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About this book

In health and social care settings, it's important to remember that not everyone uses words to communicate.

This uniquely inspiring book is co-produced with service users from Communicate2U, a not-for-profit organisation that works to improve the experiences of people who may be vulnerable because of their communication style. Providing detailed case examples and fun, practical exercises blended with examination of key research and theory, Rethinking Communication in Health and Social Care equips readers with the knowledge and skills required to interact with service users in a way that empowers them and creates a positive difference in their lives.

Tackling issues such as body language, the roles of pitch and silence, and the effects of the physical environment on communication, the book offers a range of features to help you develop a truly inclusive health and social care practice. Each chapter includes:

• Thought-provoking case scenarios to help you apply theory to everyday practice
• A wealth of questions and activities to help you reflect on what you have learned
• Links to online materials, including videos put together by service users, which will enable you to learn from the real communication experts.


Accessible yet highly informative, Rethinking Communication in Health and Social Care is essential reading for students and professionals across the full range of health and social care disciplines – from social work and counselling to nursing, occupational therapy and beyond.

Table of Contents

1. Culture and Communication

Abstract
At its heart, this book argues that all humans communicate. We can’t help it. We feel something, whether it’s a basic urge such as hunger, joy or pain, or a more complex one such as the desire to tell the world about an idea that is really important. We respond to that urge, and the result is communication. The form of communication may be relatively complex such as a book, or it may be as simple as the sound of a rumbling stomach, a smile or a wince. The result is still a message that is passed to people who are open to see or hear it. That brings us to the other central theme of this book: not everyone who works in health and social care settings is good at noticing simple communication. This is a problem, because the people who often need the most support, such as people with a learning disability (Goldbart et al., 2010), dementia (DHHS, 2014; Gray et al., 2007), mental health needs (DoH, 2011) or significant neurological impairment such as cerebral palsy (Balandin et al., 2007b) may find it difficult or impossible to use the sophisticated skills that are associated with spoken communication. Even if people can use words, they may do so in a way that health and social care staff find alien. For example, the words may be foreign, produced by a voice communication aid, or they may be in another format entirely such as a signed language. If people who work in health and social care settings are poor at recognising and responding appropriately to simple forms of communication, then they make people who rely upon this vulnerable. If you’re reading this and thinking something along the lines of ‘that’s easy – I’m great at noticing simple messages’ then you’re off to a good start, and you may well be right. However, it’s unlikely that you would have the words to effectively explain to other staff in health or social care settings why what you are doing seems to work for vulnerable people, and what may be occurring in their organisation that may prevent others from being as effective as you. It’s also worth bearing in mind that many of the staff who have actively but inadvertently contributed to the pain and suffering of vulnerable people probably thought exactly the same thing. In the UK, poor staff communication with vulnerable service users is repeatedly highlighted as a significant factor in poor care or even avoidable deaths (Francis, 2013; Heslop et al., 2013; Mencap, 2013; Mencap, 2006). The problem is often that every time that we communicate, we do so in a way that reflects the values and communication styles of one of the groups to which we belong. Groups can be as small as families or as big as organisations, professional groups or nations. However, once we’re in those groups it’s very difficult for us to actually recognise our communication styles and we often fail to notice when we communicate badly with people whose style of interacting is different to our own (Hall, 1959; Scollon et al., 2012). This chapter will help you to understand the different groups that you belong to and the different styles of communication that they adopt. It will compare your styles of communication with those of vulnerable people and support you to use that knowledge to understand the difficulties that can occur when people from different groups come together. It will do so by considering those groups as cultures.
Annette Roebuck

2. Values, Power and Communication

Abstract
Trying to pin power down to one definition actually highlights one of the key points of this book – words are slippery things that can’t always easily communicate meaning. Theorists and practitioners alike will use terms such as ‘power’ in many different ways, using different language and concepts to frame their ideas (Croom, 2012; Haugaard, 2002; Wittgenstein, 1967). These differences in views can make it difficult to understand the concept when reading about the topic from a theoretical standpoint. The theory can make power seem an abstract concept that has limited place in the real world. However, most of us at some point in our lives have known what it feels like to be powerful (feels wonderful) or disempowered with little control over what happens to us (feels horrible). We understand power from a practical and emotional perspective, even if we may struggle to explain why we feel the way that we do about the situation. This may be how service users feel at times. As you will discover as you read through this chapter, power is often inextricably linked to knowledge. If you wish to empower the service users that you work with, you need to know what types of power you actually hold, and how that power is shared (or not as the case may be). In Chapter 1 you learned that failing to see hidden dimensions of culture can cause professionals to inadvertently place vulnerable service users at risk. The ways in which power is distributed was highlighted as a key cultural dimension. This chapter explores that dimension in more depth and gives you practical techniques to map how your knowledge and power may impact upon communication with vulnerable service users.
Annette Roebuck

3. Word-Based Interpersonal Communication

Abstract
Chapter 2 started by stating that words are slippery things, and it concluded by arguing that in prioritising word-based communication, staff in health and social care settings have the potential to make service users vulnerable. The subject of words therefore clearly requires closer examination. The question as to how to train health and social care staff to communicate effectively is one that has been the subject of intensive research and review. Communication training includes consideration of both verbal and non-verbal communication (Chant et al., 2002; Eggenberger et al., 2013; Lewin et al., 2001; Perry et al., 2013); therefore, in theory, staff should be in a position to use words to communicate well. However, when service users or carers feel that they have been failed within health and social care settings, their complaints often start with identifying basic communication errors. The causes of such failures are multi-factorial, but the need to change the culture of care to avoid future repetitions is a common theme within the enquiries that have followed (Francis, 2013; Heslop et al., 2013). However, cultural change is not easy, and from discussions in Chapters 1 and 2 you should be aware that existing members of the culture may be those least likely to be in a position to identify what needs to be done (Hall, 1959). This chapter draws upon the experiences of people who may be vulnerable in health and social care communication exchanges and those who work closely with them. Their expertise as communication experts with Communicate2U and within their own family cultures informs the intercultural approach to word-based communication that follows.
Annette Roebuck

4. The Musical Aspects of Communication

Abstract
Chapter 3 focused upon the kinds of words that staff and service users use. This chapter will focus upon how those words are said, and how people who don’t use words at all may still use sounds to communicate. There are technical terms such as prosody or paralanguage that we could have used within the title for this chapter. They refer to the non-verbal elements of speech such as pitch, tone, timing and pace of speech, but the terms are often used to focus upon the deficiencies of people who find words difficult (Ayotte et al., 2002; Diehl et al., 2008; Eigsti et al., 2011; Huss et al., 2011; Lim, 2010; McCann et al., 2007). As you have probably gathered by now, the intercultural nature of this book is incompatible with a deficiency view of service user communication. Instead, we have chosen to adopt Hall’s (1959) view that culture is analogous to music. Each culture has its own rhythms, patterns and use of time or silences. These musical aspects of communication can be the icing on the linguistic cake (Tannen, 2005), adding colour and flavour to interactions. And just as the decoration on a fancy wedding cake can have an impact that is even more powerful and memorable than the cake itself, the musical elements of communication can carry a far more lasting message than the words themselves.
Annette Roebuck

5. Body Language

Abstract
In Chapter 4 you were introduced to the interlinking non-verbal constituent components of communication. Table 5.1 is a repeat of Table 4.1 to remind you that whilst we consider the elements separately, in reality these usually occur simultaneously. However, the degree to which each of the aspects is attended to may vary widely, particularly if people have sensory impairment. For example, for people with hearing loss, body language may carry a larger portion of the non-verbal message, whilst for those who are blind or partially sighted the musical aspects of speech and haptics (touch) will carry more of the message. The degree to which people have sensory loss varies widely, and the strategies that people adopt to facilitate communication are linked not only to how much sensory input is available, but also at what life stage the loss occurred (Barnett, 2002a; Bau, 1999). People who have sensory impairment will have developed their own cultural way of communicating, whether within family groupings or wider communities (Barnett, 2002b; Bau, 1999). Health and social care staff who have limited experience of service users with alternative communication strategies may be worried about how to communicate with service users who have sensory impairment (Bryan et al., 2002). Whilst there may be many situations in which it is necessary to seek expert advice from specialists such as speech and language therapists, sign language translators or visual impairment organisations, there will be many more situations in which that support is not immediately available, and you need to communicate with the person in front of you. Considering communication from an intercultural context should help you to recognise your existing communication skills and to apply them in these types of situations. Before we move on to explore skills associated with body language in more depth, have a go at the exercises in Box 5.1 to identify some of your existing competencies. Also use Table 5.1 to remind yourself of the interlinked nature of all the components of communication that are discussed within this book, and where body language is situated.
Annette Roebuck

6. Environmental Aspects of Communication

Abstract
This is the final chapter in the trilogy that has focused upon non-verbal aspects of communication and it will focus upon how the environment sends messages for us to interpret and react to. The term ‘environment’ can be defined in a multitude of different ways, but for the purposes of this chapter we will be focusing upon the physical environment – manmade or natural objects and features that can be touched and seen. Other environmental components such as the cultural or social environment (Kielhofner, 2008) are an intrinsic part of all of the chapters in this book and will not be considered separately. The virtual environment is becoming an increasingly important component of modern day life with its own evolving communication culture and style (Biocca et al., 2013), but encounters within this realm are outside the scope of this book. Our physical environments are the backdrop against which all of our interactions occur. This chapter will argue that all aspects of it are culturally determined and therefore many issues related to communication will be hidden from those who are members of the culture. These hidden features, however, play a very important role in communication. We take for granted that our buildings will have a certain style or shape, that objects that perform a function will have a particular look, and we learn to filter out familiar smells and sounds so that they become unimportant features that we barely notice any more.
Annette Roebuck

7. Performing Inclusive Health and Social Care Scripts

Abstract
Whether we are conscious of it or not, nearly all of us are actors that consummately play a wide range of different roles throughout our lives. We may be sons or daughters, siblings, parents, friends, students, teachers or health and social care professionals. Each time we slip into one of these roles, we behave and communicate differently to fit into the cultural norms that are associated with that title. Even in the same role, our act may change as soon as we encounter a different audience. Unless the situation is new or difficult we usually don’t even think about how we go about those roles – we just act and react. The exercise in Box 7.1 illustrates how we may do this within the family setting. The exercises throughout this book have been designed to help you understand the different ways that you communicate and behave in the different cultural groups to which you belong. By now you should be aware that the types of body language that you use, the words and phrases that you select and the power that you have to structure the environment varies in different cultural settings. You should also be aware that no matter how low down in the hierarchy you may think you are at work, in comparison to the vast majority of service users, you are powerful. You know the language, the systems and set the format for interactions. Most of this occurs without your conscious awareness as you are a part of the culture. If you have read through the chapters in this book and taken part in the exercises, that previously hidden knowledge should now be something of which you have conscious awareness.
Annette Roebuck
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