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This page covers all of Unit 1, Communication learning outcomes, 1, 2 &3. The power-point link below accompanies Learning Outcome 1.
1.1, 1.2, 1.3 &1.4
Behaviourism, was an founded by John Watson (1913). This approach looks at the association that people have with stimuli and responses (Herne et al, 2008, 129). It favours scientifically proven methods and considers only measurable and observable behaviours to be important. There is much less focus on how an individual is feeling or thinking (as with Humanism) and instead a focus on understanding somebody based on how they learn. Behaviourist opinion states that the way in which people behave can be attributed to the responses they have received, and that this cycle of reinforcement forms the basis for future behaviour. Therefore we can assume that behaviours we see within daily practice are being displayed because the individual has learned how to achieve a desired response. However this approach fails to consider the free will of a person, or that biological processes such as hormones can impact on behaviour. Instead, the preference is on breaking down behaviours into smaller parts and examining them closely in a reductionist fashion (Simply Psychology, 2016).
The Cognitive Approach is considered to be purely scientific and based on laboratory results. It tells us that people behave in certain ways based on how their mind processes information. Theorists compare the human brain to a computer where information can be accessed and retrieved at any time (Simply Psychology, 2013). Jean Piaget (1936) one of the first major influences in Cognitive Theory based his research around children, and identified “Schemas”, which he stated are the platform or building blocks of intelligent behaviour that allow us to create a picture and ideology of the world around us. He focused on how individuals develop reasoning and knowledge about their environment. (Simply Psychology 2015). Edward Tolman (1948) argued against the Behaviourist perception that stimuli/response occur because they have been learned and suggested that a mediational process or cognitive thinking influence how people behave. He developed a cognitive model (cognitive maps) to demonstrate that in fact people act in certain ways for a multitude of reasons – Values, Culture, attitudes and changes in their health, life or environment. Tolman suggested that reinforcement played no part in learning and that behaviour was primarily cognitive and a result of actual decisions made between the stimuli and response phase. (Simply psychology, 2013). An advantage of Cognitive Theory is that because it is based largely on scientific experiment it increases its validity. There is little data surrounding the application of this theory to those with learning disabilities, but in care practice it makes sense to promote learning and skills with an individual at a level that is appropriate to their development and to put strategies into place to support that.
The Psychoanalytical perspective is based on interpretation and focuses upon how the behaviour of people is influenced by the unconscious, and that behaviour we exhibit as adults has its foundations in childhood experiences (Simply Psychology, 2007). Sigmund Freud who founded the psychodynamic approach stated that the personality is divided into 3 parts – the ID, Ego and Superego and that these aspects are in constant conflict with each other which results in anxiety in the conscious. Freud, and another psychodynamic Theorist Carl Jung both agreed that all behaviour has a cause, therefore behaviour must determined. (Simply Psychology, 2007). While Jung continued to promote psychodynamic theory his opinion differed in that he believed that the way we behave is also influenced by our hopes for the future, and not just previous experiences.
Transactional analysis is a theory which examines interactions and relationships, and identifies ways of making those interactions more effective. Inspired by Freud and Wilder Penfield, Eric Berne acknowledged the contributions of other theorists and used them to develop his own theories. Berne claimed that the way we interact is determined by 3 areas of our personality. The Child, the parent, and the adult. He called these 3 separate aspects of behaviour Ego states (TA made simple, undated), and suggested that no matter which ego state an individual is using to interact, the aim is to receive “strokes” or units of recognition.
The Humanistic Approach
Humanism is a perspective which looks holistically at a person and draws focus to the study of the individual as a whole. There is an emphasis on how psychological well-being can influence our actions and a belief that all humans have an instinctual impulse to fulfil their potential (Simply Psychology, 2015). Humanistic Theory differs to other approaches in that it is more subjective, and focuses less on how an individual is viewed by society, and more on how that individual views society for themselves. There is also rejection of more scientific based methods of theory, such as Behaviourism and Psychodynamics because they don’t take into consideration the concept of free will or “Personal Agency”, and the impact it has upon the personality.
The approaches most famous founders were Abraham Maslow and Carl Rogers, who shared very similar, yet separate opinions on the theory. Maslow proposed that realising our full potential could only come about through essential needs being met and organised this into a Hierarchy of Needs (Brotherton and Parker, 2011, 160), with physiological needs such as food, warmth and shelter at the bottom steadily rising through more emotional and psychological needs towards the higher levels before finally reaching self actualisation or the ability to manage ones emotional, physical and spiritual well-being independently. This approach was echoed by Carl Rogers who acknowledged the human tendency to self-actualise and built upon it further by suggesting that all individuals are capable of making the right choices, and know what is best for them, and that provided with the appropriate client/carer relationship this can be achieved. Rogers emphasised that it was the attitude of the worker, in his case the counsellor towards the client, that gave it its person-centredness. (Brotherton and Parker, 2011, 181).
Because Humanism relies on qualitative exploratory research based on opinions and motivation, it can be considered by other approaches to be inferior. However when he wrote Counselling and Psychotherapy (1942), Carl Rogers posed a theory – that if a positive, congruent and understanding relationship was permitted to develop between the carer and client, the individual could resolve the difficulties in their life. This person-centred concept was successfully transferred into other caring relationships such as nursing and support work, and eventually into many other areas of industry and is now the framework for both legislation (The Care Act 2014), and in ensuring that individuals going through assessment have their voices and opinions heard and acted upon.
Miss P is 47 and has learning disability and autism. On the morning that I visited she was clearly distressed. As I knocked on the door I could hear her crying and shouting from within the flat. I asked Miss P if I could enter her flat, and she replied “Yes Please, I think I am going to die”. Once inside the property it became clear that Miss P was anxious over an article about illness which she had heard on the news. I reassured Miss P that everything was just fine, and in a quiet and calm voice asked her if she would like to sit down and talk. Miss P responded that she would like to. I asked Miss P if I could first turn her TV down, and then we sat down and miss p started to speak about why she felt upset. During our conversation I used open and friendly body language and acknowledged Miss P’s concerns in an attentive, understanding and caring way. Miss P appeared to be happier after our discussion but made me repeat what we had spoken about many times. I complied with her request initially, and then firmly but kindly reminded her that we have already discussed this. Miss P finally appeared satisfied with my response and replied “Yes that’s True, I’m not upset now”.
In the case study a Humanistic approach was applied to the situation. The tone was calm, kind and understanding and the environment and atmosphere were free from threat. There was no rush and Miss P was able to take as long as she needed to talk about why she was feeling anxious. Because she felt nurtured and enabled by having a compassionate and listener, Miss P was able to successfully relay her worries, and come to a resolution independently. Applying Humanistic theory relies heavily upon elements of common sense and having a caring and familiar listener with whom the individual feels comfortable with. Despite having a diagnosis of autism and learning disability this approach did not present barriers to her reaching a conclusion and resolving her worries and could easily be applied to a range of service users within my setting.
From a Behaviourist approach, it could be implied that Miss P is displaying behaviour as a result of her response to her environment, and that she has learned she will gain a specific response by reacting a certain way. For example her crying and shouting illicited a calm and soothing response from staff. Watson (1913) described this as Stimulous-Response, which he stated “To predict, given the stimulus, what reaction will take place; or, given the reaction, state what the situation or stimulus is that has caused the reaction”. In practice this theory could be applied to predict when Miss P may have episodes of anxiety and to support her to learn different coping mechanisms. It could also be argued that Miss P displays this learned behaviour in order to gain or be gratified by the response she gains from the staff, and that if the carer consistently changed the response given that the behaviour could be “unlearned”. (Herne et al, 2008, 129)
It could be suggested that from a psychodynamic viewpoint, Miss P is expressing irrational behaviour about the news article because she has an unresolved issue or trauma surrounding illness which developed in her childhood. Psychodynamic Theory assumes that behaviour and feelings as adults (including psychological problems) are rooted in childhood experiences (Simply Psychology, 2007) and have the potential to influence our adult responses. There is also the assumption that treating the behaviour alone will not remedy the situation, and will just be replaced by another irrational response unless the unconscious cause is addressed. This could explain why Miss P didn’t initially feel satisfied by having a calm member of staff with her, and kept asking for information to be repeated. only the behaviour was treated, and not the underlying cause. To support Miss P in addressing her fear it may be useful apply this approach and enable her to identify other, less stressful ways for her to view illness and then incorporate these new ways into her everyday support. One possible disadvantage is that members of staff may not all interpret the problem in the same way which could present barriers to identifying the issue.
In the application of Transactional analysis. Miss P was presenting with the ego state of the child ( worrying, crying, shouting) and I assumed the role of the rational adult ego state, while at times crossing over to a firm but nurturing parent ego. I initiated the conversation and became the agent, (Transaction Stimulous) and Miss P became the respondent (Transaction Response). I employed “positive strokes” by using eye contact, and being attentive and reassuring. Berne defined an ego state as “a consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behaviour (Eric Berne M.D, 2015). Strokes, or units of recognition are sought out by us, whether we are aware of it or not as they allow us to be acknowledged by another person. This can be demonstrated when one individual greets another hello and gains a reply, strokes have been exchanged. In practice I see this demonstrated within my setting, despite my client group having learning disabilities, these strokes, even if the strokes are non-verbal are still exchanged. In “Games People Play”, Berne (1968), stated that every person, even those with intellectual disabilities are capable of objective data processing if the appropriate ego state can be activated. Taking this into consideration it may be useful to continue applying Transactional Analysis as an effective way to resolve tensions and conflict that occur within my setting.
From a cognitive perspective Miss P could have been so upset because the mediational process which occurs between the stimuli (news article) and response phase was somehow flawed. With a diagnosis of autism already in place, Miss P already has issues with expressive language, anxiety and theory of mind which affects her ability to form concepts and separate her experiences into an order which makes sense to her. To support with this, the organisation could provide opportunities for learning in which she could process information about illness in different ways and therefore formulate new responses. This could be applied in a variety of ways, for example discussion/reassurance, or by providing Miss P with Picture information which is a format she is familiar with.
In practice care staff use their communication skills in many different ways, but all for the common purpose of forming a relationship or alliance with the recipient. Verbal communication is used within the health and social care setting to:
- provide support and reassurance to individuals,
- To advocate – in the case of profound and multiple learning disability
- To express how we feel, emotions
- To challenge, seek clarification or inform
- To disagree or to suggest ideas
- to engage in social conversations with another person or in groups
- explain our reasons for doing something or working in a particular way
- To respond to the questions from colleagues, clients,
- To converse with family members or professional agencies.
- To deliver important information
- To contribute in meetings or collaborations or complain and raise potential issues
- To ensure information is communicated effectively
- And in the creating of the person-centred plan of the individual within a partnership.
To ensure verbal communication is appropriate, attention must be given to the paralinguistic (Tilmouth et al, 2015, 23) aspects of speech such as accent, tone, pause timings, pitch , volume and speed. If these aspects are not cohesive then any message spoken would be poorly understood. To use an example, an excited high-pitched sing/song voice would be a totally inappropriate way of delivering bad news to someone, and would result in confusion and upset. In order to promote clear understanding in the support of people with a learning disability, it is vital that speech is free from jargon, and simplified. The way in which we deliver our verbal communication is as important as the words themselves
Written : In the Health and social care setting it is vital that written information is accurate. Support plans and daily records contain sensitive information about the individual, therefore any documentation contained inside must be correct and up to date. The scope for mistakes is easily broadened if information is wrong, cannot be understood by the person reading it, or has been communicated in a way that isn’t effective ( for example illegible handwriting, poor use of written language,) This is especially relevant in the writing of health or medication plans where any mistake can compromise the well-being of the individual. During the delivery of support, staff incorporate written communication in various ways. This may include:
- Policies and procedures for guidance on practice and ways to adhere to legislation
- Accident/near miss reports
- Support plans/daily records – which contain confidential data relating to care needs and personal choices.
- Visitors books – to ensure each person on the premises is accounted for in case of fire or emergency
- Easy read prints, – to simplify and break down information for clients.
- Memos – from management to colleagues.
- Emails – supporting people to stay in contact with friends and family,
- Medication administration records – to document who a medication is for and information about dosage, timing and frequency.
- Handover reports – which inform other staff about the well-being of the individual during the course of a shift.
Listening Working with vulnerable people requires that Listening skills are effective – that is, ensuring what has been heard has been interpreted properly. In the support of people with Learning disabilities there is often difficulty with communication which only emphasizes the importance of listening to and identifying needs. There is also the possibility that what is being said by somebody may not actually be what they mean. It is important to remember that some individuals may consider care staff or management as being in authority, or coming from a position of power, and that this can be intimidating and can potentially present a barrier to how things are listened to and perceived. There could also be a risk that Listening skills are particularly relevant when an individual is disclosing abuse, or making an accusation. Effective listening can be put into practice in various ways and could incorporate:
- Ensuring that information being heard is accurate.
- The utilisation of an individuals chosen communication method
- Listening to complaints or allegations
- Listening to information given over the phone – this could be from a social worker, a family member, or colleague
- To show respect
- Acknowledging and showing interest in the what the individual has to say
- Listening to and recognising the variations in pitch and tone that may indicate a client is stressed, unwell or unhappy.
- Being given information about an individual during collaborations.
- Listening to the family members of clients to foster good relationships
Non Verbal Most of the communication that is conveyed by people is non-verbal. Dr. Albert Mehrabian, a well known psychologist proposed, after research, that only 7% of what a recipient understands comes from spoken word. The remaining 93% results from tone and pitch of voice, facial expression and body language (Eric Burne MD, undated). Broken down, non verbal communication is information which is sent and received without the use of words and is used by everybody, everyday, whether or not they are aware of it occurring. We can tell a lot about how an individual is really feeling from the body language they use. Some examples of this are
- Touch can communicate affection, anger, urgency. It can be used to teach and learn new skills, and can also be used to alert to the fact that something is wrong. Acknowledging that someone may not want to be touched or have their personal space invaded is important. Working alongside vulnerable people can often present situations which provoke upset and empathy . Under normal circumstances a natural human response to that would be to hug an individual, or place a hand on their arm to offer support, however it is important to work appropriately within the remit of the client/carer relationship to maintain professional boundaries and promote healthy working relationships
- Facial expression – which allows us to interpret and show interest, mood, pain, and emotions like love, happiness and fear. It can also allude us to the fact that somebody may not mean what they are saying verbally if their expressions do not match their words.
- Posture – can communicate that we are tired, energetic and can determine if someone is listening, if they cant hear us, or if they are ill. It can reveal feelings of guilt (Hands touching face, throat or mouth rather than the chest/heart area) (Bifaloo, 2013)
- Posture can be offensive either directly or indirectly, for example inappropriately putting feet up during a professional meeting
- Eye contact makes us aware that we have connected with the recipient. It enables an individual to convey emotion and needs, alerts us to the fact that something maybe wrong, and lets us recognise that we may not have been heard or seen. Eye contact acknowledges that we are interested, and is a sign of respect. There are cultural variations surrounding the use of eye contact and for some Asian families, avoiding eye contact is regarded as polite and considerate. Some individuals with autism may find eye contact difficult, and may actively avoid this preferring to gesture instead.
- Gesture – signals which are used to communicate information. This can be through pointing, waving, nodding and shaking of the head or expressions of the face. Gesture enables us to decipher how a person is feeling, ( thumbs up thumbs down). Reliance on the visual cues of gesture is often very common in the support of individuals with learning disability therefore ensuring that non verbal communication is just as effective as the spoken word is critical.
Review methods of dealing with inappropriate interpersonal communication
At some point within practice everybody is going to experience inappropriate communication with another person. Within the context of a learning disability setting it is especially important to establish effective ways of communication. One of the reasons for communication becoming counter productive is the use of language that is too formal or organisational jargon. Complex communication for individuals who already have problems with speech, language and understanding can cause problems in both identifying, and having needs met. It can also result in messages either being totally misinterpreted and present barriers to making informed choice. Michael Argyle (1972) developed a model which he named the communication cycle. It highlighted an intricate 6 stage process incorporating the formation, coding, sending, receival , decoding and understanding of a message. His theory analysed and defined the multiple components that are necessary for even the smallest of messages to be exchanged. (slideplayer, undated). Further barriers to interpersonal communication may include:
- Learning difficulties. Service users with learning difficulties often require information to be simplified and straightforward. Breaking information down so it is easily accessible for the individual can aid in a better understanding of what is being conveyed, and can promote independence and inclusion.
- A lack of appropriate knowledge about the user group – Ensuring all members of staff are up to date in any training relevant to the job role ensures that the latest methods are being employed.
- Power imbalance – Acknowledging that imbalances of power in carer/client relationships occur and having an awareness of how to prevent it happening, for example working in agreed and person-centred ways and reflecting on own practice to address any issues.
- Low self esteem/poor mental health
- High staff turn over within the organisation, can mean that the client isn’t familiar with the person supporting them and this can limit effective communication
- Tensions and mistrust in the carer/client relationship , perhaps resulting from poor care, unreliability , or breaches of confidentiality
- Not respecting the private life or privacy of an individual
- Limited understanding or acceptance to the cultural values or lifestyle of an individual – Practicing in dismissive or prejudiced ways can result in a reluctance to communicate with staff, or can cause clients to refrain from sharing and celebrating important aspects of their heritage.
- Any type of abuse – this could have the potential to completely stop an individual from communicating, or staff may experience the client communicating in a way which protects the abuser for example lying or denying knowledge of any abuse. The client could display challenging behaviour as a way of expressing their feelings of fear and frustration. Staff need to have a recognition that abuse does occur, and an awareness of strategies to limit the possibility , for CRB checks on staff, risk assessment, and adopting person centred ways of working.
- Incongruent messages, which confuse the recipient because the words say one thing, and the body language is conveying something else.
- External and environmental influences, such as medication, stress, peer pressure, media, trends , all of these can impact on how the client communicates. Side effects from medication may interfere with the ability to maintain effective communication. Media presence such as music , television and film can all influence and pose barriers to communication.
An awareness of the ways in which communication can be compromised is crucial to delivering good practice. By working in agreed ways and adhering to codes of practice and legislation, the scope for barriers to present is limited.
Analyse the use of strategies to support users of Health and Social Care services
When working with vulnerable people who may have difficulty in communicating, it is essential that staff have a good knowledge of their client base and are familiar with their chosen methods of communication. In well -established relationships a carer can anticipate what is being implied simply by recognising a facial expression or a behaviour. This recognition, which has its foundations in trust can support in ensuring the individual has their needs met, and their opinions heard as effectively as possible.
There are various aides to support in the management of specific communication needs. For sensory impaired individuals glasses, magnifying glasses and hearing aides can be utilised – this will involve input from health professionals which will need to be incorporated into support by staff members. There will need to be awareness from care staff that communication can be compromised if hearing aides are not switched on, batteries are low, or if glasses are dirty or broken.
- Picture symbols are often used by individuals who have autism, speech and language difficulties or who benefit from a visual learning style. All types of situation and scenario can be conveyed through their implementation. Because they are also easily understood by other people there are few barriers to prevent their use.
- Specialised systems such as the voice output communication aide used pre stored speech as a way of communicating., any individual using a device like this would need be supported to use it independently, and organisations would need to take into account that staff may need to spend extra time with the individual so that communication can take place.
- British Sign language and Makaton are both forms of specialised sign language and would require that all staff who support the individuals using these techniques to be trained in this also. Clients should be provided with opportunities to maintain their community presence in settings such as groups or social outings with peers where Makaton or BSL is also used, their difference in communication style should never cause isolation. Communication and inclusion could further be promoted by access to television programmes which feature sign languages.
- Braille is a system of touch reading and writing in which raised dots represent the letters of the alphabet and numbers, as well as music notes and symbols. It is highly specialised. Opportunities to access books and documents in Braille format should be available, and all staff should be made aware of this necessity by inputting information into the individuals support plan,
Advocacy although provided by support staff can be limited due to conflictions with duty of care. An independent advocate can effectively represent and communicate on behalf of a client, explore choices and options and safeguard rights (SeAp advocacy, 2016) Involving the use of an advocate will require discussions with family members and any social worker, and regular reviews to ensure that it is still relevant.
Challenging behaviour significant difficulties with communication. Ensuring that only staff who have relevant training in methods which decrease and diffuse episodes of behaviour can promote clearer lines of communication with the individual, as can identifying reasons for behaviour and putting steps into place to decrease access to triggers.
Some individuals may be unable to communicate effectively because of a barrier within their environment. They may have sensory overload from too much noise, or lighting that is too bright. There could be a potential threat which is intimidating the client. Often care staff are unable to identify the problem and may need the additional support of other agencies , such as psychology, psychiatry or speech and language therapists to help determine the issue. Working in partnership allows for multiple areas of expertise to collaborate but relies on honest and factual information being presented so that the right treatment or advice can be given.
The organisation promotes the safety of clients by adhering to confidentiality policies and procedures . As part of the job role all employees are required to follow the policy of the organisation which states Personal and private information about people with learning disabilities and their families should be treated sensitively and only shared on a “need to know basis” within the organisation. Communication about personal matters relating to families and individuals should take place in a private office. Open discussion in public or open areas is discouraged. Unless there are exceptional circumstances, information should only be shared with outside agencies with the permission of the individuals concerned (please see highlighted excerpt from confidentiality policy). .
It is critical that care staff understand the procedures and embed them into any support given. Maintaining confidentiality is a crucial component of building a respectful and trusting relationship between the client and the care provider and an integral part of protection of the individual.
Private information relating to Clients, should only be given on a need to know basis, and whenever possible with consent. There may be times however when, for
safeguarding reasons, information must be passed on. Care staff working alongside clients must make them aware that should they be at risk of harm then information may have to be disclosed to other professionals. During this time only the minimum amount of information necessary to safeguard the individual should be given.
The Caldicott Standards are guidelines which are underpinned by the Data Protection Act and identify 8 principles for the handling or processing of personal data. These principles are often incorporated into the confidentiality polices of organisations and are used daily within care practice. The Caldicott Standards state that employees must:
- Justify the purpose for which the information is needed.
- Only use personally identifiable information when absolutely necessary.
- Use the minimum personal identifiable information possible – if possible use an identifier number rather than a name.
- Access to the information should be on a strict need to know basis.
- Everyone should be aware of his/her responsibilities to respect client’s confidentiality.
- Understand and comply with the law. The most relevant legislation is, the Police & Criminal Evidence Act 1984 and the Human Rights Act 1998. (Calidicott Standards and Data Protection)
Confidential information relating to clients is safeguarded by the Data Protection Act 1998. Sensitive data is defined as personal data consisting of information as to the racial or ethnic origin of the data subject, his political opinions, his religious beliefs or other beliefs of a similar nature, his sexual life, his physical or mental health or condition (Data Protection Act 1998 s.2).
In order to fully meet the needs of clients, support staff work in agreed ways as outlined in The Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England (2013) which states that “care workers should promote and uphold the privacy, dignity, rights, health and well-being of people who use health and care services and their carer’s at all times”, and by having knowledge of legislation which is relevant. The organisation promotes and enables individuals to utilise choice and maintain independence by applying a person-centred approach during the care planning stage.
learning disability can impact upon the capacity to understand rights, therefore these should be explained in a simplified and jargon-free manner. To promote autonomy, and enable in making informed choice care staff should support the individual to access information and communicate this in their chosen format,
In conclusion it has been established that the skills and approaches used to support with communication are extremely convoluted and are incorporated into support at every single level. The basis for safeguarding clear lines of communication is ensuring that support is delivered in a person centred way and that the individual continues to be empowered by this.
Learning outcome 2 (2.1, 2.2, 2.3 & 2.4)
To deliver best practice within health and social care, there must first be a recognition that identity, belief system, faith and culture have a profound effect on the communication process.
Early in life an individual is influenced by parental and caregiver identities which then shape and construct the ideals and values of the child. By the time school is started and the social circle starts to broaden, the child is exposed to the personal beliefs and diverse cultural values of peers and teachers, and to a taught curriculum which further shapes the viewpoint. As the individual matures there is access to TV, music, trends, fashion and social media. This constant barrage of exposure is highly influential in moulding the principles, prejudices and personal ideology of the individual. Robert L Health (2012) states that: “Society cannot exist without influencing one another’s opinions and behaviour through discourse. In interpersonal communication people influence each other’s judgements and behaviours; they are affected by each other’s actions and statements”.
Influence can be both verbal and non-verbal. Media influence is mostly symbolic and clearly has the power to be persuasive, for example, imposing rhetoric upon society through use of adverts, political campaigns and music videos. James Price Dillard (2002) proposes that “being persuaded applies to situations where behaviour has been modified by symbolic transactions (messages) that are sometimes linked with coercive force and appeal to the reason and emotion of the person being persuaded”. This suggests that persuasion holds an element of threat and manipulation, that if an individual doesn’t adhere to a particular ideology or belief system that they are in some way defunct and undeserving. When communicating with vulnerable individuals it is important to identify our own ideologies and prejudices and recognise that this is learnt behaviour with its roots in upbringing and external influences and to take steps to rectify this.
Culture is a process through which ordinary activities and conditions take on an emotional tone and a moral meaning for participants (Arthur Kleinman, 2006). Stepping outside of cultural norms can be intimidating, especially for minority groups who may socialise and associate only within the network of their own extended families. An ‘ethnic group’ has been defined as a group that regards itself or is regarded by others as a distinct community by virtue of certain characteristics that will help to distinguish the group from the surrounding community. Ethnicity is considered to be shared characteristics such as culture, language, religion, and traditions, which contribute to a person or group’s identity (National Youth Council of Ireland, Undated). It is crucial therefore to recognise that discrimination can occur through misunderstanding of the social behaviour and shared values of other cultures.
Gilmartin and Robinson (2002) propose that in the United Kingdom, the delivery of person-centred and individualised care could actually be responsible for tensions and opposing viewpoints in ethnic minority communities who may view health problems as a collective rather than individual responsibility. It is not difficult to see how confusion can occur in the assessment and support of clients from culturally diverse backgrounds due to differences in the utilisation of verbal and non-verbal language. There could be characteristics to the paralanguage and use of space of the individual which present barriers to accurately interpreting what is being said. This ineffective communication can ultimately result in reduced opportunities and uncertainty on the part of the individual and families who may not be accustomed to British services and hold the perspective that agencies are in a position of power and authority.
Discriminatory practice such as racism can be passive, subtle, and operated on an individual or group level with the aim of governing the outcome for the client based on a preconceived notion about their culture. Rogers (2012) explains that this is a covert form of power that controls decisions, often by ignoring grievances which already exist. Communication with individuals may be camouflaged with the intention of appearing to be in best interests but actually has the effect of promoting further isolation and exclusion. The following are examples of how barriers to the communication process may develop:
- Limited knowledge of socio-economic factors which other cultures face
- Lack of understanding of traditions and values
- Opposing ideology
- Differences in the use of speech and language (second language, accent, culture-specific words)
- Mistrust; the individual may feel powerless and have a perception that services to assess support are authority figures. The professional may be prejudiced and assume that the client is trying to get something for nothing.
- Weak communication skills within staff
- Failure to acknowledge oppression
Delivering support following a person-centred model, and maintaining sensitive anti-oppressive practice can limit the scope for discriminatory practice.
Social stratification is the allocation of individuals and groups according to various social hierarchies of differing power, status, or prestige (Andersen, 2011).
It is a universal belief but varies from culture to culture. Max Weber (1920) believed tat social stratification results from a struggle for scarce resources in society, and that as a result power struggles relating to economic resources, prestige and political power occur (Holborn, 2013). It is necessary to have an understanding that everybody holds personal preconceived ideas in some shape or form about class distinction. Impressions about people or groups can be formed on the clothing they wear, the way they speak and their sexuality. In society, we have been conditioned to accept that certain accents and styles of clothing must mean better education, income, and integrity. This can be traced to family/peer viewpoints and the lack of broad regional accents on the news, TV and radio. There is an assumption that people who live in nice homes must have a better education, higher paid employment and therefore be in some way more proficient and elite. As a culture, there is the same disparity aimed at those who perhaps live in social housing, are unemployed and in receipt of benefits – the societal perspective is that these groups of people are educated to a lower level and are in some way “milking the system” and have poorer values than their more financially secure counterparts. The public appear to abide by the social-class roles identified by sociologists such as Weber and Marx and indirectly classify themselves and other individuals as upper, middle and lower/working class. This can cross over into the assessment and support process if services fail to acknowledge their own predetermined attitude.
Recognition of social-class ideology allows the organisation to maintain awareness while interacting with individuals and can promote in providing supportive rather than defensive communication. Gibbs identified that the communication climate can be altered by using supportive or defensive behaviour. Defensive behaviour is defined as that conduct which occurs when an individual perceives threat or anticipates threat in the group (Gibbs, 1961). This can occur if stakeholders within the collaboration hold inflexible and predetermined ideas about the gender, ethnicity, age and sexual orientation of the individual, thus interacting in a way that is prejudiced, restrictive and ineffective.
Specific factors which can impact upon communication, such as age, can influence the assessment process and thus any care delivered. There are now 10 million people in the UK who are over the age of 65. The latest projections are for 5½ million more elderly people in 20 years time and the number will have nearly doubled to around 19 million by 2050 (Parliament, 2010). As a culture, we are living longer and consequently there are more people requiring care and support. The older generation have seen society change more than any other portion of the population, and have more life experience, “yet are one of the most vulnerable groups for ageism” (Barnard, 2011). McEwan (1990) suggests that ageism is “unrecognised discrimination”. Similarly, many elderly people report being victims of prejudice and stereotyping which further impact on the communication process, self-esteem and self-image. In addition to this much of the younger generation use different terminology to their older counterparts and hold very different viewpoints. This can be confusing for individuals born in an era of “make-do and-mend” and who possibly hold the opinion that problems are to be dealt with in a stoic fashion, without the need for intervention. Furthermore, there is often a fear of losing independence and consequently information from the individual could be withheld which may lead to the need for crisis involvement. Arber (1993) states that “elderly people are likely to retain many of the attitudes and traditions that were prevalent during their formative years…and have lived through periods which differ radically from today’s society. With this in mind, “getting it just right” clearly requires an approach to communication to be adopted in way that is honest, in a familiar setting and with as much involvement from loved ones as possible.
Sexuality and sexual orientation are a part of an individuals’ unique identity. Some clients, however, may feel a sense of shame in disclosing this information to services. There may be a fear of isolation or worry about loss of integrity and credibility. Gay, lesbian, or bisexual individuals may have experienced previous discrimination or homophobia which has left them unwilling to divulge important information that could improve the care they receive. The health and social care needs of gay people are impacted by numerous social, behavioural, and physical influences combined with prejudice and a lack of understanding and, conversely, despite being more at risk of mental health problems such as depression, anxiety and suicidal feelings than heterosexual men and women (NHS Choices, 2014), they are less likely to visit the GP and report poor mental health or illness. Reluctance to report ill health may be entrenched in:
- Worry about potential questions surrounding lifestyle and sexuality
- Fear or HIV, AIDS and other sexually transmitted diseases
- Fear that health care professionals may also hold outdated and discriminatory views
- Disproportionate shame
- Lack of education/information surrounding own life style.
- Being gay and part of an ethnic minority where stigma and discrimination is amplified.
While it should never be a mandatory requirement to disclose one’s sexuality – acceptance from society can only result from people being open and unashamed about their sexual orientation and via reinforcement through the powerful channel of media and internet. There is a clear necessity to determine ways to improve the communication process for gay people in the health and social care system, and this could perhaps be achieved by focusing on a “No shame” campaign nationally.
A weak comprehension of the law surrounding health and social care can impact on the communication process, and disempower people and groups in need of support. National legislation such as the Data Protection Act 1998 endows an individual with the right to have their personal and sensitive information protected, and ensures anybody responsible for handling data follows “Data Protection Principles”. The information must only be used fairly and lawfully, kept safe and secure, and kept for no longer than is absolutely necessary. For more sensitive information such as sexual health, ethnic background and criminal history, there is stronger legal protection (Gov.Uk, 1998). The impact of not observing legislation and codes of conduct can be multifaceted:
- The reputation of the organisation can be compromised.
- Individuals in receipt of assessment and care can be at risk of neglect, injury, and in the worst scenario- death.
- The partnership relationship can be damaged.
- There may decline in the physical or mental health of the individual.
- Clear guidelines are ignored
- Abuse may occur
- Sensitive information may be leaked
Having knowledge of and adhering to legislation and codes of practice promotes equality, respect, and the exercising of rights. It also ensures appropriate procedures and codes of practice are being incorporated into the job role and that the individual gets up to date, relevant, person-centred assessment and care. By embedding strategies such as the confidentiality policy into everyday practice, there is demonstration of respect and dignity towards the individual and a clear message that the organization understands how important it is to protect sensitive information.
“No Secret’s” the guidance for safeguarding vulnerable adults promotes partnership working, and encourages transparent lines of communication between public, voluntary and private sectors. There is also importance placed on consulting with service users, their carers’ and representative groups. Part of the “No Secrets” guidance was intended to balance the need of confidentiality with the consideration that, to safeguard vulnerable adults, it may be necessary to share information on a ‘need-to-know basis’ (Department of Health, 2015). Locally, authorities and agencies use the objectives from “No Secret’s” to incorporate into their safeguarding policies and procedures. Application of “No Secrets” into assessment and practice can pose a risk of conflict and damage to the communication process, especially surrounding the care and support of those individuals with intellectual disabilities. There may be limited understanding of the critical need to share certain sensitive information, which can impact upon the individuals’ confidence in services and present barriers to further disclosure. In the scenario of abuse, individuals who withhold critical information are at risk of further exploitation, poor support and harm and the need to maintain transparency within the client/support relationship is crucial.
The Data Protection Act 1998 was established throughout England and Wales in 1998 and is incorporated into local confidentiality and safeguarding procedures and into social care workers’ Code of Practice. The legislation is applicable to everyone dealing with personal information about others. The Act asks that those who possess sensitive information examine:
- If they have permission to hold it
- Why they have the information
- Who else can access it
The need to ensure sound knowledge of data protection is vital. Weak understanding of data protection principles can indirectly be a cause of discrimination and disempowerment of the individual leading to breakdown of communication and trust in the agencies delivering support. There is additionally the probability that the individual can be further affected and experience decline in physical and mental health.
Similarly, The Caldicott Principles are based on the same values as the Data Protection Act. They state that sensitive information should only be used in specific circumstances:
1) Justify the purpose for which the information is needed.
2) Only use personally identifiable information when absolutely necessary.
3) Use the minimum personal identifiable information possible – if possible use an identifier number rather than a name.
4) Access to the information should be on a strict need to know basis.
5) Everyone should be aware of his/her responsibilities to respect client’s confidentiality.
6) Understand and comply with the law.
Evidence Act 1984 and the Human Rights Act 1998 (Tameside Metropolitan Borough, 2017).
Ensuring that guidelines are followed empowers the individual and provides scope to communicate in a completely honest and confident way, which in turn leads to a clear understanding of needs and improved outcomes.
The Health Passport for people with a learning disability has aided in promoting effective communication within a hospital setting. Individuals with learning disabilities can find accessing health care services problematic resulting in miscommunication, poorer quality of care and possible misdiagnosis. Mencaps’ “Death by Indifference” report in 2007 highlighted the needless deaths of six people with intellectual disability in UK hospitals who could have been saved were it not for the confusion and discriminatory practice surrounding their care. The report was considered to be a wake-up call to the NHS and stated that the National Health Service is simply not doing enough to ensure a reasonable standard of treatment for people with a learning disability (Mencap, 2007).
Barbara Bowness states in her Improvement Guide article titled “Improving general hospital care of patients who have a learning disability” that if individuals have poor understanding, communication difficulties or sensory impairments, people will need to communicate with them in an appropriate and accessible manner. However, professional barriers can inhibit this. Professional barriers include:
- Lack of awareness of learning disabilities.
- Lack of training in learning disabilities.
- Assumptions and biases about people with learning disabilities.
- Diagnostic overshadowing – attributing symptoms and behaviour associated with illness to the learning disability rather than any other cause, and consequently appropriate investigations and treatments may not be undertaken and illness can be overlooked (Bowness, 2014).
The Health Passport, despite being a simple concept enables health care professionals to have an understanding of an individuals’ disability, the way it affects them, and how this impacts upon their communication. As well as detailing previous health conditions and any medication they may be prescribed, it allows health care staff to know how the person usually behaves when they are in pain. This modest utilisation of client information has enhanced the communication process and has broadened the scope for a non-discriminatory, safer delivery of care.
The Codes of Practice for Social Care Workers are ethics and guidelines which define the expected standards of professional conduct and practice within the health and social care remit. The standards are incorporated nationally and promote communicating with clients in a transparent, honest and appropriate way while endorsing values such as dignity, respect and privacy as an expectation of care. The codes insist that social care workers must strive to establish and maintain the trust and confidence of service users and carers. This is paramount in building a client/carer relationship that has open and clear communication as its basis.
In the care and support of vulnerable adults, particularly those who may have already faced discrimination prior to accessing services, there are greater difficulties with communicating effectively. Wilkinson and Pickett (2013) propose that “unequal societies have measurably lower levels of trust between people. It is harder for them to trust one another if there are big inequalities between them”. The concept that Wilkinson and Pickett present can be evidenced in practice, predominantly in the older generation who may have been receiving input from services prior to the Human Rights Act and the Mental Capacity Act being established, and therefore have had limited opportunities or hold a viewpoint that services which aim to help people are not to be trusted. This mind-set can delay appropriate care being established and as a consequence may result in urgent support which is crisis-led, rather than needs led and person centred. The aim of the Codes of Conduct are to eliminate this perspective and encourage the authentic and transparent communication which is embedded into high quality care.
The Health Charter for Social Care Providers is intended to provide social care organisations’ with support to effectively work in partnership with health stakeholders to challenge the discrimination and inequality that individuals who have a learning disability may experience. Published by Public Health England, the charter acknowledges that people with a learning disability suffer from poorer health than the rest of the population and recommends:
- That all staff within an organisation understand and apply the principles of Mental Capacity Act.
- Listen to, respect and involve family carers to achieve the best possible outcomes for the individual.
- Provide ongoing training to staff on basic health and wellbeing issues including pain recognition and the implications of specific syndromes and health conditions.
- Provide information on health and wellbeing that is accessible to people with a learning disability make sure support is available from someone who can, if necessary, advocate on behalf of the individual so that people can attend and benefit from all types of health appointments.
- Supporting the person to understand the importance of a health check.
- Supporting the person to ask the GP for a health check (Public Health England, undated).
The Charter supports understanding surrounding health for those individuals with intellectual disability. Lines of communication are broadened with the charters application of accessible information and this ensures that a variety of formats will be available to make comprehension of important health information simpler. The promotion of further training for health care providers on the subjects of pain recognition can enable staff to identify discomfort/illness and possibly adopt a pre-emptive approach once recognised. Equally important is the support of the individual to seek a health check. Clients who are supported to do this independently will have improved autonomy in decisions regarding their health and have increased motivation to willingly communicate. The result is a shared vision of good health and well-being that is based on mutual trust and effective communication.
The Autism Charter was produced with and for individuals with autism and aimed to identify attainable and realistic objectives for sites to become autism -friendly. The charter requested that locations nationwide:
- Make reasonable adjustments should they suspect an individual has autism
- Develop autism friendly environments by proactively responding to suggestions from people with autism.
- Make staff aware of how to communicate effectively with someone in distress
- Create a clear process for staff to disclose their autism should they wish to.
- Be aware of the different ways people with autism communicate and respond to them appropriately (Autism Alliance, undated)
The rise in autism combined with the increased campaigning and awareness has illustrated the need for improved communication with people that have autistic spectrum conditions. This charter has benefits for both parties. With barriers lifted the individual is empowered, and with greater opportunity to communicate effectively their independence and confidence is promoted. The venue will gain more custom and an improved reputation in addition to commissioning relevant and up to date business ethics.
Example from work setting
Miss P is 47 years old and has autistic spectrum disorder and moderate learning difficulties. Because of her autism, she has problems with social communication and interaction. Her ability to understand the information she is being given is also affected. When Miss P is supported to the supermarket she finds the experience difficult to handle. The lights are too bright for her and she finds the tannoy system and noise from crowded spaces overwhelming. This sensory overload further impacts on her capacity to communicate and she becomes anxious requiring intense support. At the checkout, Miss P suffers an anxiety attack, the cashier is ringing the items through too quickly and is asking her lots of questions all of which Miss P cannot answer. Confidence levels are reduced and despite understanding that she needs to do her shopping at the supermarket, Miss P begins to dread it, knowing that once inside the store she will be overcome with anxiety.
Outcome from Autism Charter
The Supermarket now has now recognised that individuals with autism require a different setting to the rest of the general population. They have introduced an autism-specific morning for shoppers where lights are slightly dimmed and volume on tannoys turned down. With less people in the store the noise inside is manageable. Cashiers and greeters having now had autism training are able to pre-empt where and why a person may need assistance. There is recognition that people with autism may need to be spoken to in a calm, soft voice without direct eye contact, and that any information given to an individual should be done in a simple and straightforward way. At the checkout Miss P is offered help with bagging and the items are rung through at a much steadier pace giving her time to plan what she needs to do next without the overwhelming anxiety she felt before. Miss P is calmer on these occasions and therefore now able to effectively communicate her needs to care and store staff. As a result of the charter, Miss P faces less discrimination and has more opportunity to exercise her autonomy and independence.
The Human Rights Act 1998
The Human Rights Act 1998 is a law to safeguard the rights and freedoms that are essentially fundamental to living a just life. These are convention rights and include:
- The right to life
- The Right to respect for private and family life
- The right to freedom of religion and belief
The Human Rights Act protects everyone in the UK. It doesn’t matter if – for example, you’re a British citizen, a foreigner or an asylum seeker (Citizens Advice, 2017).
All public authorities must adhere to the act, comprising:
- Courts and tribunals
- Local Authorities
- Government Departments
- NHS trusts and hospitals
- Public Prosecutors
Article 10 of the convention states that everyone has the right to freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and ideas without interference by public authority and regardless of frontiers (UK Human Rights Blog, undated). In a health and social care capacity, genuine, honest communication is key to gaining good support. If the Human Rights Act is not upheld by the organisation, or furthermore by those who are in a position of power, there is the probability that the individual will not be heard. Heywood (2012) proposes that rights are a “broad ideological disposition that is characterised by sympathy for principles such as authority, order, hierarchy and duty”. Rights have always been the root of debates, especially in the health care sector where legislation and funding can conflict. The satisfaction of rights, however defined, is seen as central to ideas of justice. A just soiety is one where sets of rights are satisfied (Barnard, 2011).
The effectiveness of organisational systems and policies in promoting good practice in communication
People communicate to form relationships and to transfer their thoughts and feelings to others. The reputation of an organisation is dependent upon whether it communicates effectively with its service users, employees and with other partnering agencies. To enable this to successfully occur, the organisation must use robust systems and policies which work well in practice. There are numerous procedures and strategies in place – one of which is “supervision” for employees. Supervision is an opportunity for staff to communicate with their supervisor or manager and discuss any problems, ask questions, reflect, or to seek advice. By offering supervision, the organisation acknowledges that the job role can be demanding on employees and that their experience and time is valued. Agencies regularly performing 1-1 supervision with employees report lower staff turnover and “research has demonstrated that good supervision is associated with job satisfaction, commitment to the organisation and retention (Social care institute for excellence, 2012). Staff who receive supervision on a regular basis are more likely to feel valued within their employment, and deliver better quality care. Longevity within the job role leads to a higher level of skill and continued staff development, which ultimately benefits any individual in receipt of support.
The Equality and Diversity policy states the benefits of achieving diversity within the organisation include:
- Developing a friendly and honest organisation
- A more productive and satisfied workforce resulting in better outcomes
- All people receiving support to develop their full potential.
Teams that are satisfied with the job role experience less conflict, and are able to approach managing staff with the knowledge that their opinion is important and matters.
Equal opportunities relate to treating an individual fairly regardless of race, socio-economic status, age, ethnicity, disability, gender, and sexual orientation. For these values to be incorporated into care and support there must be a smooth transition from theory to policy. There is little point in applying equality into practice with elderly clients if that same standard of care cannot be effectively applied to an individual of ethnic minority. To create good balance in equality and diversity the organisation providing support must ensure a high quality of training for staff, and that it is regularly reviewed. Similarly, systems must be put into place to ensure that after training is complete, employees are actually adopting learned skills into care and support with the individuals they care for. This could be done by:
- spot-checking services,
- by ensuring the complaints procedure is accessible for clients,
- by holding regular short refresher courses
- Encouraging staff and clients to challenge poor practice.
The Whistleblowing policy
Whistle-blowing (or public interest disclosure) is when a worker reports a concern about improper actions or omissions of their colleagues or the organisation they work for which may cause harm to others or to the organisation (Merton Mencap, 2014).
Disclosure of poor practice against colleagues can be a cause of tension within an organisation, and may go against the very nature of employee values. The policy provides an opportunity for anyone within the company to report improper practice. This can range from the emotional, sexual or financial abuse of an individual through to misuse of medication and physical harm. The policy is a safety net for employees and encourages that those with genuine concern about another colleague pass the information on without fear of reprisal or discrimination. However, the policy can be misused and misinterpreted. Malicious allegations can occur if there is conflict between staff. Fear of retaliation or “getting it wrong” may be a factor in those who do not report poor practice. To make whistleblowing more effective and improve upon this policy, an abstracted easily understood version would be useful to place where all staff can see and access it. Having the appropriate use of the policy broken down into straightforward steps can support in preventing misuse and confusion, and lends more assurance to those who may have been cautious to utilise it. This minor adaptation would ensure the continued safety of any individuals in receipt of care and support.
Action plan to
Objective: Create an inclusive document within the organisation to promote improved education on autism
The action plan is intended to involve the service users while creating a document about autism, which will be placed into each service. The implementation of the document into services across the region will support in gaining knowledge for both clients and staff about autism spectrum conditions and is in keeping with the company equality and diversity policy, which aims to:
“incorporate a friendly and welcoming company” (organisation, 2009)
It is thought that with improved understanding about the condition, people viewing the document will feel confident enough to speak about it in an open way and be more accepting of differences. The document will also be seen by other health professionals and visitors to the service and could benefit the service in several ways:
- The organisation will be regarded as up to date and relevant
- The organisation is considered autism friendly
- Local authorities will be more inclined to do business with the organisation.
With information freely available throughout the service to all residents, those with autism will have increased opportunities for inclusion and therefore to form new relationships with others. The communication process is made easier by making information on the condition accessible. There is scope to build on this strategy further by making links to useful websites available for service users and staff, and by having accessible easy-read literature from the National Autistic Society in communal areas.
Learning outcome 3 – 3.1, 3.2 & 3.3
Be able to explore the use of information and communication technology
Vulnerable Adults and the use of ICT
Information communication technology is a central feature of societal inclusion. It has paved the way for the future of all infrastructures, and continues advancing constantly with a wealth of information ready to access day or night. Opportunities for social interaction are at a peak with 2015 statistics showing that “86% of households in Great Britain (22.5 million) had an internet connection (Prescott, 2015).
Children as young as 3 in nursery education are, at a basic level, using the internet, digital cameras and computer art software as gateways to learning and development, and yet some of the most vulnerable adults, particularly those individuals with learning disabilities, do not and cannot access ICT. Additionally, there is often a philosophy that adults at risk have no interest or need to take advantage of this technology. Consequently, “recent policy statements and guidance from the UK government have underlined the importance of ICT for adults with learning disabilities specifically, as well as for the population in general, through the potential it offers for social inclusion” (Daniels, Parsons, Porter, & Robertson, 2005).
Research conducted at the Parliamentary Office of science and Technology (2012) explains that “In the UK, almost half of disabled people do not access the internet regularly” and states that one of the difficulties stems from “barriers to entry”. A known barrier is self-stigma which occurs through generalised misconceptions being imposed, resulting in a mind-set in which a person autonomously identifies as less capable. This attitude can be the source of missed social and learning opportunities and has the potential to deprive an individual of their rights.
Adults at risk are a user group who are seldom have input in choices which relate to the actual design of ICT devices, and this partly explains why, until recently, there has been only limited technology of this type available. This absence of inclusion toward such a large part of the population is responsible for the gap in who can utilise ICT, and who cannot. Goggin and Newell (2003) clarify how individuals with disabilities are rarely in the position of power required to make decisions on Internet policy and remain “systematically excluded from interactive digital communications even while receiving consolatory attention in policy discussion”.
The benefits of ICT use for individuals
In recent years’ there has been a significant improvement in software and hardware designed to make communicating with ICT for those who have sensory impairments, and intellectual or physical disabilities much easier.
The benefits of implementing ICT in the support of individuals are multifaceted and include:
- Hands on involvement in an accurate creation of a support plan
- Ease of maintaining peer/family relationships
- Social media
- Access to complain through the website of the organisation.
- Inclusion through the use of modern and relevant technology
- Educational/employment prospects and opportunities to learn new skills
- Preservation of cultural values
- Increased independence with finances (ability to access online banking).
- Improved autonomy
From the perspective of a health and social care client, a company website enables more clarity in decision making about whether the organisation is relevant to their needs. In one current care and support charity, there is a specific section of the website dedicated to campaigns which have made a difference in health and social care legislation. In addition to this, there are real accounts from supported individuals explaining how the delivery of care they receive has impacted them. Most care company websites include their CQC ratings and misson statement which can promote in decision making based on the standard of care being delivered and the values the company considers important.
The use of ICT can promote confidence and give service users more control over their own lives. Social media, email and text messaging allows for relationships with peers and family to be maintained and the communication process to be enhanced. Personal interests can be pursued in addition to accessing relevant community and national news. With increased awareness about local social opportunities and events, there is the potential for new relationships to be formed. “The popularity of social networking sites, such as Facebook and
Twitter, has contributed to a greater online social inclusion. Holmes and O’Loughlin (2012) show that the involvement of adults with learning disabilities in online social networking can have positive effects, such as increased self-esteem, and negative effects, such as involvement in misunderstandings” (Glenn & Waine, 2015).
ICT includes the use of electronic assistive devices, which encompass a wide variety of appliances to enable those with physical, intellectual, or sensory impairments to have increased communication and accessibility in their environment. These include:
- Touch screen technology
- Electronic pointing devices—used to control the cursor on the screen without use of hands. Devices used include ultrasound, infrared beams, eye movements, nerve signals, or brain waves (Microsoft Accessibility, 2015)
- On screen/alternative keyboards – these can magnify, adapt for use with one hand, or incorporate substituted text and symbols.
Possibility of risk is ever-present when a vulnerable group are accessing a gateway to potential abuse. Some adults requiring support have a poor understanding surrounding appropriate sexual behaviour. This, in turn, results in a lack of knowledge about how to protect and defend themselves against abuse. Furthermore, there may also be an element of institutionalised behaviour in individuals who have lived within a care home setting for long periods which additionally puts them at risk. In this scenario, the vulnerable adult is conditioned to be obedient to benefit the organisation. Subsequently, the individual becomes accustomed to going along with the wishes of others, rather than exercising independent choice.
Without appropriate support, there is a possibility of
- Sensitive data being shared/stolen/misused
- Fraud/financial theft.
- Sexual abuse/grooming.
- Clients accessing or downloading inappropriate content which could impose legal implications upon them.
To limit risk, it is imperative that effective communication between the individual and the organisation is maintained. Scope for abuse and other circumstances which could pose harm to a client can be lessened with the use of risk assessment, adhering to support plans and by accurate, factual record keeping. Honest discussions with service-users about the dangers involved, and the consequences of poor decision making while using ICT can broaden understanding surrounding data protection, abuse, and inappropriate content. With consent, filters which limit access to risky content can be applied during computer use to further protect the individual.
The benefits of ICT to care organisations and employees
ICT is one of various ways to promote effective communication with service users, the organisation and any other stakeholders who may be in partnership with the individual. Most companies promote their services through the use of a website, which allows potential consumers to see the type of facilities being offered and allows for a better understanding of the ethos of the agency.
In the support of vulnerable adults, ICT allows for information about the individual to be accurate, and more efficiently updated when circumstances change. The use of email can ensure that all stakeholders within a collaboration can exchange information more effectively – a key part of successful partnership working. Professionals within health care settings are able to use this technology to send images and results from tests via email to the appropriate department, expediting any treatment which is needed.
Options to instantly video conference using software such as “Skype” establish that multi-disciplinary teams can now hold meetings without the need for physical presence. This can benefit when there are limitations on the partnership, such as distance, and can save both time and resources, and possibly making an overwhelming experience for the individual more tolerable.
The use of a local intranet system within the organisation provides employees with resources and information much faster than by traditional methods. This improved communication and increase in productivity can enhance integration within the company, resulting in a more cohesive employee base with less of a divide between management and front line support workers. The benefits of pooling required organisational data into one location include:
- The ability to access policies and procedures & Rotas
- Using role -specific documentation, i.e review support plans
- Obtaining information about training opportunities
- Messaging colleagues and other departments
- Receiving and sending in-house memo’s
- Keeping up to date with relevant company information
When each department within an organisation inputs onto the same local database, the audit trail becomes clearer culminating in greater accountability, less margin for poor business conduct and reduced opportunities for information to be lost-in-transit.
Video conferencing, mobile phones and intranet systems are there to make life (both working and personal) more convenient. However, over-reliance on these tools can come with the risk of losing personalisation, with much of the focus being placed on convenience rather than interpersonal communication. There is a danger that messages could be misinterpreted and an uncertainty surrounding whether everybody receiving information has conveyed the message in the way it was intended. One potential outcome to this could be that the individual feels they are receiving a type of remotely led e-support rather than palpable care being delivered in the way it was designed to be. It may also be harder to build a trusting collaborative relationship if stakeholders are substituting physical presence for ICT based communications.
Security, safety and legal considerations
Security issues are always a hazard in the use of ICT. Organisational intranet systems and emails can contain much sensitive information, that if accessed could pose a risk to both the service users and the company, therefore any company holding confidential information about consumers has a legal obligation to secure the information. “The Data Protection Act 1998 requires that appropriate security measures are in place to safeguard against unauthorised or unlawful access/processing of personal data” and directs businesses to take “appropriate technical and organisational measures against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data” (Gov.uk, 2015). Confidential data about an individual, such as information regarding health, circumstances or finances must only ever be transferred to countries that offer adequate data protection.
How is data defined?
The Data Protection Act 1998 defines personal data as information which relates to a living individual who can be identified:
- from the data or
- from the data and other information which is in the possession of, or is likely to come into the possession of, the data controller
The information may be in either electronic or manual (ie paper) form.
By law each company is duty bound by The Health and Safety at Work Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees (Crown Copyright, 2017). In the use of ICT several health conditions can occur:
- Repetitive strain injury
- Posture related pain
- Eye strain
It is vital that employees recognise their own responsibility to report injuries to themselves and the potential for injury to others within the workplace, and to inform the relevant person about equipment which may be causing poor health.
The Computer Misuse Act 1990 is legislation to make provision for securing computer material against unauthorised access or modification; and for connected purposes (Crown Copyright, 2016). The act considers a person guilty of committing a crime if:
- he causes a computer to perform any function with intent to secure access to any program or data held in any computer, or to enable any such access to be secured;
- the access he intends to secure or to enable to be secured, is unauthorised; and
- he knows at the time when he causes the computer to perform the function that that is the case
Violation of The Computer Misuse Act is punishable by up to 2 years in prison, and an additional fine. Being aware of this legislation, and the penalties it incurs can support in creating clearer boundaries and understanding which can then cross over into the care and support process.
The legislation surrounding data is clear, but in practice, guidelines may not always be applied. Factors which influence the delivery of good care and support are usually rooted in poor communication.
- Poorly trained staff are likely to break data protection principles without realising, putting both clients and the company at risk.
- Failure by the organisation to CRB/DBS check can result in staff members with criminal backgrounds involved in the support of vulnerable adults.
- A total dependence on ICT rather than interpersonal interaction.
To improve upon the risk of violating data protection principles, information on the subject should be available in easy read format, in both office and communal areas for staff and clients. Policies and procedures are often kept out of sight on shelves, only for the eyes of staff, rather than being an inclusive and integrated resource. To increase safety, individuals in receipt of health and social care services should also be informed about confidentiality, and how they can avoid breaking the law. Additionally, clients should also be made aware of what to do should they suspect their own personal data is being contravened and supported to exercise their rights. Staff training should be current and should come from a quality provider with a good reputation. The organisation should observe support staff to ensure that learned confidentiality and data protection procedures are being put to use. Client feedback can also support in ensuring continued good practice.
Communication is the most important aspect in establishing effective support and is at the source of all relationships. It is vital that the values depicted by the organisation are represented by commitment to data protection and confidentiality principles. Information communications technology has without a doubt improved efficiency in the remit of health and social care but should remain a part of providing good quality care not be a replacement for it.
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