Unit 01

Promote communication in care settings

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Unit purpose and aims

This unit is aimed at those who work with adults in health or social care in a wide range of

settings. The unit explores the central importance of communication, as well as ways to

meet individuals’ communication needs and preferences. It also considers issues of

confidentiality.

The learner will:

1. Understand why effective communication is important in the work setting

2. Be able to meet the communication and language needs, wishes and

preferences of individuals

3. Be able to overcome barriers to communication

4. Be able to apply principles and practices relating to confidentiality

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1.1 Identify the different reasons why people communicate

What is communication?

Communication can be defined as:

‘Any act by which one person gives to or receives from another person information

about that person's needs, desires, perceptions, knowledge, or affective states.

Communication may be intentional or unintentional, may involve conventional or

unconventional signals, may take verbal or non-verbal forms, and may occur through

spoken or other modes.’

In order to communicate effectively with people, it is helpful to understand what is

involved in the process and what it means. The purpose of communication is to get your

message across to others. This is a process that involves both the sender of the

message and a receiver.

Communication does not necessarily have to involve language and does not have to be

verbal; for example, people who have a hearing impairment often communicate through

gestures and sign language. Babies can communicate their needs through crying and

facial expression. It is useful to think of communication as a loop, as shown below.

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On the whole, this process may look simply, but really, it is not. A breakdown in

communication can occur at any point within this loop; if any part of the process is not

successful, this will ultimately lead to a breakdown in communication. This simply means

that there is a break somewhere in the loop.

Very often, information surrounding the issue of communication is based on the

assumption that all parties can absorb and understand the information and can respond

verbally. This, however, is not always the case. Communication barriers can arise at any

stage of the communication process; messages can be misinterpreted by one or more of

the people involved and can lead to confusion. In fact, a message is only successful when

both the sender and the receiver perceive it in the same way.

Understanding how to communicate effectively, practicing new skills and improving

existing ones will benefit not only you, but all those with whom you communicate. As a

care worker you are communicating with other people all of the time, so the

effectiveness of your communication, whether verbal, non-verbal or written, will have a

direct influence on the care that individuals receive in your health care setting.

Message

Sender Receiver

Response to show

understanding

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Understanding the communication and language needs of individuals

Communication is a basic human right. It is through communication that we are able to:

Control our existence

Make friends and build relationships

Become independent and make choices

Learn

Express our feelings, thoughts and emotions

Make sense of the world around us

Form and maintain relationships

Exchange of information/views and opinions

Make an individual’s, needs, wishes and preferences known

Understand the needs, wishes and preferences of others

Convey feelings, thoughts and opinions

Understand the feelings, thoughts and opinions of others

Enable and enhance learning and understanding

Instruct and teach

Build and maintain self-esteem, a sense of security and promote feelings of

belonging

Take part in social interaction

Plan services.

This list is not exhaustive. You may be able to think of many other reasons.

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1.2 Explain how communication affects relationships in the care setting

Effective communication impacts on all aspects of working within an adult care setting.

Every aspect of care involves effectively communicating with the individual themselves,

those significant to them, and those involved in assessing, planning, implementing and

evaluating care holistically. This could include care professionals and others from within

and outside the organisation.

Therefore, those within the care setting will benefit, as work teams co-operate and

collaborate in order that individuals receive the best quality of care.

Communication can occur at differing levels.

Particularly important interactions in your workplace will occur between:

Healthcare staff and individuals, they care for

Healthcare staff, the relatives and personal carers of the individual

Professionals within the multidisciplinary team

Healthcare staff communicating with each other

Individuals, their relatives and friends.

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Why is communication important?

Good communication, at an appropriate level, increases the chances of an

effective working relationship between professionals and individuals

Good communication decreases the chances of individuals feeling patronised.

Many people will have lost their independent lifestyles, so it is extremely

important to help them retain as much independence as possible

Good communication will help to reassure individuals (and their family and

friends) who have recently been admitted to your care environment as they may

be feeling anxious

Open, honest communication from the start will allow realistic goals to be set,

as trust develops between all parties

Trust forms the foundation for effective communication

Poor communication can result in misunderstanding and cause unnecessary

distress for the individual, their family and friends

Poor communication can result in the individual’s fears and questions remaining

unanswered which can increase stress for individuals, their relatives and friends,

as well as for care staff.

Communication is a two-way process that enables positive relationships to develop in the

workplace. Workers, colleagues, individuals and others are able to communicate

effectively. There is clarity, so comprehension and understanding are promoted, enabling

reflection, feedback and evaluation to take place.

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Communication in work settings

Effective communication impacts on all aspects of working within a care setting. Every

aspect of care involves effectively communicating with the individual themselves and those

involved in assessing, planning, implementing and evaluating care holistically. This may

include:

The immediate care team

Other care professionals within and outside the care organisation

Family, friends and carers

Work teams who support the work you do (e.g. domestic, catering, maintenance)

Other agencies who provide service resources and support to care staff,

individuals and their families.

Effective communication will impact positively on all aspects of the care setting.

Therefore, those within it will benefit as work teams co-operate and collaborate in order

that individuals receive the best quality of care.

1.3 Explain ways to manage challenging situations – see learning

outcome 3.5

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2.1 Demonstrate how to establish the communication and language

needs, wishes and preferences of individuals

All communication should focus on the individual, their needs, preferences, and method

and style of communication. Full assessment of needs should be carried out and a care

plan developed with the involvement of the individual. All those involved in the care of the

individual, should be fully aware of the contents of the plan of care and work together to

promote effective communication. Taking a comprehensive history during the admission

process will assist this, as any communication difficulties may be highlighted.

Obtaining information on an individual’s communication and language

needs and preferences

Even though you may not be directly involved in the initial assessment process, it is

essential that you are aware of the communication needs that a person has, in order that

you can support them fully. To obtain information about a person’s communication

preference and needs, it is important that you know something about them. You can:

Speak to the individual and find out more about them, if this is possible. Talk

with the individual, confirm information with them and discuss any changes in

their needs. This will involve and empower the individual and ensure that the plan

of care meets their needs, acknowledging and addressing changes as they occur.

In some care settings, obtaining information from the individual maybe difficult.

This could be because an individual has no speech, a lack of insight into their

communication needs (such as individuals with dementia), or those who are

unable to communicate due to an unconscious state. You will need to seek

guidance and support, in order to fully meet the needs of these individuals

Read the individual’s care plan where their needs, likes and dislikes should be

outlined

Liaise with other care workers. Communication differences must be

communicated to all staff, especially when

- The individual’s ability to communicate changes

- The staff on duty are unfamiliar with the individual

- In preparation for, and during and after review meetings

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Liaise with key people such as family and friends of the individual. If an

individual is not able to express their needs to you, family and friends may be

able to give valuable information. Family and friends may have been the first to

notice and alert health care professionals to any communication difficulties, and

may encourage the person to seek help for sight, hearing, speech or memory

impairment

Liaise with other health care professionals such as speech and language

therapists, nurses etc.

Observation

Before you talk to the individual, you will make your own personal observations about them.

Those observations will directly influence the way in which you communicate with them.

Getting to know the individual will help you to understand their communication needs. In

order to understand a person’s communication needs fully, it is essential that an initial

assessment is carried out. In carrying out this assessment the outcome will be dependent

upon the assessor’s communications skills.

Identifying communication and language needs

Undertaking an assessment of any individual requires skill and should be based on the

general principles of a person-centered approach, and the individual's right to a high

standard of assessment and services. A person-centered approach means ensuring that

everything we do is based on what is important to that person. It is essential to take into

consideration the whole care needs of the individual.

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Any assessment should take into account the psychological, social, spiritual and physical

needs of the person. It is not enough to simply look at the person’s medical condition. In

order to provide care that is holistic, you must look at the person as a whole.

The Importance of working in partnership with carers, families, advocates and others

Individuals need to feel successful in their daily lives. Empowering individuals,

encouraging self- management and allowing them to become partners in care will ensure

that realistic goals are set. The individual can then achieve his or her full potential. This

will lead to a sense of fulfillment.

The importance of working in teams and in partnership with others

When teams work well together, it has a positive impact on both individuals and

other staff. Having the right attitude at work is expected of all staff.

There are many instances where individuals have to work as a team. Within a team, it is

ideal to have people from different backgrounds and experiences; this can help the team to

evaluate individuals’ needs, using ideas from a diverse group of people.

The Skills for Care standards 3.3 and 4.1 state that:

3.3 - You must work openly and co-operatively with colleagues including those

from other disciplines and agencies, and treat them with respect

4.1 - You must communicate respectfully with people who use health and care

services and their carers in an open, accurate, effective, straightforward and

confidential way.

Partnership and participation

Standard 3 of the Skills for Care Code of Conduct states that you must “work in

collaboration with your colleagues to ensure the delivery of high quality, safe and

compassionate healthcare, care and support”.

Individuals should be included in the planning and delivery of all aspects of their care

(standard 4). This will ensure that the service provided puts the individual at the centre of

everything you do.

Decisions are made and care is delivered with the individual’s knowledge, understanding,

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co- operation and consent. You, as a care worker, should actively support individuals to

participate as much as they are able.

As a care worker, you can help an individual hold onto his sense of ‘who they are’ by

respecting their individuality, getting to know them and learning their life history.

Understanding the uniqueness of the person will promote individuality. If we look closely at

the person’s individuality, recognising their strengths and skills, this will also help to

promote independence.

Standard 2.6 of the Skills for Care standards states that:

“You must maintain the privacy and dignity of people who use health and care

services, their carers and others.”

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2.2 Describe the factors to consider when promoting effective

communication

Learning how to communicate effectively is a skill that we develop throughout our lives.

This is made more complex as each person is influenced by many differing variables, such

as:

Some people may achieve effective communication skills confidently, whilst others may

find communicating daunting and, at times, stressful. This applies not only to you as a

care worker, but also your colleagues, individuals and their visitors. Intrapersonal

variables can make each interpersonal communication unique. Every person interprets

messages differently.

Having knowledge of these factors may help you to understand why some people have

difficulty in communicating, and the strategies you may need to adapt, in order to help

them. It is important to remember that everyone has the right to control their existence

through the recognition and meeting of their communication needs; different ways of

communicating should be equally valued and accepted.

Gender

Perceptions

Disability

Setting (where the interaction takes place).

Life experience

Culture

Age

Personality

Values

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Environmental issues

It is essential that the environment in which the communication of individuals takes place,

is suitable in all respects. A private area should be provided for individuals to discuss

personal issues. Surroundings should be comfortable and relaxing, and interruptions kept

to an absolute minimum. An environment that has been carefully thought out can assist

individuals to communicate effectively, so that their needs and wishes would become

known. Peace, quiet and privacy are essential elements of the environment. If the

environment is the individual’s own home, family members, telephones and the television

can all be sources of distraction. In health care settings, interruptions can occur

frequently. Other health care workers need to be made aware that you should not be

disturbed. Within hospital settings, where often the only thing that separates people is

curtains, this may mean that others are able to listen to conversations, therefore

confidential, personal, complex or sensitive information may need to be discussed in a

more private environment.

Supporting the communication needs of individuals

Some people you care for may have a specific communication difficulty that makes it

difficult for them to transmit and/or receive information. The support required will vary

according to the skills and impairment of the individual. It is essential you check they

each have the appropriate support to enable them to communicate.

Some of the factors affecting communication may be immediately apparent; whereas

other factors may not be quite so apparent until you get to know the person a little bit

better. Another factor to take into consideration is that an individual’s ability to

communicate effectively, and also their needs, may change over time. Therefore, whilst

an initial assessment may not have highlighted a problem with communication, their

needs may change at any time. Assessment should, therefore, be ongoing, but may not

necessarily be formal. You may notice subtle or dramatic changes whilst simply having a

conversation with an individual. It is vital that if you notice deterioration, or if the

individual’s needs change, it is reported to an appropriate person, is fully documented and

is acted upon.

Having knowledge of barriers to effective communication can help you to recognise where

a barrier may arise and ensure that steps are taken to amend the care plan, in order to

minimise any distress to the individual.

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The manner, level and pace of communication

It is important to remember that each person is an individual with their own

communication skills and style. Ensuring that you speak at a level and pace to suit each

person is a skill that will take time and practice to perfect. Speaking in very simple

language to an able, intelligent person can appear patronising or worse, insulting and

humiliating. However, using complicated language and complex instructions to an

individual who has limited understanding, can result in misunderstanding and them

becoming confused and anxious. The use of medical terms and jargon should be

avoided, as this can be difficult for individuals to understand and may prevent them from

receiving all the information they require. It may also create a barrier between care

worker and the individuals they care for.

Meeting the needs of individuals

Remember, all individuals have the right to communicate in the way they prefer, and

their rights must be actively promoted.

The way that you communicate with an individual will depend upon the person’s needs.

There is little point in communicating verbally if the individual cannot hear what you are

saying and only communicates using sign language and does not lip-read. Attempting to

communicate with an individual in a manner that they do not understand will only cause

unnecessary frustration and distress and could lead to misinterpretation of what has been

communicated.

You should be aware of any communication barriers, and the needs of the individual,

before communicating any form of sensitive information. You should take steps to

ensure that appropriate support is put in place in order to help the whole communication

process. This may involve the use of outside agencies in the form of a sign or language

interpreter, or it may be something as simple as ensuring that the individual has their

hearing aid switched on.

Understanding communication

No communication can be successful if one of the parties involved does not understand

what the other is trying to communicate. There may be a variety of reasons for this,

ranging from a physical or psychological barrier, to lack of understanding of language,

dialect, accents, using complicated language, unfamiliar words or medical jargon.

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Communication can break down due to either party misunderstanding or misinterpreting

what is being conveyed. This can happen even in the absence of a communication barrier

and can be due to something as simple as misunderstanding or misinterpreting a gesture,

facial expression or the tone of voice.

It is vital that you ensure you understand and make yourself understood. If there are

problems, adapt your communication and seek extra support, if necessary.

Dignity, respect and individuality

All people have a right to be treated with dignity and respect. You must ensure that

individuals are given reasonable choices, so that their rights are not denied. Individuals

should be involved in, and communicated with, concerning all matters relating to their

care needs. This means talking to them clearly, in a language they understand, and

listening to their ideas. If you are ever unsure about what is acceptable and what is not,

discuss this with your manager.

Confidentiality

Confidentiality must be maintained at all times. Individuals will trust you if they believe

you keep their confidences. However, if there are circumstances where maintaining

confidentiality is not in the individual’s or other’s interest, you must be honest with them

and give clear reasons supporting your decision. Individuals should always be fully

informed of when and with whom confidential information is shared.

Trust

Maintaining confidentiality, dignity and respect, and enabling individuals to express

their needs and wishes in a way that is supportive of them and their current

communication and language needs, will build a therapeutic and trusting relationship.

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2.3 Demonstrate a range of communication methods and styles to

meet individual needs

Styles and methods of communicating

When communicating within your workplace, it is not only the way that you communicate

with others that is important. You can speak as clearly as you like, but if the person who is

receiving your message cannot hear you, then the process will break down. You also need

to consider the person who is receiving the message, and whether the way that you are

communicating is appropriate to their ability to receive and understand the message.

Verbal communication

Verbal communication is a method of communicating that we mostly take for granted. It is

communicating by words in the individual’s first language. This can take a number of forms,

such as:

Spoken word

Sign language

Technology; for example, the use of computerised systems to help the deaf.

When a verbal discussion takes place, there are two or more people involved and the

message that people hear can be interpreted in different ways. Remember, when we

are talking to others we become the transmitter and when people are talking to us we

become the receiver.

Written communication

The most important aspect of quality care is effective communication. However, verbal

communication alone cannot be relied upon as this information can easily be forgotten or

misunderstood, especially with the passage of time. Written communication is important

within the field of care. It is essential in ensuring that all care staff know the care needs of

every individual that they are caring for. Written communication can be:

Hand written

Computer generated.

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Basic skills used in communicating

Communication is such a familiar part of everyday life that we often underestimate the

importance of good communication. It is helpful to have some understanding of the

processes and skills that help us to communicate effectively. These are:

Questioning

Explaining

Listening

Reflecting.

Questioning

The art of questioning is an important skill to learn. Used properly, questions will

encourage people to communicate.

Listening

Listening is much more than just hearing what another person is saying. It is about

understanding the feelings and emotions associated with the words. It is about making

time, and letting the other person know that you are interested and are listening. Listening

involves both verbal and non- verbal aspects of communication. Simply nodding your

head and smiling can indicate openness to listening. It is important to maintain eye

contact and adopting an open posture can help to encourage better communication. It is

essential to give the other person your full attention as doing something else, whilst

someone is speaking to you, simply portrays that you are not listening.

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Explaining

Often, within your working day, you may have to explain things to people. An explanation

can be simple or complex. A simple explanation merely states the facts without going into

too much detail. A more complex explanation may go into more specific and complicated

detail. The complexity of an explanation will depend upon many factors including the

knowledge of the person who is explaining, plus the age, background and mental ability of

the person who is receiving the information.

It is important to recognise that adequate explanations start with planning. This involves

structuring the explanation and putting the facts into a logical order. It is also important to

recognise that any explanation you give to individuals should only be given if it is within

your own sphere of competence. If you are unsure of something, you should always

refer to a more senior member of the team. Where a one-off explanation is required, you

may not have all of the facts. In such a case, it is best to tell the person that you are not

aware of the facts, but you will find out and come back to them. You will then be able to

check out all of the facts and prepare an explanation. This will prevent inflammation of

the situation.

When giving explanations, it is vitally important that you use words the individual can

understand. Using clinical jargon can confuse a person and cause misunderstanding.

Reflection

Reflection involves paraphrasing and reflection of feelings. Paraphrasing is not simply

repeating what the person has just said but is about taking the ideas the person has

conveyed and translating them into your own words. Paraphrasing is about:

Summarising what the individual has said, in order to check understanding

Rewording the individual’s speech to confirm your understanding

Using similar language to ensure understanding.

Reflection has many functions, but above all it demonstrates that you are interested in

what the person is saying, and that you are listening and understanding.

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Non-verbal communication

Non-verbal communication is something we all do when we communicate with others

and very often without realising it. Non-verbal communication usually takes place

through our body language. For example:

Sitting close to someone and facing them to show that you are interested in

what they have got to say

Nodding or shaking your head to show that you agree or disagree with what

someone is saying

Holding someone’s hand while they are talking to show that you want to

support and comfort them

Raising your eyebrows when you are amazed or surprised.

These examples all support good communication and understanding. Non-verbal

communication can also indicate that verbal communication is not going too well. For

example:

A person may look vacant or anxious when you are talking to them

Body language may tell you that the person is not interested in what you are saying.

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Space and position

Different situations and circumstances with different people will require us to decide what

is appropriate, as far as the distance from the individual and the position you adopt. What

is appropriate for one person may not be appropriate for another. We all like our personal

space and do not wish people to invade that space, unless we invite them to do so.

Certain circumstances within the care setting will allow you to invade that space e.g. care

giving activities. However, getting too close to an agitated or aggressive individual can be

inappropriate and may exacerbate the situation further. Actions such as sitting, standing

or bending down may convey different things in different circumstances.

Eye contact

Maintaining eye contact will convey interest and show you are listening. Frequently

looking away or avoiding eye contact may suggest the person is uncomfortable or does

not wish to communicate. Likewise, continuous uninterrupted eye contact will feel

uncomfortable and may be seen as threatening or confrontational.

Acceptable use of physical contact and touch

When communicating it is vital to understand what type of physical contact is acceptable

and what is not. You must also understand the circumstances in which certain types of

physical contact, such as touch, can be used. Physical contact should never be used to

relieve your own distress.

Acceptable forms of physical contact

Holding an individual’s hand

An arm around the shoulders

During physical care activities (e.g. bathing etc.).

This must be agreed with the individual and care team, and consistent with the care plan

and the needs of the individual.

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Unacceptable forms of physical contact

Invasion of personal space

When the individual is made to feel uncomfortable

Inappropriate restraint

Where the contact is abusive (e.g. physical assault or any form of sexual contact).

Situations where physical contact can be useful

To communicate care and concern

To aid recognition by a visually impaired individual.

Situations in which physical contact must not be used

When cultural issues make contact unacceptable

When the individual’s body language suggests this is not acceptable

Where the actions may be misinterpreted.

The appropriate use of physical contact can help to form relationships between

individuals and care worker. Individuals can be reassured and made to feel valued and

cared about. However, each person must be assessed individually, as what is

considered acceptable and appropriate by one person may not be by another.

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Allowing individuals time to communicate

In order to give the individual time to communicate and to allow them to communicate

effectively, you need to let them know that you are listening and that you are interested

in what they are saying. You can do this by showing that you are relaxed and that they

have your full attention.

This will give them the confidence to communicate in a supportive environment.

Silences

Silences give the speaker a chance to think and plan their reply. They are especially

useful for those who have problems understanding, hearing or expressing speech. A

vital part of your role as the listener is to ensure that silences do not make the person

feel uncomfortable or awkward.

Translation and interpreters

Some organisations have provision for translation of written material. This may include

individuals’ information booklets and service users/resident’s charters. Written material

may also be translated to the spoken word. Individuals, whose first language is not

English, may require the service of an interpreter. For the purposes of accuracy,

objectivity and confidentiality, the use of family (especially young children) and friends

should be viewed with caution.

Advocate

A relative who is acting on behalf of the individual must have the individual’s consent

before records are shared, unless that person is the person’s legal guardian or is a

representative appointed by the courts. Independent advocates can be appointed to act

on behalf of an individual who is unable to represent their interests themselves. Records

may be shared with an advocate to ensure that the individual’s needs are being met and

their rights upheld.

What is a communication aid?

A communication aid is anything that can help an individual to communicate more

effectively with those around them. This could range from a simple letter board to a more

sophisticated piece of electronic equipment. Selecting the right communication aid will

depend on many factors such as access and personal preference. It is always

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recommended that a specialist assessment is sought through a speech and language

therapist or communication aid centre. It is not essential for the user to be able to read

text in order to use a communication aid. Many aids are symbol based and still enable

individuals to communicate with others.

Formal and informal methods of communication

Communication may take place formally in a pre-planned meeting, interview or handover.

However, a significant amount of communication takes place in day-to-day informal

exchanges between staff, individuals, family and friends. This type of informal

communication may take place during conversations or in the course of care activities.

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2.4 Demonstrate how to respond to an individual’s reactions when

communicating

Immediately before and during communication with an individual, you will make your own

personal observations about that person and their reactions to the communication. Your

observations will directly influence the way in which you communicate with them. You will

quickly assess the way in which you need to communicate in order to meet their needs,

wishes and preferences. Every person is different in the way they will react and, to a large

extent, the individual’s reaction will depend upon the nature of the information that is

being communicated. Having an understanding of the types of reactions that individuals

may display will help you to understand and support the feelings a person may

experience.

Reactions may include:

Distress Fear

Tearfulness Hyperventilation

Nausea Bewilderment, confusion, inability to concentrate

Shock Disbelief

Relief Guilt.

Anger with others and themselves

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It is important that you detect these reactions as they present themselves, to prevent

stress becoming distress. By observing a person’s body language, you will be able to

gauge how best to support that person. Support may take many forms, from physical

presence, the appropriate use of touch and verbal support, to practical interventions and

enlisting the support of other professionals and outside agencies.

Because every situation is different and the needs of all individuals vary, every

experience is a learning experience. You will need to reflect on the situation, look at how

you coped with it and how you might do things differently in the future. It is also essential

that you gain the support of your senior colleagues and your manager.

Responses must be appropriate and supportive of the individual and their situation.

Responses may include:

Support for individuals’ communication using positive approaches

Addressing their needs

Reviewing needs and identifying preferences

Evaluation of approaches and strategies used.

3.1 Explain how people from different backgrounds may use

and/or interpret communication methods in different ways

You will be aware that people come from a variety of backgrounds. This may lead to

them using or interpreting communication methods in different ways. It is vital you

recognise these, as differing uses and ways of interpreting communication and language

can create misunderstandings. These may result in tensions and distress, and lead to

communication needs not being met. Differences may include:

Dialects and accents - even individuals who speak the same language may use

different dialects or accents. This may create a barrier due to understanding and

interpretation difficulties

Slang - the use of slang may change the meaning of words or create or adapt

words. This may result in individuals misinterpreting what is said or using words

or phrases others may find confusing, inappropriate or offensive. Slang amongst

certain communities or sub- cultures may even sound like a different language to

those unfamiliar with the terms used. Care professionals may use a form of slang

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that only they understand. For example, use of abbreviations such as ‘Temp’, ‘BP’

can create a breakdown in communication between care professionals and those

they care for

The use and interpretation of gestures and signs may differ, particularly between

cultures. The members of certain groups may use gestures or signs which others,

even those within their culture or family, may not use or understand. The way in

which certain cultures express themselves and use gestures maybe misinterpreted

Cultures and, indeed, some families or social groups may have hierarchical

structures where an individual or a particular gender will be seen as a leader and

decision maker. Care professionals should be aware of this; particularly in cultures

where females are not permitted to communicate or share information with others

unless there is a male family member present or someone who is responsible for

communicating on their behalf. Attempts to communicate with the individual may be

misinterpreted and the reluctance of the individual to communicate may also create

misunderstandings

It is important to consider the life experience, age and gender of the individual. A

child may have limited understanding of the meaning of certain words or phrases

and may use or interpret these inappropriately. Parents and children may use slang

terms for parts of the body or bodily functions and misinterpretation of these by

others may lead to misunderstandings, distress and unmet needs.

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3.2 Identify barriers to effective communication

Communication is about a speaker talking to a listener (sender to receiver). Although we

may think this is a simple process, this is not always so. There are a number of barriers

or obstacles that can affect the way the message is sent or received. These may be

present initially, or may develop as individual’s needs and preferences change. Any

changes must be reported and recorded immediately, in order for the individual’s needs

to be met.

Physical barriers

The individual may experience hearing or visual impairment:

Speech impairment

Mobility problems

Physical disability

Pain.

Mental health barriers

The individual may become:

Isolated from others, due to the impact of an illness on the ability to communicate

Detached from reality

Attitudes, beliefs and ideas can significantly affect the way that people communicate

Believing that personal issues must not be discussed with those outside the

family group, when dealing with individuals with mental health problems.

Cultural barriers

Between the two parties there may be:

Differences in the use/understanding of individual words

A lack of understanding of language, accents and dialects

Misunderstanding of body language and gestures

Differences in the interpretation of body language and gestures.

Personal barriers

The individual or key person may have:

A quiet, shy personality that prevents them from communicating

An impatient, abrupt or loud manner that makes others feel uncomfortable.

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Care worker and others

Care workers and others, such as relatives, can create barriers to communication.

These are rarely deliberate and are generally due to misunderstandings.

Stereotyping and labeling

Making judgements about a person because they belong to a particular ‘group’ is called

‘stereotyping’. This can have a negative effect on the way an individual is treated and can

lead to unfair discrimination. Labeling can lead to the person being considered as

‘demanding’, ‘awkward’, or ‘difficult’, or elderly people being treated as if they are all

‘forgetful’, ‘confused’ or ‘hard of hearing’.

Environmental barriers

Factors such as:

Background noise/interruptions

Poor or very bright lighting

Extremes of temperature

Uncomfortable seating

Unattractive or unwelcoming décor and furnishings

Lack of privacy.

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Understanding difficulties

Those with hearing problems may have difficulty understanding conversation because

they cannot hear the words. Other people such as those with dementia, brain damage or

following a stroke may be able to hear the words, but either do not understand the

meaning of the words or do not remember what has been said. There are a number of

ways in which you can recognise key changes in communication:

Listen carefully

Observe body language

Observe actions and behaviour

Collect information from a variety of sources, including colleagues, the

individual, family and friends.

It is important to monitor communication, and recognise and respond to change, in

order for individuals’ needs to be met fully.

3.3 Demonstrate ways to overcome barriers to communication

In order for barriers to effective communication to be reduced, various ways need to be

developed within the work team. These are only likely to be effective after a full

assessment of the barriers has been completed. Information should be communicated

verbally and effectively, and written accurately, completely and legibly.

Physical

Assessment of sight, hearing and mobility needs:

Providing aids and equipment

Hearing aids have a functioning battery. Understand their use and maintenance

Spectacles are clean and worn when required

Adjusting the level and pace of communication to suit the individual’s needs

Being patient with those who have problems expressing speech

Providing a clear description for a visually impaired person

Facing a person who is hard of hearing

Assisting individuals with mobility problems to access areas where

communication can take place

Treatment to alleviate problems e.g. new spectacles, eye surgery, removal of

excess ear wax.

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Report any problems you are unable to deal with to your manager who can arrange for

specialist support for your patients, e.g. speech therapists. Education and training can also

be arranged for you.

Cultural

Being aware of language differences - an interpreter may be required

Using body language and alternative ways of saying things when a

individual misunderstands

Speaking in short, clear sentences

Using your listening skills to check understanding

Making greater use of pictures and non-verbal communication

Being aware of the way different cultures understand and express themselves.

Personal

Accepting personality differences

Supporting, respecting and understanding the person

Providing feedback and encouragement

Showing acceptance of the person

Providing encouragement to communicate

Adapting communication to accommodate changing needs and preferences.

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Care worker

Practising self-appraisal to identify knowledge and understanding

Asking for help to address areas of which you are unsure. This may be especially

relevant when you first become a care worker as you may have had little

experience of ill or disabled people and have had limited contact with care

professionals. The importance of gaining support, advice and guidance from your

colleagues and manager cannot be overstated. This will prepare you to

communicate effectively and will eventually enable you to support others

Obtaining education to develop knowledge.

Environmental changes

An environment which has been thoughtfully designed can assist individuals to

communicate effectively and make their needs and wishes known:

Check and adjust lighting, and reduce background noise

Ensure the level of heat is appropriate and comfortable

Provide privacy and areas for socialising

Ensure the seating is comfortable and positioning enhances communication

Provide assistance to access

Provide pleasant and welcoming décor and furnishings

Keep interruptions to a minimum.

Care worker interventions

Be sure of the nature and scope of the communication barrier, and the

individual’s plan of care

Don’t wait for the person to approach you. Don’t make them feel communication

only takes place when absolutely necessary – initiate conversation

Adopt a relaxed posture, showing you have time to listen and converse

Face the person, avoid covering your mouth or turning away - this is particularly

important if they lip read

Ensure speech is clear and at a manner, level and pace to suit the individual’s

needs

Do not dominate the conversation or suddenly change the subject

Use non-verbal communication to enhance verbal communication

Observe the person’s body language to assess understanding

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If the individual mishears and responds inappropriately, do not be afraid to repeat

yourself or ask them to clarify or confirm that they understand

Allow the person time and space to respond

Write things down and use symbols

Report any changes immediately

Make sure others are aware that the individual has a communication barrier - be

tactful and maintain confidentiality

Do not answer for the individual

Be patient - imagine how you would feel in the person’s position.

Lack of understanding

This can be extremely distressing for the person, especially if they have the insight to

realise something is wrong. This is called ‘receptive dysphasia/aphasia’. The brain

cannot ‘unscramble’ the spoken words and the individual can understand little or nothing

of what is being said. When the brain has been damaged due to injury caused by stroke

or trauma, rehabilitation will play a major part in the individual’s treatment. You should

be guided by therapists who will advise on speech therapy and the use of gestures,

signs, symbols and the written word. Remember, be patient with the individual who

becomes very frustrated as they may feel everyone is speaking a language they do not

understand.

In dementia, this type of problem usually occurs late in the illness, making it very difficult

to communicate with individuals. This is where the use of non-verbal communication,

such as the tone of voice, facial expressions and the use of touch becomes particularly

important.

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Empathy

Empathy is the ability to understand the world as it appears to another person by putting

yourself in their position. This is a skill that will help you to understand why people behave

in certain ways. It will also enable the individual to feel that you can see things from their

point of view. This will develop a relationship based on trust and understanding, and

enhance the quality of care you deliver.

Changes

It is extremely important to recognise any key changes in the individual’s ability to

communicate effectively. Communication skills and abilities should be assessed,

reviewed and evaluated. All those involved in communication with the individuals should

be aware of the initial assessment, to enable them to recognise any key changes. Any

changes should be recorded and reported, and your approach adapted to respond to the

change identified. An urgent review may be needed, referrals made to the appropriate

care professionals and changes made to the plan of care.

Respecting the needs of differing cultures

When communicating with individuals it is important to take into account the barriers that

cultural differences may bring. Language differences can create a barrier to

communication, so you will need to be aware of how you can help overcome this

obstacle. Between the health care worker and the individual there may be:

Differences in the use and understanding of individual words

A lack of understanding of language, accents and dialects

Misunderstanding of body language and gestures.

By being aware that differences in language may lead to problems with communication,

steps can be taken to reduce miscommunication from happening. You can help to

support individuals by ensuring that you take steps to minimise the reasons why they

should have difficulty in communicating by:

Being aware of language differences and organising for an interpreter, when

required

Using body language and alternative ways of saying things, when an

individual misunderstands

Speaking in short, clear sentences

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Using your listening skills to check understanding

Making greater use of pictures and non-verbal communication

Being aware of the way different cultures understand and express themselves.

In your role as a health care worker, you will not be solely responsible for undertaking

an initial formal assessment of the communication needs, preferences and difficulties

that a person may have. However, if you work in the community, you may be the first

person to meet an individual and may make an initial assessment of their

communication needs. It is important that you are aware of appropriate referral systems

that will help individuals if they have difficulty in communicating or if you have difficulty in

understanding the individual’s chosen method of communication. If the individual is new

to your care organisation, it is likely that they will have undergone a detailed needs

assessment prior to being admitted. This is so that care can be planned and all of the

required facilities put into place.

It is essential that you are given the opportunity to develop yourself in specific areas of

communication, particularly where you are unable to meet the communication needs of

the individual. You will need to know which key people to call upon for help and advice.

These could be other professionals, or friends and family of the individual. It is also

essential that individuals have access to aids that will help them to communicate and

you should be able to support individuals to access these. For example, if an individual

needs an interpreter in order to communicate, then this should be arranged.

Matching communication to the person

It is important that you and your colleagues change and adapt the way you

communicate with each person. So, you will need to consider their:

Individuality

Life history

Culture

Unique strengths

Experience of a dementia or/mental health issue/learning disability, where applicable

Feelings.

An important skill in communication is to display genuineness and that you are ‘there’ for

the person.

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Ways to adapt communication

Communicating becomes more challenging when there is a barrier to communication.

Using touch to enhance verbal communication, to get a person’s attention or to convey a

message, can be very effective. Allowing the individual to use touch may also be an

acceptable way for the individual to communicate with others and be a useful vehicle for

communication, when an individual is unable to communicate in other ways.

In order to fully support individuals to communicate with others, you may need to ensure

that specific aids are provided. This will involve working with other members of the

multidisciplinary team and calling upon them for their expertise and help. It is essential

that everyone involved in the care of individuals has access to the same information

which will be based upon a thorough assessment of the individual’s communication

needs. Any concerns that are outside your level of understanding and competence,

should be reported to your manager who can arrange for specialist support for

individuals.

Extra care should be taken to ensure that any accents or dialects do not create barriers,

and that you avoid the use of complicated language and medical jargon. Communication

should be adapted to suit individuals and the circumstances in which communication

takes place. Use should be made of any recommended aids to communication.

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Reviewing practice

It is essential that you be given the opportunity to reflect on your own behaviour,

communication skills and your reaction to different people. The purpose of this is to

explore aspects of your practice you do well and those that you may be able to improve

upon.

Active listening

A vital part of good communication for any professional involved with caring for an

individual is to be able to listen quietly to any problems and fears the patient is having,

whether they can be resolved or not.

Active listening is a skill that can help you understand what a person is saying and will

make the person feel that you are giving them your full attention. Careful listening will

ensure that you can understand the content of what the person is saying, as well as

their associated feelings. There are some basic principles that you can apply to help

you with active listening.

These are:

Avoid any distractions or interruptions such as telephones, television, passers-by

etc.

Give the individual your full attention, concentrate on what the individual is

saying - not what you are going to have for lunch

Look interested in what the individual has to say, even though you think that what

the individual is telling you is unnecessary and boring, remember that all

information is relevant

Stay directed and focus on the individual’s feelings

Allow the individual to complete what they are saying and avoid interrupting the

individual whilst they are talking

Try to use positive non-verbal cues to encourage the individual - for example, by

maintaining eye contact, using facial expressions and touch, and being aware of

your body language

Ensure that you do not pretend to understand what the person is saying - if needs

be, ask questions to help your understanding

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Ensure that any feedback you give is clear and unambiguous

Give minimal prompts in order to acknowledge that you are listening and that

you are interested - for example, nodding or shaking your head or simply

saying ‘yes’

Be well-timed and vary your responses, ensure that you reflect back to the

individual during brief interactions - for example, ‘If I understand correctly you feel

that…’

Try not to put your own feelings, ideas and opinions on to the individual, and hold

back the need to respond with advice or an opinion, unless asked to

Be aware that the person's feelings and perspectives may not be the same as yours

Listen to the person in order to understand them, rather than to achieve an

agreement.

Honesty

It is important that an open culture exists that encourages people to ask questions and to

voice their concerns. A regime that discourages questioning and ignores concerns is

failing in its duty of care.

Honesty is essential in meeting the needs of individuals in your healthcare environment. If

they ask you difficult or sensitive questions, under no circumstances should you ever give

false or inaccurate information. If you are asked a question that you find difficult to

answer, you must seek advice from a senior colleague or your manager. This will enable

you to address the individual’s concerns and answer questions, or provide referral to

other members of the team who may be able to help. Any information given should be

clearly documented in the individual’s notes.

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3.4 Demonstrate strategies that can be used to clarify misunderstandings

Following any communication that is difficult, complex or sensitive, you will need to

clarify the individual’s understanding. You can simply do this by asking the individual if

they understand everything that has been discussed. It may be that a doctor has

explained to the individual that they have an incurable illness or that a loved one has

died. The doctor may have used medical jargon or language that the individual did not

understand, or the individual may be in shock and may not have taken in anything that

has been said. On the other hand, the individual may have completely misinterpreted

what the doctor had said. Perhaps the doctor had said that if the individual did not stop

smoking they could die. They may have misinterpreted this and thought that the doctor

had said that they were going to die. By using appropriate methods of communication,

and checking the individual’s understanding, any misunderstandings can be cleared up

which could otherwise lead to unnecessary worry and distress.

You have a vital role in helping to clarify any misunderstandings. It may be necessary to

give the individual time to think about what has been discussed. Always make it clear

that they can ask questions and that you or another member of staff will be available as

and when the individual wishes to discuss further issues. On receiving bad news, many

people shut off and recall very little of what has been said; every effort should be made

to arrange a follow up discussion, once the individual has had time to reflect and think.

3.5 Explain how to use communication skills to manage complex,

sensitive, abusive or challenging situations and behaviours

In health and social care settings, complex situations often arise, for example when

dealing with:

complicated issues, such as a whether or not an individual has enough

understanding to give informed consent to treatment

a large number of diverse individuals, often under time pressure.

Likewise, sensitive situations are commonly encountered, with personal care often

being a daily part of the role for care workers and sensitive information being shared.

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Sometimes abusive situations may arise in care settings. Abuse is behaviour which is

harmful and may take many forms including coercion, threats or physical acts.

Other challenging situations (such as lack of required staff or equipment or working with

individuals whose behaviour may challenge) require a high level of communication skills

on the part of staff. Examples of behaviour that may challenge includes not engaging with

care services, verbal or physical aggression, or unusual behaviour such as rocking,

undressing in public or ‘wandering’ as if lost.

Factors that need to be taken into account when communicating complex and

sensitive issues

Complex and sensitive communication refers to information that is likely to be

distressing, traumatic, frightening or threatening. It may include information that may

pose a risk to the individual or it may have serious implications for them, their family

and friends; for example, the breaking of bad news. It is essential to keep an open

mind as to what bad news constitutes.

When hearing these words many people tend to think of the worst-case scenario; for

example, informing an individual that they have cancer, or informing them that their loved

one has died or is going to die. Working in the field of health care we do not always

recognise the information that we convey as being bad news. For example, for some, a

simple blood test may be a terrifying prospect; for others, the thought of having to use a

hoist to be lifted may be extremely daunting. It is vitally important to understand that

although you may not perceive something as being serious or sensitive, this does not

mean that individuals will think the same. To them the issue may be extremely sensitive,

and this could be even more so if the individual has communication difficulties and does

not fully understand what you are trying to convey to them.

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Communicating and handling sensitive issues requires an appropriate environment, where

information can be discussed at an appropriate time. It requires the care worker to show

empathy, through active listening, as well as honesty which is essential, in order to gain

and maintain trust. Communication skills can be used in many ways to manage complex

and challenging situations and behaviours. This is demonstrated by the examples below of

the many ways communication can be used to support individuals whose behaviour may

be challenging. These are summarised below under the headings:

Getting to know the individual and their loved ones

Forming a trusting working relationship

Assessment, planning and prevention

Calming techniques

Interventions

Review.

Getting to know the individual and their loved ones

Effective communication begins with getting to know the individual and their loved ones

by being friendly, professional and approachable and gently questioning and

listening to the person and their family

This is the foundation for person-centered care, which puts the individual (and not their

condition or the needs of the care setting) at the centre. By assessing the individual’s

preferences, needs and communication style, care staff can begin to learn:

How much the person understands (for example, how much does this person’s

dementia affect their understanding of what is happening around them?)

How they communicate and any communication difficulties they may have (such

as use of basic sign language by someone with learning disabilities)

What support they need from family and professionals. Talking to (and most

importantly listening to) families can be the key to understanding an individual

with complex issues. Family members are often the main carers and the most

knowledgeable about the person

What works for the individual and what is challenging for them, for example, a

person on the autistic spectrum who is very sensitive to noise may respond well

to a quiet voice but be overwhelmed in a noisy environment.

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Forming a trusting working relationship

Sensitive use of communication skills such as active listening, prompting, showing

respect and giving information clearly can help care workers to build a trusting working

relationship with individuals and their families.

Assessment, planning and prevention

Care workers are often involved with assessing individuals to find out what their

strengths, difficulties and needs are. The process of using communication skills to get

to know the person and forming a trusting working relationship helps the assessment

process a great deal. When working with individuals whose behaviour may be challenging

at times, the assessment may include working out what the triggers for the behaviour are

and how they may be avoided, and what promotes more positive behaviour. Sensitive

use of questioning combined with observation will be needed. By understanding what

triggers behaviour that challenges, a plan can be put in place so that care workers take a

consistent, person-centered approach to each individual’s care. This plan may be part of

a general care or support plan or a specific behavioural support plan. This sort of

planning can help prevent some behaviour that challenges.

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Calming techniques

Skilled communication can help to calm a person whose behaviour may challenge. These

include calming gestures, keeping an appropriate distance, speaking calmly,

suggesting alternative behaviour and distraction techniques.

Interventions

If calming techniques aren’t successful, interventions may be needed. Again, skilled

communication is needed, to reduce or stop the behaviour that challenges. Examples

include calmly guiding a person to a quieter area and making clear what is or isn’t

acceptable. Senior staff may be required to deal with more serious incidents which may

need to be reported to relevant authorities.

Review

Communication between staff, the person and the family is essential to reduce

behaviour that challenges, to share good practice and to review approaches to work

out what works and what doesn’t for that individual. Communication skills in reporting

(verbally) and recording events (on paper or electronic records) and observations

are needed for this. The care, support or behaviour plan will need to be reviewed

periodically to ensure it meets the individual’s needs which may change over time.

3.6 Explain how to access extra support or services to enable

individuals to communicate effectively

It is vital you seek support to enable you to communicate with and understand individuals,

in order for them to be able to understand and communicate with you. The advice and

guidance of appropriate people should be sought, so that any additional support, such as

education and training, can be accessed. Your manager is probably responsible for this.

Extra support to enhance understanding may include:

Speech and language therapy

Referral to audiologists, ear, nose

and throat specialists

Ophthalmologists or opticians

Psychiatrists, specialist

psychiatric nurses or

psychologists

Translators

Interpreters

Social workers for the deaf and/or

blind

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Occupational therapists

Social workers

GP

Physiotherapists

Pharmacist

Nurse/specialist nurse

Dementia care advisor

Family or carers.

3.7 Explain the purposes and principles of independent advocacy

Advocacy means helping people to access services, be involved in decisions about their

care and upholding their rights. Independent advocates are those who are not family

members or friends and are independent of the NHS and social services.

The purposes of independent advocacy are:

to safeguard vulnerable individuals who may have difficulty accessing health

and social care services, understanding their care and treatment options and

being involved in decisions about theirtreatment

to uphold the legal and human rights of vulnerable

people The principles of independent advocacy are:

that everyone’s human rights (currently as defined by the European Convention on

Human Rights and enacted in the Human Rights Act 1998) should be protected in

law and in practice

That some people are vulnerable and need help to ensure their rights and best

interests are upheld.

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3.8 Explain when to involve an advocate and how to access advocacy

services

There are three types of statutory independent advocates as defined by legislation in

England and Wales. Statutory means that qualifying individuals have a legal right to

access the relevant type of advocate. These are:

Independent Mental Health Advocates (IMHAs) who were introduced by the Mental

Health Act 2007 to give statutory help to individuals who are detained in hospital

under the Mental Health Act 1983 or receiving a Community Treatment Order

under the Mental Health Act 2007. A Community Treatment Order (CTO) is

supervised treatment in the community for individuals who were previously

detained under a section of the Mental Health Act1983.

Independent Mental Capacity Advocates (IMCAs) introduced by the Mental

Capacity Act 2005 to assist individuals who are legally deemed to lack capacity

(ability) to make decisions for themselves (for example due to severe dementia

or learning disabilities)

Care and support advocates introduced by the Care Act 2014 who assist

individuals who have substantial difficulties. They may assist with matters such

as accessing a suitable care home.

Access to the statutory mental health advocacy service is as follows:

1) The individual must be a ‘qualifying person’, in other words they must be either

detained in hospital under the Mental Health Act 1983 or receiving a Community

Care Order under the Mental Health Act 2007

2) The qualifying person can request a IMHA from their clinician (such as a

psychiatrist) or approved mental health professional

3) Under the Mental Health Act 2007, the IMHA should have access to visit the

person in hospital or at home to provide advocacy services.

Access to statutory mental capacity advocacy requires the following:

1) The individual must be aged over 16 and meet the criteria of lacking capacity

(unable to make decisions for themselves) and be facing serious medical

treatment or a change in accommodation, a care review or an adult protection

procedure

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2) The person must not have anyone else suitable to act as advocate (such as a

close family member)

3) NHS or Local Authority staff can request an Independent Mental Capacity

Advocate on the individual’s behalf. The role of the IMCA will be to ensure best

interests procedures are followed (in other words decisions are made in a way

which respects the person’s rights, preferences and are in their best interests) but

IMCAs do not make best interests decisions themselves.

Access to statutory care and support advocates requires that:

1) The person has substantial difficulty understanding or accessing the support they

need and has nobody suitable (such as a family member) to act as an informal

advocate

2) Access to statutory care and support advocates is via the Local Authority.

More informal independent advocacy can be accessed for anyone in need from local and

national charities such as MIND

Health and social care workers who believe an individual may need independent advocacy

services, should raise this with senior staff so that the most appropriate service can be

considered.

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4.1 Explain the meaning of the term confidentiality

Defining confidentiality

Confidential: to be kept secret; not to be disclosed.

Confidentiality has been defined by the International Standards Organisation (ISO) as

ensuring that information is accessible only to those authorised personnel. Confidentiality

also refers to an ethical principle associated with several professions (e.g. medicine, law,

religion). Confidentiality is an important principle in health and social care. It is in place to

impose a boundary on the amount of personal information and data that can be disclosed

without consent. Confidentiality arises where a person disclosing personal information

reasonably expects their privacy to be protected, such as a relationship of trust.

The relationship between health and social care professionals and patients/ individuals

centers on trust, and trust is dependent on the individual being confident that the personal

information they disclose is treated confidentially.

It is extremely important for you to understand the meaning of confidentiality and what

constitutes confidential information, in order that you can maintain confidentiality in the

care setting.

Confidentiality will apply to verbal, written and stored information, and will also include the

access, retrieval and transmission of information.

4.2 Demonstrate ways to maintain confidentiality in day-to-day

communication

Confidential information

As a health care worker you are in an extremely privileged position. During the course of

your work, you will receive some very personal or highly sensitive information about

people. Whether to share this, and with whom, can be quite difficult at times, so it is

important that you know what confidentiality means and understand how it affects your

practice.

The Code of Conduct for Healthcare Support Workers and Adult Social Care Workers

standard 5 states that “You must treat all information about service users as

confidential”.

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Precautions to maintain confidentiality

Individuals’ details should only be discussed or written in private; in areas where

information cannot be overheard or overseen. Discuss with your manager what

information you should share and in what circumstances. NEVER discuss confidential

information in public areas, with other individuals or visitors, or outside the workplace.

The individual must give permission for confidential information to be shared, but before

you do this, check with your manager. You should not reveal confidential information

over the telephone. Callers should be referred to the manager or trained nurse.

Lockable cupboards or drawers should be available for storage of confidential information.

Confidentiality statements should be in place for all staff, volunteers and students stating

that no one will discuss individual’s, children and families outside the setting, and incidents

will only be passed on to relevant staff members. Practices should be in place that prevent

the identification of individuals, such as using initials or codes in public areas. Information

that is not necessary or appropriate should not be collected or stored.

Computer records

An individual’s personal information can be held as a computer record, but access

should be limited to restricted personnel only and with the additional protection of

passwords.

Legislation

Legislation (laws) governs what records residential homes and home care agencies are

required to keep, and the standards to which they must adhere:

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Data Protection Act1998

Access to Health Records Act1990

Freedom of Information Act2000

Health and Social Care Act 2008: The fundamental standards

Human Rights Act1998

Computer Misuse Act 1990

GDPR (General Data Protection Regulation)(2018).

Legislation relating to confidentiality is covered in more detail in unit 02.

The Data Protection Act 1998

The purpose of the Data Protection Act is to protect human rights. Registration with the

Data Protection Registrar limits what can be done with information. This will affect the

way the computerised information is stored, and commits the organisation to keeping the

information safe and secure.

These regulations offer good advice for the handling of hand-written records. For

example, records held in a file should be stored in a locked cabinet with access

restricted to only those people who have a right to access.

4.3 Describe the potential tension between maintaining an individual’s

confidentiality and disclosing concerns

Whilst you may fully understand the concept of confidentiality, deciding whether to share

the information that you receive with others, especially when it is of a serious nature, can

be a very difficult decision to make. While the rights and desires of staff, individuals and

families to keep their personal details private are important, there are also some

circumstances under which certain information should be shared. Confidential information

can be disclosed to an appropriate health care professional, if it is relevant to the care of

that individual. It is justified on the basis that the individual may suffer if that information is

withheld e.g. not passing on the fact that a person has an understanding difficulty may

result in that individual’s needs not being identified.

Individuals giving information in confidence have a right to expect that it will only be used

for the purpose for which it was given, and will not be shared with others without their

consent. Care staff are not released from this responsibility, even when a person dies.

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Information care workers are expected to share

You have a duty of care to protect vulnerable people from abuse. If an individual reveals

that they are being abused, you must reveal this to your manager in order to protect them.

If an individual indicates that their health and social wellbeing is at risk, or that they are

suffering symptoms which may be signs of ill-health (mental or physical), you must report

and record this. Information which directly affects the care organisation and its

effectiveness must be reported.

These requirements may be identified in documents such as legislation, codes of conduct,

plans of care, policies and procedures. Individuals must be clearly told by the care worker

that the information they have revealed cannot be kept secret, must be reported to the

manager and the reason why. Information will also be passed amongst the care team.

This may be done both formally, during meetings and handovers, and informally, during

discussions and conversations.

You should always work within agreed boundaries and seek advice from management before

confidential information is shared. If an individual is unable to give consent, advice must be

taken from management who will act on guidance contained in legislation and

organisational policies and procedures.

Even though you can legitimately disclose information with the person’s consent, you

must ensure you are aware of your responsibilities and the possible limitations of your

role.

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There are certain laws and legal procedures which make disclosure of confidential

information compulsory, such as:

The Road Traffic Act (1988) - personal injury or death must be reported to the police

The Public Health Act (Control of Disease Act 1984) - doctors must report

notifiable diseases to public health officials

Misuse of Drugs Act (1971) - doctors must notify the Home Office if a person

appears to be dependent on drugs.

It is therefore understandable that the disclosure of confidential information could create

tensions between care professionals, individuals and their families, as the implications

may be far-reaching. Staff must make every effort to communicate the reasons why

certain confidential information needs to be disclosed, and individuals must be supported

and represented throughout this process.

How and when to seek advice about confidentiality

If you have any questions, queries or concerns with regard to the maintenance, sharing or

disclosing of either verbal or written confidential information, you should seek advice from

your line manager. Your care organisation will have policies, procedures and guidelines to

advise and inform you, should you need support and guidance. These policies will reflect

current legislation, codes of practice and regulations and should always be adhered to.

Conclusion

The information you have read within this unit should increase your knowledge and

understanding which will benefit you, the individuals you care for, key people and others.

Now complete the assessment questions for this unit in the workbook section.