Communication for Health Care Work
Health care workers (HCW) in a community care setting have a duty to promote patient confidentiality. It is both parts of good care practice, and essential to building a strong relationship between the HCW and the patient. Everybody has a right to have their personal details kept confidential. It is ‘seen as a fundamental ethical principle in healthcare and a breach of confidentiality can be a reason for disciplinary action’ (UK Clinical Ethics Network, 2011).
There are many ethical obligations surrounding confidentiality. They include respect for autonomy which is allowing the patient to control their own decisions and rights over their personal information.
Non-maleficence instructs the HCW to avoid causing harm to the patient regarding confidentiality such as sharing information that could damage the individual’s reputation.
Justice relates to abiding by the law and respecting a person’s human rights. There are laws that help safeguard personal information such as the Data Protection Act 2018 (DPA) and the Welsh Accord for the Sharing of Personal Information (WASPI). To uphold the DPA, any information should only be shared on the basis that it is necessary and shared only with those who have a need for it, accurate and up to date, shared securely and in a timely fashion, and not kept for longer than necessary for the original purpose. To uphold WASPI, the minimum necessary information on a need-to-know basis can be shared with the patient’s consent but if there is a risk, information can be shared without consent. These laws are in place to also ensure equality and for patients to be treated fairly.
Beneficence is a principle that helps HCWs to balance the benefits and harms of disclosure of personal information against non-disclosure. This must be specific to the individual, as what is good for one patient may not be beneficial for another There are certain circumstances when a breach of confidentiality can happen. Confidentiality can be breached if it is to protect the patient’s best interests or if you have information that may lead to harm to the patient. The Public Interest Disclosure Act (1998) law is there to protect the HCW who raises a concern.
Verbal and non-verbal communication is about understanding the emotion and intentions behind the information, according to HelpGuide (2019a). They play an important role in sharing information and developing a positive relationship in community care.
When using verbal communication in a community care setting, there are several issues an HCW would have to consider as each individual is unique. Some consist of the length and complexity of the sentences, formality of language style, using colloquialisms, language and style of the communication must match the patient. An example of this could be if the patient were a child and had a limited understanding.
Talking with complex and lengthy sentences may not be beneficial in that circumstance, but short words which are easy to understand may be the best route. But if the patient were an adult with a better understanding, lengthy sentences may be a better option. An HCW must also consider the use of paralanguage. PhysicianLeadership (2017) states that the tone spoken accounts for 38% of the overall message that the listener receives.
Non-verbal communication is just as important as verbal. “When your nonverbal signals match up with the words you are saying, they increase trust, clarity, and rapport. When they do not, they can generate tension, mistrust, and confusion” (HelpGuide, 2019b).
HCWs need to use appropriate eye contact as it shows the patient that they are interested in what they are saying (see figure 1), relevant facial expressions as it indicates how a person is feeling, and suitable body posture such as leaning forward or standing upright shows interest, but “crossed arms could mean someone is bored, uninterested or angry” (SkillsForCare, 2018a). Proximity should also be considered as personal space is essential. Getting to close to the individual may make them feel threatened and uncomfortable, yet too far away may indicate isolation suggests SkillsForCare (2018b).
Figure 1: Eye contact allows the HCW or patient to check whether the information that is being conveyed is understood.
Effective communication in a community care setting requires strong listening skills and requires attending to the individual. There are two different types of listening: passive and active.
Passive listening is simply hearing the words being said and not giving your full attention. It is not doing anything else whilst listening, yet not really paying attention to what is being said, states Gift of Life (2020). It is a one-sided conversation, with little effort needed and gives no feedback to the individual. Lifehack (2020) suggests that a passive listener does not usually even nod his/her head, maintain eye contact, or give much indication to show they are listening.
Active listening is more of a skilled process, demonstrating that the information given is understood. It establishes trust in the healthcare professional-patient relationship and shows care. It is “a specific way of hearing what a person says and feels and reflecting that information back to the speaker” suggests NCNC (2014).
To reflect that information back to the individual, a couple of steps may be involved. These include checking with the patient such as “I’m not sure if I understood what you were saying about…?”. Clarification involves summarising and seeking feedback by asking questions to ensure that the correct message has been received. Showing support by saying “I hear you, please carry on.” Building on involves asking things such as “I would add to your last point…” This helps to reinforce that the HCW shows interest in what the individual is saying. Reflecting includes the HCW repeating or paraphrasing what the individual has said back to them as it will “help make a more thoughtful response and enable you to check to understand” (NHS, 2011).
There is also a technique an HCW can use called SOLER (square, open, leaning, eye contact, and relaxed). Using this method (see figure 2), it should “help others feel heard and valued while ensuring that their messages are fully understood by the listener” suggests My RT Wellbeing (2019).
Figure 2: A way to physically demonstrate your interest and engagement using the SOLER method.
“When communication is difficult, it is often because of some kind of barrier” according to OpenLearn (2017). When out in the community working, an HCW may face some barriers to effective listening and attending.
A major barrier when working in the community would be the workload. Community working involves caring for individuals in their own homes and usually having a short amount of time to provide all the necessary care needed. A recent study carried out by PMC (2015) showed that HCWs being overworked was one of the most frequent communication barriers. HCWs may have too many tasks to complete which leaves them unable to effectively listen to the individual and may also lead to stress. When people lack the knowledge and abilities to match the work demands and pressures, they lose the ability to cope and become stressed suggests WHO (2007). Also, ACAS (2019) suggests that 60% of employees blame their workload for their stress/ and or anxiety.
Communication also suffers from noisy conditions, which can impair speech comprehension, and even more, if they suffer from hearing or language impairment, attention deficits, or another first language suggests Frontiers (2019). These can include noise from medical machines such as a ventilator or a SATS monitor, noisy background from a television, or even a house pet.
Another barrier that can affect an HCW’s ability to effectively listen is when they are preoccupied by their own concerns. “We are all living in a world full of distractions, which makes us all highly susceptible to the lure and appeal of distracted listening” suggests ATD (2016). Many problems can distract HCWs from communicating properly including but not limited to money/debt, family, divorce, bereavement, and car problems (see figure 3). According to Harvard Business Review (2017), people struggle when they are distracted, and we fail to pick up on other people’s behaviors and emotions.
Illness can be a barrier for communicating successfully. Some of the illnesses that can affect people’s ability to communicate effectively can be motor neuron disease (MND), multiple sclerosis, Parkinson’s, head, and neck cancer. According to Marie Curie (2019), these illnesses can cause dysarthria (difficulty speaking) as the individual is less able to control their muscles and nerves for speech, which makes them difficult to understand.
Figure 3: Interruptions and distractions may compromise the attention of HCW
- ACAS (2019) Stress and anxiety at work: personal or cultural?, Available at: https://archive.acas.org.uk/media/6245/Stress-and-anxiety-at-work-personal-or-cultural/pdf/Stress_and_anxiety_at_work_personal_or_cultural.pdf (Accessed: 23/09/2020).
- ATD (2016) We Must Stop Distracted Listening, Available at: https://www.td.org/newsletters/atd-links/we-must-stop-distracted-listening (Accessed: 23/09/2020).
- Frontiers (2019) The Others Are Too Loud! Children’s Experiences and Thoughts Related to Voice, Noise, and Communication in Nordic Preschools, Available at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01954/full (Accessed: 23/09/2020).
- Gift of Life Institute (2020) The Importance of Active Listening, Available at: http://www.giftoflifeinstitute.org/the-importance-of-active-listening/#:~:text=Passive%20listening%20is%20one%2Dway,about%20his%20or%20her%20experience. (Accessed: 20/09/2020).
- HelpGuide (2019a) Effective Communication, Available at: https://www.helpguide.org/articles/relationships-communication/effective-communication.htm (Accessed: 19/09/2020).
- HelpGuide (2019b) Nonverbal Communication, Available at: https://www.helpguide.org/articles/relationships-communication/nonverbal-communication.htm#:~:text=When%20your%20nonverbal%20signals%20match,trust%2C%20clarity%2C%20and%20rapport.&text=If%20you%20want%20to%20become,but%20also%20to%20your%20own. (Accessed: 19/09/2020).
- Lifehack (2020) Active Listening vs Passive Listening: Is One Better Than the Other?, Available at: https://www.lifehack.org/881336/passive-listening (Accessed: 20/09/2020).
- Marie Curie (2019) Communication difficulties, Available at: https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/individual-needs/communication-difficulties (Accessed: 23/09/2020).
- My RT Wellbeing (2019) Active listening skills using the SOLER method, Available at: https://www.myrtwellbeing.org.uk/communication/active-listening-skills-using-the-soler-method/401.article (Accessed: 20/09/2020).
- NCNC (2014) ACTIVE LISTENING, Available at: https://ncnc.unc.edu/files/2014/03/ActiveListening.pdf (Accessed: 20/09/2020).
- NHS (2011) Active listening, Available at: https://improvement.nhs.uk/documents/2085/active-listening.pdf (Accessed: 20/09/2020).
- OpenLearn (2017) Barriers to good communication, Available at: https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=79881§ion=2.1 (Accessed: 23/09/2020).
- PhysicianLeadership (2017) More Than Words Can Say: How Delivery Affects the Message, Available at: https://www.physicianleaders.org/news/more-than-words-can-say-how-delivery-affects-the-message (Accessed: 19/09/2020).
- PMC (2015) Communication Barriers Perceived by Nurses and Patients, Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954910/#:~:text=According%20to%20the%20patients%2C%20gender,to%20communication%20(Table%204). (Accessed: 23/09/2020).
- SkillsForCare (2018a) Communication skills in social care, Available at: https://www.skillsforcare.org.uk/Documents/Learning-and-development/Core-skills/Communication-skills-in-social-care.pdf (Accessed: 19/09/2020).
- SkillsForCare (2018b) Communication skills in social care, Available at: https://www.skillsforcare.org.uk/Documents/Learning-and-development/Core-skills/Communication-skills-in-social-care.pdf (Accessed: 19/09/2020).
- UK Clinical Ethics Network (2011) Ethical Issues – Confidentiality, Available at: http://www.ukcen.net/ethical_issues/confidentiality/introduction (Accessed: 19/09/2020).
- World Health Organisation (2007) Stress at the workplace, Available at: https://www.who.int/occupational_health/topics/stressatwp/en/ (Accessed: 23/09/2020).