Communication

We humans are unique in using a system of symbolic communication known as language. However, there is more to communication than just language. 

Every time some form of communication occurs, there is a specific process that takes place. We can break this process down into its different parts so that we can see exactly what is happening and identify any problems that can occur. By doing this we can try to eliminate these problems and become better communicators.

The message is encoded, with the code being the language used by the sender. This may refer to the actual language the person is speaking, or it can refer to spoken and written language (verbal) or body-language, facial expression and signals (non-verbal). It can also mean tone of voice.

The recipient then needs to decode the message so they can understand what is being communicated to them. They need to hear the message and then convert it into meaning. Sometimes errors can occur in the process, meaning the correct message is not transmitted.

Warning signs 

These are some warning signs you may notice when a person you are communicating with does not understand you.

• Leaned forward to hear you 
• Asked you to repeat something you had just said 
• Repeated a word (of yours) incorrectly 
• Reacted (especially visibly) to inappropriate slang you used

Your role as a health and wellbeing support worker is to support tangata/clients to achieve autonomy (independence) and self-determination (be in control of their own decisions/life) and foster hope. To do this you will need effective communication skills.

Interpersonal skills

Interpersonal skills are the skills we use every day when we communicate and interact with other people, both individually and in groups. Interpersonal skills are sometimes referred to as social skills, people skills, soft skills, or life skills.

They include a wide range of skills, but particularly communication skills such as listening and effective speaking. They also include the ability to control and manage your emotions.

Interpersonal skills are the foundation for success in life. People with strong interpersonal skills tend to be able to work well with other people, including in teams or groups, formally and informally. They communicate effectively with others and tend to have better relationships at home and at work.

As a health and wellbeing support worker, being able to listen to and talk to tangata and their whānau is an essential skill. Having poor interpersonal skills and failing to communicate effectively can lead to poor outcomes for all concerned. 

You can improve your interpersonal skills by developing your awareness of how you interact with others and practising your skills. 

Improve your basic communication skills

Start with the basics of speaking and listening. When speaking:

• Adopt a friendly tone of voice.
• Ensure you speak at a speed and volume that is suited to the tangata.
• Ensure the language you use is clear and professional, but not filled with medical jargon. Remember shorter sentences are easier to process and understand. Simpler words are also easier to understand.
  • This is particularly important if the tangata and their whānau do not have English as their first language.
  • If you cannot explain something in simple terms, you have probably not understood it yourself.
• Learn to seek feedback or clarification to ensure your message has been understood.

Listening is not the same as hearing. It is important to take the time to listen carefully to what people are saying, considering both their verbal and non-verbal communication.

• Using questioning and reflection when communicating demonstrates that you are both listening and interested in what is being said.
• By using questions effectively, you can both check others’ understanding, and also learn more from them.

Non-verbal communication

Some experts suggest that around three-quarters of the ‘message’ is communicated by non-verbal signals such as body language, tone of voice, and the speed at which you speak.

Non-verbal signals reinforce or contradict the message of our words and are much harder to fake than words. They are therefore a much more reliable signal. Learning to read body language is a vital part of effective communication.

Body language

Body language includes how you stand, your facial expressions, the way you use your hands to emphasise your speech, and even whether and with whom you make eye contact. For communication to be effective, your non-verbal communication needs to reinforce your words: the two must say the same thing. Positive, confident body language helps to build trust with tangata.

Voice

The sound of a voice and the content of speech can provide clues to an individual’s emotional state. For example, if a person you are supporting has low self-esteem, it may be reflected by hesitancy in the voice. A shy person may speak quietly, but someone who is confident in themselves will be more likely to have command of their voice and clarity of speech.

Emotion

Various emotions can get in the way of communicating, including anger and aggression, or stress. Few of us are able to communicate effectively when we are struggling to manage our emotions. As a support worker you will need to judge when it is ‘the right time’ to have a conversation with a client and/or with their whānau. Sometimes it may be best to delay the conversation for a time when all involved are calm.

Emotional intelligence

Emotional intelligence is the ability to understand your own and others’ emotions, and their effect on behaviour and attitudes. This involves personal skills – how we manage ourselves, and social skills – how we handle relationships with others. Improving your emotional intelligence improves your understanding that other people have different points of view. It helps you to try to see things from their perspective and in doing so, you may learn something whilst gaining the respect and trust of others.

Reflecting on conversations and interpersonal interactions will help you to develop and improve your interpersonal skills.

Barriers to communication

Communication is the sharing of information between two people. A barrier to communication is something that prevents either person from understanding the information they are being told. 

Barriers can be physical, psychological, and social and may include:

• environment
• stress
• being distracted 
• low self esteem
• lack of confidence to ask questions
• information overload
• cultural differences
• language used
• emotional disconnection
• discrimination

Feedback is an important tool to support tangata to achieve autonomy and self-determination.

As a support person involved in client’s care, you have knowledge about them and their progress that must be shared. Giving feedback is about providing relevant and appropriate information to either the interdisciplinary team or to the relevant health professional specified in the personal plan, so that they can do their jobs properly.

Giving feedback includes:

• following your organisation’s policies and procedures for giving feedback
• communicating effectively
• maintaining confidentiality

Your organisation will have policies and procedures about how feedback occurs.

Feedback may be given:

• face-to-face to the relevant health care professional(s)
• in writing
• over the telephone
• at meetings of the interdisciplinary team
• at formal reviews of the personal plan

Feedback on achievement and/or progress towards goals may be part of a scheduled review process as outlined in the personal plan. However, there may also be occasions when you need to provide important information to the relevant health professional(s) in response to an unplanned event or a change in the person’s condition or circumstances.

Tips for giving feedback

• Give information that is: 
  • relevant to the client’s needs and goals 
  • purposeful - leads to achievement of the team goal 
  • timely and relevant to the team’s requirements and expectations.
• Be clear and direct.
• State observations not opinions. State what you have noticed, not what you think happened. Observations are factual and more constructive than opinions.
• Start each main point with ‘I’. For example, “I have seen” or “I have heard”. 
• Give specific examples as evidence to support your feedback. For example, “Joe could not perform the exercise because the range of movement caused him pain”. 
• If the feedback is negative, avoid being emotional or blaming. For example, “I notice that Joe has not completed his exercise programme each day", and not “I’m really annoyed that Joe hasn’t...”  
•  Give feedback on things that can be changed.

Maintaining confidentiality

The information you give or receive about someone’s progress towards their goals is personal information. You already know that privacy concerns are very important. You must not discuss personal information with anyone outside the team or organisation or leave notes or emails lying around or visible to others either at work or at home. Also, it may not be your role to talk to the person being supported about discussions within the interdisciplinary team. Even if you were part of the discussion, it is important that you keep any decisions confidential until the appropriate and delegated representative of the team speaks to the tangata/client and their whānau/family.

Feedback framework

The following framework can be used to provide feedback to an interdisciplinary team when caring for a client.

1. Focus on progress towards achieving goals

Provide specific examples of what the client has achieved, providing accurate and detailed information. For example: 'Janice can now get out of bed and walk to the bathroom unaided'. Consider such questions as:

• 'What tasks can the client perform now that they could not before?'
• 'What tasks need less support than required previously?'
• 'What has the client told you they find easier now?'

2. Provide feedback when barriers arise

Barriers to client autonomy may arise suddenly. For example, your client may be injured in a fall, reducing the activities they can perform independently. Or they may need additional equipment installed in their home such as handrails. These barriers to autonomy may reduce the level of care you are able to provide.

These barriers need to be communicated to the relevant team members so they can take any action required, such as reviewing care plans, installing new equipment, or providing additional support. Someone in your team may have come across a similar barrier and may be able to suggest strategies to manage it. New barriers may also mean that goals need to be re-evaluated. An example of feedback might be 'Since Daiki fell and injured his elbow, he needs help to get dressed. His independence goals will need to be reviewed'.

 3. Re-evaluating goals  

When barriers arise, the interdisciplinary team may have to re-evaluate client goals. The current goals may now be unrealistic or may no longer meet the client's needs. The team will have to work with the client and/or their whānau, to determine which goals need to be modified. Identify what new goals the person has identified and determine whether they are relevant, appropriate and realistic. Identify what needs to be done and what resources will be required. For example, 'Toby has a goal of showering unaided. This could be facilitated by the installation of a handrail in the shower'.

4. Modifying goals  

Goals which are no longer fit-for-purpose need to be replaced. The new goals may be more modest, or timeframes may be extended. They need to be realistic and achievable, however, they also need to motivate the client and reflect something they want to achieve. For example, 'Flora wants to be able to walk to the letterbox and back, however the timeframe for this has been lengthened due to Flora's ongoing back pain'.

These new goals need to be documented and communicated to the interdisciplinary team. This feedback will ensure that the new goals are implemented and that any resources required to support these goals can be sourced. 

Sixty second rule

For people who do not speak English as their first language, it can take 60 seconds for people to go through translation process.

They have to:

• hear the English words
• translate the English into their language
• think through the answer in their language
• translate the answer into English
• speak the answer in English

If a person does not answer you immediately, it may be that the translation process is still occurring. Be patient and wait.

If it seems that the person is struggling with understanding your words, you may need to rephrase the sentence.

Observing and listening

Get to know the attitudes and preferences of the people you support by observing them and listening to them. What are some of the things that they do regularly?

• How do they speak?
• What words do they use?
• What do they talk about?

Planning for a language issue

Potential supports for language issues:

• Ensure an interpreter is available.
• Read up about your client’s culture prior to your initial visit.
• Attend training to understand verbal and non-verbal communication.
• Communicate with GP prior.
• Use visual aids: language cards/pictures/leaflets.
• Communicate with family members.
• Be mindful of your own communication style.

Allied health professionals

Communication with other health professionals should be fairly straightforward. For example, you should be able to use medical terminology that might not be appropriate with a client.

However, remember to consider the following:

• people who are hard of hearing
• non-English speaking people, or people with limited English skills

When communicating with health professionals in these situations, you will need to speak particularly clearly and slowly (BUT not loudly).

Greeting clients

When you meet a client, you must think carefully about your position in the company, and your relationship with the client. There are a range of greetings from the less formal ('Hi there'), to the more formal ('Good morning'). Māori greetings are also common in many New Zealand services ('Kia ora' or 'Tēnā koe').

Services often have a policy for the way that clients and professionals should be greeted, particularly when you are answering the phone. You will usually be given training for this, but you should ask if you are unsure what to do with greetings.

Terms of address

It is always better to be more formal than more casual. Few people will object to being called “Ms de Angelis”, or “Mr Cayard”. You may find that some people don’t like being called by their first names if they don’t know you well. Listen carefully to the other people around you in the workplace. How do they address others?

You may also need to introduce yourself and say what your position is within the company. You can choose whether to call yourself by your first name, your full name, or Mr/Ms/Mrs X.

'Good afternoon, Mr Schnakenberg. I’m Barbara/Barbara Sutton/Mrs Barbara Sutton. I’m the carer who will be supporting the physiotherapist this afternoon.'

Situation

Is this the first time you have met the person, or do you know them well? Is this a formal or an informal situation? Are you meeting to discuss a sensitive issue, such as the declining health of a whānau member? The more difficult the occasion, the more formal you usually are in your greeting and language.

Medium 

Medium is a jargon word for the method used to communicate. Are you meeting face-to-face/email, or is it on the telephone?

If you know the person already, you do not always need to introduce yourself face-to-face. However, don’t always expect a client to remember your name. It is often best to give your name to avoid embarrassment: 'Good morning, Miss Sua. I’m Jamie – we met last week in the clinic'.

When you are speaking on the phone you should always introduce yourself and your company. 'Good morning, Mr Hyde. This is Ron Finau from Homestay.'

Taboo topics

Certain subjects may be inappropriate to discuss with a client; for example, dementia and mental illness are taboo subjects in some Asian cultures. What is normal to one person may not be normal to another person within the same culture or even the same family.

A note on eye contact

In some cultures direct eye contact is considered threatening or taboo, also too little eye contact can also be impolite.

If you feel uncomfortable due to the client’s indirect eye contact or other gestures, you should consider disengaging your emotions and keep in mind the cultural context.

Another communication tool is reporting. Reporting on the progress of tangata/clients is a legal requirement.

Correct reporting ensures:

• continuity of, and proper standard of care
• effective monitoring and review
• validation of service delivery
• identification of risks for tangata/clients and staff
• evidence for potential legal issues

You will need to give feedback regarding the tangata/clients you are supporting. Your feedback may be:

You need to make sure that you report in accordance with organisational policies and procedures. They include legislative and regulatory requirements, which may apply across a company, a specific site, or a workplace.

Reporting back to the team

Reporting is all part of working collaboratively so that all members of the interdisciplinary team can work together to achieve the common goal of supporting the person as well as possible. Collaborative practice involves the following:

• sharing information within the team so that the person’s care continues to be relevant and appropriate.
• contributing ideas to overcome barriers.
• making the best use of each team member’s time and resources.
• responding appropriately and quickly to changes in the person’s needs.

Factual reporting

A fact is a piece of information about circumstances that exist or events that have occurred.

You can usually find out the facts you need if you can answer these questions:

1. Who is the report about?
2. What did I notice about that person?
3. When did it happen?
4. Where did it happen?
5. Why or how did it happen?

Avoid reporting unrelated details, even if they are facts. Also, avoid reporting opinions, such as what you think about what has happened.

Reporting your observations

Objective observations are pieces of information that you gather by using your senses. To describe these observations accurately, you will need to document or report with detail. Here are some examples:

Hearing

Refers to how you may listen to changes in a person’s breathing pattern, for example, wheezing.

Seeing

Refers to visually observing the person doing more or less for themselves than they could a week ago.

Smell

Refers to how you may observe changes through scent. There may be smells that you do not usually associate with that person, for example, a strong smell of alcohol.

Touch

Refers to how you may feel that the person’s skin is hot, damp, cold, clammy or has goosebumps.

Monitoring and recording

Monitoring tangata/clients you are supporting and recording their progress, or lack of progress, is important. It is essential so that plans are kept up to date, are relevant and achievable.

To make sure that you are supporting them in the best way, and that the plan is working, it is important to monitor and record what is happening. There may be different forms of recording that you will be expected to do in your workplace. For example, there may be a form to complete to record progress on individual plan goals.

Your organisation will have policies and procedures about recording and monitoring progress. If you are unsure of what your organisation’s policies and procedures are, you should talk to your supervisor.

When writing reports and updating plans, always be aware of role boundaries, where your role ends, and another begins.

Effective communication is a two-way process that means getting your message across and also understanding what the other person has to say. The term ‘own cultural communication needs’ refers to the communication preferences and expectations that individuals have based on their cultural background and upbringing.

This includes things like the:

• use of language
• body language
• tone
• other cultural norms and values that shape how people communicate

In some cultures, certain ways of communicating, like speaking loudly, making direct eye contact, using acronyms or jargon, or gesturing while talking, might be considered offensive. Differences which may be based in culture can include:

Understanding and respecting these cultural communication needs is important for effective intercultural communication while at the same time building positive relationships with people from diverse backgrounds.

Being effective in this involves being mindful of one’s own cultural biases and then learning to better adapt to the communication styles of others to promote mutual understanding and respect.

Watch: The Impact of Cultural Differences on Communication (5:29 Minutes)

Watch the following video, and write down the three tips it provides for communicating authentically.