THE CARE CERTIFICATE WORKBOOK
Communication
The CARE CERTIFICATE
6
Standard
What you need to know
THE CARE CERTIFICATE WORKBOOK STANDARD 6
1
The importance
of effective
communication
Good communication develops
your knowledge and understanding
about individuals and the part
played by other workers so that the
best care and support possible can
be provided. It helps build working
relationships where each person’s
views are valued and taken into
account.
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THE CARE CERTIFICATE WORKBOOK
Communication
Communication is an essential part of a caring relationship and helps to encourage
trusting relationships with other workers and families as well as the individuals you
care for.
Types of communication
Talking is often seen as the most common method or type of communication but most
communication is silent. Gestures, tone of voice, grins, grimaces, shrugs, nods, moving
away or closer, crossing arms and legs all tell us far more than words. Learning to take
account of these reactions is all part of developing your communication skills to achieve
the best outcomes for individuals. Communication can be harder when we can’t see these
signs such as when we use the phone, texts or email.
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Different people have different ways of communicating that work best for them. Some of
the different types of communication are:
Verbal communication - Differences in how you speak, including the tone, pitch,
speed and volume of your voice could change how your messages are taken in.
Try to avoid using jargon or abbreviations and complicated words and terminology.
Make sure you always speak in a respectful way, adjusting your speech to suit the
individual.
Sign language - This is a recognised language throughout the world. British Sign
Language (BSL) is used by individuals in this country and there are variations of sign
language in different regions.
Makaton - This is a form of language that uses a large collection of signs and
symbols. It is often used with those who have learning and physical disabilities, or
hearing impairment.
Braille - Is a code of raised dots that are ‘read’ using touch. For people who are
visually impaired or who are blind, the system supports reading and writing.
Body language – This is a type of nonverbal communication. There are many
different aspects of body language, including gestures, facial expressions, eye
contact, body positioning and body movements. Each of these will communicate
information about an individual or a worker often without them realising it.
Gestures – These are hand or arm movements that emphasise what is being said or
used as an alternative to speaking.
Facial expressions – These support what is being said by showing reactions or
feelings. They can give you valuable clues that you can use to check out a
person’s feelings.
Eye contact - Maintaining good eye contact is an important way for a worker to
show that they are engaged and listening.
Position - The way that we stand, sit or hold our arms when we are talking will
provide others with clues about our feelings, attitude and emotions.
Written communication - This method is used to send messages, keep records, or
provide evidence.
Communication with other workers and individuals
Workers will develop many different relationships. Some will be formal and others more
informal. Successful two-way communication is crucial in both cases. A relationship based
on trust and understanding from the beginning will provide the basis for good care and
support whether short or long-term.
Poor communication can quickly lead to confusion and distress. The process of
exchanging information through communication is not always straightforward. If the
information shared is inaccurate or misleading, mistakes can be made which can result in
poor care.
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Formal
Formal communication is likely to be used in the working environment, particularly
between you and other workers.
Informal
Informal communication is likely to be used with friends and family, using familiar
words or slang.You should always use the communication method that is appropriate
for the person and situation.
You should watch for clues from any individual that come from unspoken messages.
These non-verbal ways of communicating come from body language, position, facial
expressions or gestures. For example, when asking someone if they are in pain, they
may say ‘no’ but a wrinkled brow, uncomfortable facial expression or body movement may
say otherwise. As an observant worker you will be able to notice when an individual is
becoming confused, angry, upset, stressed or anxious without them telling you. You can
then take action to help stop this from happening or help them express their feelings in the
best way for them.
By noticing an individual’s reactions you can ask yourself the following questions:
Do I need to change the type of communication I am using to help the individual
understand?
Do I need to be aware of how the conversation is affecting them?
Is there something that the individual is not communicating to me that may help?
Recognising the unspoken messages can help you to ask good questions and develop
supportive relationships. It improves trust as the individual can see that you are interested
in them and trying to understand and meet their needs.
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Communication and language needs, wishes and preferences
To find out what an individual needs or wants, so your work can be centred on them as
a person, you have to connect with them. So that means that you must understand their
communication needs right from the outset.
People’s unique communication needs vary depending on their ability, disability, illness
or condition, as well as on their personal preferences. If you can’t find out from talking
and listening how a person needs to communicate, you will need to use other methods
of communication to help them get information across to you in a way that works best for
them. The individual’s family, friends or carer might be able to share experience of which
communication methods work best—but sometimes part of the problem is that they don’t
communicate well with the person being supported, so don’t rely on this method alone.
Communicating by touch or physical contact
The individual’s preferences are particularly important in relation to using touch as part of
non-verbal communication. Touching a person might be done as a form of communication,
for example shaking hands or kissing. But other types of touch will almost certainly
also communicate something to them, for example what they experience from the ways
that they are physically helped to stand or sit or turn over in bed, and particularly their
experience of being touched in the course of intimate personal care such as washing.
In all cases, how you touch anyone must be decided thoughtfully and in a person-centred
way. So your use of touch may well be different from one person to the next, and will be
something that you will need to talk about with each person whom you are helping so
that you know their particular preferences. This is also a key area to talk about with your
manager and work colleagues, especially if you are supporting anyone who cannot clearly
communicate their own preferences to you.
On the whole, any form of touch must be consented to by both people. But sometimes it
may be necessary to touch someone when they do not want to be touched, for example if
they need to be physically restrained for their own or someone else’s safety. You must talk
with your manager about what are the agreed ways of working in your workplace so you
know what to do if this happens.
Remember too that the use of touch must be within the rules for infection control in your
workplace.
See also Care Certificate standards 7 (Privacy and dignity) and 15 (Infection prevention
and control).
Some specialist methods of communication
Touch is used in particular ways to communicate with people who are deaf and visually
impaired. Workers sign information onto the individual’s hands as a way of passing on
information.
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For those whose communication skills may be limited, technological aids can be used.
Hearing aids, hearing loops, text phones, text messaging on mobile phones and magnifiers
are all forms of technological communication devices.
Some individuals may use word or symbol boards to support their speech and/or their
understanding. This helps the listener by to associating a picture or printed word with the
verbal communication in order to be able to understand what is being said.
Others may use speech synthesisers, which replace speech either by producing a visual
display of written text or by producing synthesised speech that expresses the information
verbally. Voice recognition software can be purchased for computers (including many
tablet ‘pad’ computers with touch screens) to translate speech to written text or the other
way around. Some word-processing programs and apps have this already built in.
When using communication aids always check that they function properly, that they are
clean and in good working order. Should you have any worries about communication aids
or technology not working properly, or being unclean, report this to a senior member of
staff or the individual’s carer or family member.
Barriers to effective communication
A barrier is anything that will get in the way of communication. There are a wide range of
barriers including:
Attitude – When a worker is abrupt due to time limits, not having enough resources or
their mood, the person they are speaking to may feel intimidated or frustrated and not want
to communicate.
Limited use of technology – When the technological aids known to be the best way for
someone to communicate are not available.
Body positioning – Sitting too close could be intimidating and would make an individual
feel uncomfortable. Sitting too far away could show lack of interest or concern.
Emotions – When someone is depressed, angry, embarrassed or upset their emotions
may affect their ability to think and communicate in a sensible way.
Physical – When someone has physical conditions that create communication difficulties,
for example, being breathless, not having any teeth or being in pain.
Not enough time – Not giving individuals time to say what they want may make them feel
rushed and reluctant to express their true wishes.
Poor or negative body language – Crossed arms or legs, poor facial expressions, poor
body positioning, constant fidgeting or looking at a watch or mobile phone can all make
someone less likely to communicate.
Lack of privacy – Think carefully about where and when private and confidential
conversations should take place.
Stereotyping – Generalisations about a group of people that are wrong and misleading.
An example would be that ‘all older people are hard of hearing’.
Other barriers include sensory impairments, culture, language, noise, lighting or substance
misuse.
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Reducing barriers to communication
As a worker you should do what you can to reduce any barriers to communication. The
most effective way to make sure that you are meeting someone’s communication needs
and providing person-centred care is to know as much as possible as you can about them.
A ‘communication passport’ might be used by some which provides vital information
about their needs, wishes and preferences. This pulls together the information into a
format that is easy to read, often with pictures and photographs. Putting something like
this together with an individual can be another good way of getting to know them well
and understanding their needs. Your organisation might have a suggested format but at a
simple level you can put one together with the individual to suit them.
It is important to get regular feedback about your communication style and methods from
the people you provide care and support to so that you can continue to improve how you
communicate. You could also increase your awareness of different communication needs
and methods through taking up learning opportunities. Experience will help you to develop
a variety of new methods of communication and selecting the best one in each situation.
Be creative. Open body language and a positive, non-judgemental attitude will further help
reduce barriers. Your communication skills should be seen as a toolbox, using the right tool
for the right job and choosing a different tool if one doesn’t work well.
Checking understanding
Checking that communication has been understood
is an essential part of the process. A vital skill that
checks understanding is summarising. A summary
should bring together the main points of an exchange
of information. This will allow the individual to correct
you if necessary. This can help you to check that you
have correctly understood. Questions are another way
of checking whether a message has been received.
Make sure you ask questions in a way that the
individual has to provide a detailed response (open
questions), rather than asking questions which require
only a ‘yes’ or ‘no’ reply (closed questions). For
example: ‘What do you like to do in your spare time?’
However, closed questions can be useful in some
situations.
Summarise
This means to think about the main points of the conversation or communication and
shorten or simplify them in order to repeat them back to the individual. This will help to
check your and their understanding.
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Additional information and support
Information and support on particular communications needs can be found from specialist
charities and associations, especially those specialising in particular disabilities or medical
conditions. Websites can provide material on forums, services or groups in the local area
that you could attend or use to find out more.
In addition, some local charities offer specific human aids such as befrienders, advocates
or mentors. A befriender could support an individual in overcoming emotional difficulties
that are a barrier to their communication. An advocate could communicate on an
individual’s behalf if their skills are very limited.
A number of additional key experts available to support individuals with their
communication needs include speech and language therapists, interpreters, translators,
and clinical psychologists or counsellors. Further learning can come from other workers,
your manager and a wide range of courses and qualifications.
Confidentiality
Confidentiality is an essential principle in health and social care and forms the basis of all
ways of working and codes of practice. The basis of a good working relationship is trust.
This is dependent on the individual being confident that personal information about them is
treated confidentially. Information about someone must only be shared with others involved
in their care and support on a ‘need-to-know’ basis. Any information should not usually
be disclosed without the person’s informed consent. The circumstances when information
must be shared even if the individual does not give consent are listed later in this section.
An individual’s right to confidentiality also means that a person’s notes or details must
always be stored securely, for example in a locked cupboard, and not be left where they
can be seen by unauthorised people. Computers or mobile devices such as electronic
tablets need to be protected by a password and firewall. When talking about an individual
you must ensure no others can overhear you.
It is essential that you obey the laws about confidentiality, particularly:
General Data Protection Regulation 2016 – which place obligations on organisations
to process personal data securely. This includes protecting people’s privacy, giving
individuals the right to consent to data collection and the right to have data removed.
Informed consent
To give informed consent the individual must be provided with all of the necessary
information in order to make a considered decision. See standard 9 for further
information about consent and informed consent.
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Human Rights Act 1998 – This Act determines a number of basic rights for any citizen of
the UK. The important one in this context is the right to respect for private and family life,
home and correspondence.
www.legislation.gov.uk/ukpga/1998/42/contents
You must find out from your manager what your workplace’s agreed ways of working are
for putting these laws and other aspects of confidentiality into practice.
Limits to confidentiality
Whenever possible, individuals should provide their consent for the transfer of information.
However, this may not always be possible and there will be occasions when information
normally considered confidential needs to be shared. Examples of occasions when
confidentiality may have to be broken are:
a person is likely to harm themselves
a person has been, or is likely to be, involved in a serious crime
a person is likely to harm others
your safety is placed at risk
a child or vulnerable adult has suffered, or is at risk of suffering, significant harm.
There will be times when you face dilemmas about confidentiality, not knowing what to do
or if you should speak to anyone about the information you have. At these times it
is important to speak with your manager and follow the agreed ways of working. If your
manager is not available, a senior member of staff or other worker should be able to help.
See also Care Certificate standard 14 (Handling information).
Communication in summary
Communication may take place face-to-face, by telephone or text, by email, internet or
social networks, by written reports or letters. It requires you to listen or read (and
understand) as well as to speak or write. Whether you are communicating face-to-face,
on the telephone or in written form, always be respectful, try to match your method of
communication to the individual’s needs and be aware of confidentiality.
THE CARE CERTIFICATE WORKBOOK
Communication
The CARE CERTIFICATE
6
What do you know now?
Standard
THE CARE CERTIFICATE WORKBOOK STANDARD 6
10
Activity 6.1a
Choose five different types
of communication and
describe how and when
they might be used.
Type How and when it could be used
1.
2.
3.
4.
5.
Communication
Describe - to describe means to create a
picture with words but not simply writing
a list of bullet points.
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Activity 6.1b
Use examples from your
own workplace to describe
how good and poor
communication could affect
relationships at work.
1. Examples of good communication affecting a work relationship:
2. Examples of poor communication affecting a work relationship:
Describe - to describe means to create a
picture with words but not simply writing
a list of bullet points.
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Activity 6.1c
Imagine you are talking to an
individual about a change to their
care plan. During the conversation,
which starts very relaxed, you notice
that the person starts getting fidgety
and avoiding eye contact. Their
body language changes, they turn
sideways on their chair so they no
longer face you.
1. Why is it important that you notice the changes in the other person’s reactions?
2. Why is it important that you respond to the changes in the other person’s
reactions?
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Activity 6.2a
Part i) Use the spider
diagram to list four ways
that can help you to
establish an individual’s
communication or language
needs, wishes and
preferences.
Ways that can help
me to establish
communication
language
needs, wishes &
preferences
List: to list means to write in bullet points
or provide short answers that are straight
to the point.
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Activity 6.2a
Part ii) Describe how each
of the above can help you
to establish an individual’s
communication and
language needs, wishes
and preferences.
2
3
4
Describe: to describe means to create
a picture with words but not simply writing
a list of bullet points. Include details like
why and how.
1
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Activity 6.2b
Think of the different communication
needs, wishes and preferences that
individuals may have. Complete
the diagram below to list at least
six different styles or methods of
communication that could help
you when communicating with
individuals. An example has been
provided for you.
Communication
styles and
methods that help
to meet needs,
wishes and
preferences
Touch
List: to list means to write in
bullet points or provide short
answers that are straight to the
point.
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Activity 6.3a & b
Complete the table below
to make a list of potential
barriers to effective
communication and
describe ways to reduce
the barrier. An example has
been provided for you.
Barrier to communication How it can be reduced
1. Substance misuse If an individual’s behaviour is affected because of misuse
of substances, I need to think carefully about how I will
use my communication skills to make sure the individual
is supported. If they are frustrated and angry I will need to
use a calming tone of voice and relaxed body language
but maintain a safe distance.
2.
3.
4.
5.
Describe: to describe means to create
a picture with words but not simply writing
a list of bullet points. Include details like
why and how.
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Activity 6.3c
During any conversation or
discussion, you would like to know
that you have got your point across
to the other person or people, and
that they know or understand what
you mean. How could you check
to make sure that the other person
understands what you are saying?
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Activity 6.3d
Think of an individual or group of
individuals in your workplace that
you might struggle to communicate
with. Make sure you respect
confidentiality by not using their
name. Who could help you with
information, support or services to
communicate more effectively? How
could they help?
The example from my place of work I have chosen is:
I could find information and support or services from:
They could help me to:
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Activity 6.4a
In your own words,
describe the meaning of
confidentiality in relation
to your job role. You might
use your contract or job
description to help you.
In my job role as _____________________________________ , confidentiality
means:
Describe: to describe means to create
a picture with words but not simply writing
a list of bullet points. Include details like
why and how.
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Activity 6.4b
Familiarise yourself with
your workplace’s agreed
ways of working in relation
to confidentiality. Complete
the table below to list
legislation and agreed
ways of working to maintain
confidentiality in your daily
routines.
Agreed ways of working: this refers to company
policies and procedures.This includes those less
formally documented by individual employers and the
self-employed as well as formal policies such as the
Dignity Code, Essence of Care and Compassion in
Practice.
Legislation Agreed ways of working
List: to list means to write in bullet points or provide
short answers that are straight to the point.
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Activity 6.4c
At times you may come across
situations where you need to
share confidential information,
even if the individual doesn’t
want you to. Give three
examples of situations that might
happen in your workplace where
information might need to be
passed on to other key people.
Example 1:
Example 2:
Example 3:
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Activity 6.4d
Imagine one of the situations
you have described in the
last task happens whilst you
are on duty. Who could you
ask for advice and support
about confidentiality? And
how would they be able to
help you?
People I could ask: They could help me with advice and support because:
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