcoming barriers interest
to communication will be useful in helping you to • nodding your head slightly while talking to
avoid triggering aggression. Reflective listening skills communicate messages such as ‘I see,’ or ‘I
are vital in order to make the other person feel understand,’ or ‘I agree’
valued. • using an appropriate gentle tone of voice.

Case study: Bill and Tony

Bill is a resident in a care home, who has been Tony (serious, sincere but calm): No Bill, honest,
diagnosed with dementia. Tony is a care worker who I would never spy on you. We had a long talk
knows Bill well. Bill will sit for long periods of time and yesterday and I really enjoyed hearing about all the
then become agitated. While sitting in his chair he has things you used to get up to. I was really interested
started to shout angrily at other residents. – you’ve lived an exciting life. I was wondering
whether you might have time to tell me a few more
Bill (very angry): You lot can get out of here, I don’t
stories?
want you round here anymore.
Bill (calmer tone of voice): Well, what about all these
Tony (calm and gentle tone of voice): Hello Bill, I
people in here?
am going to bring some coffee around in a minute.
Would you like a cup? Tony (expressing genuine interest): We could leave
them for the moment – tell me more about your
Bill (raising his fist): You can get out of here too. Go
time in South America.
on, get off or I’ll have you!
Bill (calm): Not sure I can remember, what were we
Tony (stepping back and lowering his head in a non-
talking about?
threatening way): Bill, you remember me. You told
me about your time in the Merchant Navy back in 1 What might have happened if Tony had
the fifties. confronted Bill and told him to stop shouting at
Bill (still angry): Don’t remember you – you weren’t the other residents?
there! 2 Can you explain how Tony showed respect and
Tony (calm, gentle, serious): No – but you told me all created trust?
about your time on the Sea Princess. How you went 3 Why did Tony avoid talking about the other
to South America, how you met your first wife. residents?
Bill (less angry but accusing tone): How do you know 4 How did Tony use his personal knowledge of Bill
all that about me? Have you been spying on me? to help defuse aggression?

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 BTEC’s own resources

Appropriate environment Table 1.5: Aspects of communication that increase self-esteem

The following ideas can help to reduce communication

Appropriate non- • Smiling
barriers in the environment:
verbal behaviour • Relaxed body posture
• Improve the lighting. • Looking interested
• Reduce any noise. • Being calm
• Move to a quieter or better-lit room. Appropriate • Using correct level of
• Work with smaller groups to see and hear more communication formality
easily. • Using language appropriate
to speech community
• Organise any seating so that people can see and • Using appropriate preferred
hear each other. language
Meeting self-esteem needs and • Using technological aids

maintaining an appropriate attitude Listening skills • Using reflective listening

• Having an appropriate
People who use services are often vulnerable. Many
attitude and valuing other
vulnerable people do not have the emotional security people
that comes from a high level of self-esteem. If a • Being willing to build an
person feels dominated or threatened he or she may understanding of another
develop low self-esteem. If children don’t feel valued, person’s views
they may not develop self-esteem. Adults who do not
feel valued may have difficulty in maintaining a high
level of self-esteem.
Your communication with people in care settings Key term
should involve understanding and responding to their Self-esteem – This is how you value or feel about yourself.
emotional needs.

Case study: Karen

Interviewer: You talk about about some of the good things in the news –
having the right attitude and soaps and things like that! I try to create a happy
‘putting yourself in other atmosphere because that can sometimes make a
people’s shoes’ but doesn’t person feel included and valued and increase their
that often make you feel sad self-esteem.
and depressed?
Interviewer: So just talking through positive things
Karen: No, you can in your life might make life seem more worthwhile –
understand how someone you value yourself more.
might feel without becoming
Karen: Yes, thinking over the good things is often a
overwhelmed. I always try to
way to increase self-esteem.
leave feeling happy or at least a little bit happier
than when I arrived. 1 What is self-esteem?
Interviewer: So how do you do that? 2 Why would talking about positive past life
experiences help some people to increase their
Karen: Well, keep people talking – most people self-esteem?
have some happy memories. I try to get them to
talk about some of the good things. I try to get a 3 How is Karen likely to know if she has been
positive feeling going. Sometimes, if it feels right, successful in making an individual feel happier
I mention happy things in my life or else talk about after working with them?

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 Unit 1 Developing effective communication in health and social care

Whether you work with children, older people or 3.2 Aids to communication
people with health needs, or physical or learning
disabilities, it is always possible to think of ways to help Human aids
increase another person’s self-esteem. There are several services that may assist people
to communicate or help to remove the barriers to
effective communication.
Advocates
Sometimes, when people have a very serious learning
Case study: Karen disability or illness (such as dementia) it is not possible
to communicate with them. In such situations, care
Interviewer: You services will often employ an advocate. An advocate
talked about creating
is someone who speaks for someone else. A lawyer
‘positive feelings’ – is
there any more to this, speaking for a ‘client’ in a courtroom is working as an
other than just talking advocate for that person. In care work, a volunteer
about positive past might try to get to know someone who has dementia
experiences? or a learning disability. The volunteer tries to
Karen: Well, sometimes understand and then communicate the person’s needs
it’s little things that make and wants. Advocates should be independent of the
people feel good. First, staff team and therefore able to argue for people’s
you have to make the rights without being influenced by what is the easiest
right relationship. I think it’s important to be
cheerful. I always think this is ‘their time’. I have
or cheapest thing to do.
to be cheerful for them – and very often when
I come out from a visit being cheerful with that
person has made me feel better too. Then I Key term
always try to remember the little details from a Advocate – Someone who speaks for someone else.
previous visit. I think people often feel valued
if you remember things about them. It always
helps to give people a choice about how they Advocacy is not straightforward; volunteers may not
want work done, what products they want and so
always understand the feelings and needs of the
on. I think people need to feel in control of their
lives in order to maintain a sense of self-esteem. people for whom they are advocating. Some people
Then I think it’s important to listen to people. If argue that it would be better if people who use
people listen to you then you matter, don’t you? services could be trained and supported to argue their
If people cut you short – well, then, perhaps own case. Helping people to argue their own case is
you’re not worth much. called self-advocacy.
1 What verbal and non-verbal behaviours might
help to create a cheerful atmosphere?
Interpreters, translators and signers

2 Why does choice have anything to do with self- Interpreters are people who communicate meaning
esteem? from one language to another. This includes
3 Why is listening to people linked to self- interpreting between spoken and signed languages
esteem? such as English and British Sign Language. When an
interpreter works with people, they become part of a
communication cycle with that person.
Translators are people who change recorded material
from one language to another. Translating and
interpreting involve communicating meaning between
different languages. Translating and interpreting are
not just technical acts of changing the words from
one system to another. Many languages do not have
simple equivalence between words. Interpreters and

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translators have to grasp the meaning of a message Interpreters may be professional people who are
(decode the message) and find a way of expressing it employed by social services or health authorities in
in a different language system. This is rarely easy, even order to communicate with people who use different
for professional translators. spoken or signed languages. They may also be friends
or family members who have sufficient language
ability to be able to explain messages in different
Activity 8: Exploring ICT circumstances.
translations When people do not use English as their first
language, they may experience difficulty accessing
Use an automatic language translation system to health or care services, unless they are supported by
translate a website that is written in a language
translators and interpreters. People who use signed
other than English. You may find examples
of confusing or even funny mistakes that the languages may also need assistance from interpreters
system makes. Compare your results with your and translators – see page 14 for further details of
colleagues’ research and discuss the problems signed languages.
that can arise when words are simply changed to
another language without any input from a human
translator. Mentors
Mentors are usually people who are highly
experienced in a particular job or activity; they advise
others who are new to the activity or less experienced.
Functional skills Mentors need effective communication skills, coupled
ICT: This activity may help you demonstrate ICT skills with some ability to explain issues and provide
associated with presenting information and English: guidance. If a person is referred to as a mentor, it
skills associated with reading and understanding text. might be assumed that they will provide guidance
based on their experience and knowledge of an issue.

Table 1.6: Important issues in interpretation

Knowledge of the A professional interpreter may be able to explain details of legislation or procedures
subject matter for claiming benefit because they understand the issues. If a relative or friend is acting
as an interpreter, they will have to make sense of the technical details before they can
communicate clearly.
Trust People must have confidence in their interpreter. Some people may find it hard to trust
a member from a different community. Many women may not feel safe and confident
discussing personal issues using a male interpreter. The issue may not be about the
interpreter’s language competence, but about the interpreter’s ability to understand and
correctly convey what a person wants to say.
Social and cultural The choice of an interpreter must support the self-esteem needs of people who need to
values access interpretation services. Many people may feel that it is inappropriate to discuss
personal details using an interpreter of the opposite sex. Some Deaf people do not feel
confident using interpreters who have not experienced deafness themselves.
Confidentiality Confidentiality is a right. Professional interpreters are likely to offer guarantees of
confidentiality. Using a relative or volunteer may not necessarily provide people with the
same guarantee of confidentiality.
Appropriate attitude A professional interpreter is likely to offer advanced interpersonal skills, which include
the ability not to judge what is being said. Volunteers, relatives and friends may have
language competence, but these people may not be able to interpret without involving
their own values, attitudes and beliefs.

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 Unit 1 Developing effective communication in health and social care

operator hears the reply and types what is said so that

Case study: Jasu the Deaf person can read the typed message.
Jasu is 10 years old. Her father does not Loop systems
speak English although Jasu has grown up to
A loop system enables people who use hearing aids
be multilingual. Jasu’s father is in poor health and
needs to explain his problems to a health worker. to hear sounds more clearly. A cable surrounds a given
area such as a public area, room or even a car. Sound
If Jasu had to interpret her father’s problems in
from a TV, microphone or music system can then
English:
be amplified into the loop. People with appropriate
1 How might she be affected emotionally while
hearing aids can switch their aid to a special setting,
explaining her father’s illness to someone she
does not know? enabling them to hear the amplified signal from the
loop.
2 Would Jasu be likely to find the right
terminology to explain complex health issues Voice-activated software
to a professional?
Voice-activated software enables a person to use
3 Why might the services of a professional speech commands to get their computer to perform a
interpreter be more appropriate in this
situation?

What qualities do you think a befriender

should have?
Befrienders
Befrienders seek to create a supportive relationship
with others. A befriender will have good
communication skills that enable them to listen to, and
build an understanding of, another person’s views and
feelings. A befriender will work ‘as if’ he or she was a
friend. Befrienders will not be assumed to have any
particular professional knowledge.

Technological aids
Hearing aids
Hearing aids are battery-powered electronic devices
with small microphones to pick up and increase the
volume of sound received by a person. Hearing aids
will often amplify background sounds as well as the
voice or other signal that the person wants to hear.
For this reason, a hearing aid will not always work
effectively in a noisy environment.
Text phones, relay systems and minicoms
Text phones and minicoms have a small screen and a
keyboard to enable messages to be typed. The reply
can then be seen on the screen. The Royal National
Institute for Deaf People (RNID) operates a text relay
service, whereby an operator can enable conversations
between speech phones used by hearing people and
text phones used by people who may be Deaf or hard
of hearing. A person can text their message to the
operator, who will read it to the hearing person. The

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variety of tasks. Some people use speech recognition

software to type messages without using a computer
Activity 9: Discussing
keyboard and this facility is particularly useful for barriers to communication
people with dyslexia, who may find it harder to
Think of particular examples of barriers to
communicate using typing or writing.
communication (perhaps taken from the
table opposite) and discuss the strengths and
PLTS weaknesses of different strategies to overcome
them. Your discussion activities may help you to
Independent enquirer: This discussion and thinking
work out some reasoned arguments for using
activity may help you demonstrate that you can
particular strategies within your work
support conclusions, using reasoned arguments and
placement.
evidence.

Case study: Gloria

Gloria grew up in the Caribbean and came to the UK and that trying to communicate with her is a
60 years ago. She now lives in a residential care home waste of time. Gloria sometimes becomes distressed
because she has developed some memory loss and because she is lonely and there is no one to talk to.
disorientation associated with Alzheimer’s disease.
Gloria also has some hearing loss and uses a hearing 1 Can you list the barriers to communication that
aid. Gloria’s first language is English but care workers Gloria is experiencing?
sometimes have difficulty understanding her speech. 2 Can you list ideas for overcoming these barriers?
Sometimes Gloria will talk about places and events 3 How could you use communication skills in order
from the past that care staff have difficulty identifying to increase Gloria’s self-esteem?
with. Some care staff think that Gloria is ‘confused’

Table 1.7: Ideas for reducing barriers to communication where people have a disability

Visual • Use language to describe things.

disability • Assist people to touch things (e.g. they might want to touch your face to recognise you).
• Explain details that sighted people might take for granted.
• Check what people can see (many registered blind people can see shapes, or tell light from
dark).
• Check glasses, other aids and equipment.
Hearing • Don’t shout. Use normal clear speech and make sure your face is visible for people who can
disability lip-read.
• Show pictures or write messages.
• Learn to sign (for people who use signed languages).
• Ask for help from, or employ, a communicator or interpreter for signed languages.
• Check that hearing aids and equipment are working.
Physical and • Increase your knowledge of disabilities.
intellectual • Use pictures and signs as well as clear, simple speech.
disabilities • Be calm and patient.
• Set up group meetings where people can share interests.
• Check that people do not become isolated.
• Use advocates – independent people who can spend time building an understanding of the
needs of specific individuals to assist with communication work.

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 Unit 1 Developing effective communication in health and social care

Table 1.8: Strategies for overcoming communication barriers

Type of barrier Possible strategies

Communication that involves Use listening skills/skilled use of the communication cycle. Develop a ‘caring
difficult, complex or sensitive presence’. Professional workers may develop empathy.
issues

Unmet language needs or Assessment of needs. Staff training to enable assessment of need. Use of
preferences preferred language. Training to learn to communicate using different languages
or systems.

Sensory impairment Use human or technological aids to compensate for impairment.

Disabilities See Table 1.7 on page 38 for strategies.

Communication involving Use listening skills/skilled use of the communication cycle. Try to make the other
personality or self-esteem person feel valued. Develop a ‘caring presence’. Use open questions, keep the
needs, or anxiety or depression conversation going. Avoid focusing on/discussing emotionally negative issues.

Aggression/submissiveness Stay calm, show respect. Use skills associated with assertion and defusing
aggression (see pages 30–33).

Assumptions, values or beliefs Use listening skills/skilled use of the communication cycle to detect barriers. Use
reflective learning skills to question own values, beliefs or assumptions. Staff
training to develop reflective learning skills.

Jargon Use listening skills/skilled use of the communication cycle to detect barriers. Use
appropriate language for other people.

Cultural variations Use listening skills/skilled use of the communication cycle to detect barriers and
check your understanding. Learn about the cultural variations among people
you work with. Staff training to learn about cultural variations. Avoid making
assumptions about people who are different. Consider involving advocates who
will represent the best interests of others.

Abuse of power Try to empower others. Reflect on and question own assumptions. Avoid
behaviours aimed at controlling or manipulating other people.

Alcohol or drugs Stay calm, show respect. Use appropriate non-verbal behaviour, avoid making
demands. Assess risk of assault.

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Assessment activity 1.4 P4 M2 D1

Using examples from class activities, your placement A strategy is a plan of how things are
or visits to health and social care environments, intended to be done but actual practice may not
explain how barriers to effective communication and be the same. Comparison of what is intended
interpersonal interaction may be overcome in health and what actually happens could be helpful.
and social care. For M2, review these strategies against
M2 Consider strengths and weaknesses of observed
best practice in communication and interpersonal interactions and communication practice and
interactions, particularly in relation to overcoming compare these with theories.
barriers. For the D1 evaluation, you will need to include
judgements about the effectiveness of different In preparation for the assessment, take part in
strategies for overcoming barriers to communication role-plays designed to simulate possible barriers
and support these with suitable explanations using to communication and discuss in class the
theories of communication and comparisons between effectiveness of how they were overcome.
different health and social care environments. D1 An evaluation requires both a judgement to be
made eg whether something is or is not effective
Grading tips in overcoming barriers and a justification or
P4 Use examples already explained and discussed explanation of how this judgement has been
in the previous three assessment activities, plus reached.
others as appropriate, to explain the strategies Your evaluations should include references to
used. relevant published sources in addition to your
Continue to use the notes in your logbook as a log book evidence or understanding gained
source of examples to illustrate points you make. from this book.

4 Be able to communicate and interact effectively

in a health or care environment
4.1 Contexts 4.2 Communication skills and
You will practise interactions and discuss their effectiveness
effectiveness before you present evidence of your own
To begin with, you might demonstrate your
practical work. To begin with, you might watch videos
communication skills using role-play or simulation.
or film clips of interpersonal interactions. You should
In role-play you have to behave in such a way that
practise identifying and describing different behaviours
other people can – at least temporarily – believe in
that you have seen and/or heard in recorded material.
the character you are portraying. Simulation does not
As you become more confident, you can role-play or
require you to use acting skills or portray a character.
simulate communicating in various contexts including:
If you simulate a conversation, you simply say (or sign)
formal; one-to-one; group; with people using services;
the appropriate responses. You do not expect people
with professionals/colleagues.
observing your behaviour to perceive you as anyone
This section of the unit is about your own skills in but yourself. Both simulation and role-play involve
communicating in interpersonal interactions. It is your thinking through appropriate responses but role-play
opportunity to demonstrate your ability to apply what involves a greater level of acting skill.
you have learned from the unit.
To demonstrate your communication skills, you will
need to cover verbal and non-verbal skills such as
listening and responding, tone, pace, language,
appropriate environment, proximity, clarifying or
repeating, questioning, responding to difficult
situations and defusing anger.
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Table 1.9: Checklist for analysing communication and interpersonal interaction

One-to-one interaction • How did you start and finish your interaction? Did you try to meet the person’s
emotional needs?
• Could you identify a communication cycle involving feedback on your understanding
of the other person’s ideas?
Group interaction • Were you able to take effective turns in speaking?
• Could you identify group values and/or purposes within the group?
• Was there a group leader? How was the interaction managed?
Context • Who was involved in the interaction? People who use services? Professionals?
Colleagues? What role did you play?
Verbal listening and • How effective was your use of language, pace of speech and level of formality? Was
responding skills there any use of specialist language? How far did you encourage others to talk?
Non-verbal listening • How appropriate was your voice tone, posture, facial expression, eye contact and
and responding skills proximity?
Reflective listening • How did you use reflective listening and the communication cycle? Can you identify
skills examples of clarifying your understanding or repeating important ideas?
Questioning skills • Did you keep the conversation going using open questions? Can you identify probes
and prompts that you used?
Environment • Did the environment create any barriers? Could everybody see and hear each other
clearly?
Barriers • What barriers did you detect? Were there any barriers to interpreting communication,
such as language differences?
• Were there any barriers to understanding, such as cultural differences, assumptions
values or beliefs?
Difficult situations • Did you act in a calm and respectful way? What skills did you use to interact with
people with strong emotions?
Defusing anger • Were you able to act in an appropriate, calm and respectful way? Were you able to
avoid triggering aggression? Were you able to use assertive skills appropriately?

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4.3 Effectiveness interpersonal skills, attitudes, overcoming barriers,

adjusting interactions, and your own assertiveness.
You should demonstrate effective communication in The checklist in the table below may be useful as a
both group and one-to-one situations including an starting point for assessing role-plays and recordings
awareness of the needs and preferences of others, of real interactions.

Assessment activity 1.5 P5 P6

P2 M2
M3 D2

For P5 take part in a one-to-one interaction. For are not in placement, you may need to visit the
P6 take part in an interaction with a small group of environment in advance to better understand
individuals in a health and social care environment. At the context and likely influences so you can
least one of the interactions should be with individuals take these into account when preparing for the
using services although one could involve a specific interactions. The interaction may be focused on
interaction with a professional in the environment a specific activity eg a creative activity or other
relating to an important aspect of care. care task and your preparation would include
For both interactions produce evidence to appropriate planning for this activity as well as
demonstrate your role in each interaction. This should the communication skills you will use.
include a witness testimony from a professional in the Your contributions to the interactions do not
environment who has been present whilst you have necessarily need to be transcribed but your
carried out the interactions. You should also provide evidence should consider the skills you used,
your own account of each interaction. influences and context of the interactions
For M3 you will need to include a detailed description and you should demonstrate respect for the
of the skills you used in the interactions and how rights and confidentiality of the individuals
these related to the context of each interaction and involved in all records/notes you do make of the
the responses made by the individuals involved. For interactions and in your assignment evidence.
both interactions, you should explain how and why M3 To achieve a merit grade, you must reflect on
you applied theory, took account of influences on the your own communication and interpersonal
interactions and minimised or overcame any barriers. skills and provide an analysis, preferably
For D2 the account of the interactions should also including your strengths and weaknesses within
include an evaluation of each and of the skills you each interaction. This reflection should cover
used. both one-to-one and group interactions. You
could discuss the notes you have made on your
Grading tips one-to-one and group observations with your
P5 P6 Gain written consent to carry out the supervisor or tutor to help you develop the
interactions from a suitable professional in the ability to analyse your own interpersonal skills.
health and social care environment and include D2 At this level, you need to go further and
this in your assignment. evaluate the quality of your communication
Both interactions need to be specific planned and interpersonal skills in one-to-one and
activities for the purpose of the assessment group interactions. Your evaluation will involve
and you should obtain confirmation from your a more in-depth discussion of the factors that
tutor that the plans are appropriate before have influenced the effectiveness of your own
carrying out the interactions. It is not possible interaction. Emphasise your good points and
to achieve these criteria from casual, ongoing also those skills which you find difficult and
day-to-day interactions in a placement. If you need to practise more often.

PLTS
Self-manager: This activity will enable you to demonstrate the ability to assess yourself and review progress.
your ability to organise your own time and resources. You may evaluate your experience and learning and
communicate what you have learned in different ways.
Reflective learner: This task will enable you to demonstrate

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 Unit 1 Developing effective communication in health and social care

Resources and Useful websites

further reading Braille www.brailleplus.net
British Sign Language www.bda.org.uk
Argyle, M. (1972) The Psychology of Interpersonal
Behaviour, second ed. Harmondsworth: Pelican Makaton www.makaton.org

Burnard, P. (1996) Acquiring Interpersonal Skills, Signs and finger spelling alphabet
second ed. London: Chapman & Hall www.british-sign.co.uk
and at www.royaldeaf.org.uk
Burnard, P., Morrison, P. (1997) Caring and
Communicating Basingstoke and London:
Macmillan Press Ltd
Engebretson, J. (2003) ‘Caring presence: a case
study’ in Communication, Relationships and Care
Robb, M., Barrett, S., Komaromy, C., Rogers, A. (eds)
London & New York: OU & Routledge
Pinker, S. (1994) The Language Instinct
Harmondsworth: Penguin
Tuckman, B. (1965) ‘Development Sequence in
Small Groups’, Psychological Bulletin, Vol. 63, No. 6

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Just checking
1 Why is tone of voice categorised as a non-verbal rather than a verbal issue?
2 Is it true that effective, caring, communication can be defined as ‘clear, concise transmission of
information between people’?
3 What is reflective listening and why is it important?
4 Rachel says, ‘I never let anyone else win an argument with me – I always get my own way!’ Is it
correct to describe Rachel’s attitude as being assertive?
5 If you met a person who said, ‘I can’t hear you, I need to put my glasses on’ what sense could you
make of this communication?
6 Is it possible for a person who has no knowledge of the English language to be able to sign using
British Sign Language?
7 What problems might arise if a relative (with the necessary language skills) acts in place of a
professional translator?

Assignment tips
1 Before you start to make logbook records you might like to state how you will record details of
conversations and other interactions. You could include a statement about how you will respect
confidentiality, respect the rights of others, and show respect for other people. You must also be
sure that if you take notes about people who use services your note-taking will not create any
misunderstandings or cause any stress to these people.
2 Use video recording of role-plays or simulations to help you identify how theories of communication
work before attempting to analyse workplace interactions.
3 A range of potential barriers and misunderstandings can influence communication in care settings. Very
often there will be a number of issues that are relevant to any particular observation you have noted.
4 Use role-play and simulation followed by discussion to help you develop skills for reviewing and
evaluating strategies to overcome barriers.
5 It may be a good idea to record a practice one-to-one and group interaction and discuss your
performance with colleagues, supervisors and/or tutors before undertaking the observation that you use
for your assignment. If you practise taking notes and discussing the quality of your interaction you may
pick up some good ideas that you can incorporate in your final assignment.
6 When you make notes about a one-to-one or group interaction you should make your notes
immediately after the conversation or meeting. These notes will help you describe your interactions at
a later date. You will not be able to remember everything that you said or did, or that other people did.
You should aim to recall some of the key things you said and to remember the responses others made.
You should also make notes about some of the non-verbal behaviours you saw in others as well as your
own non-verbal behaviour.

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