Dignity in care
Dignity factors - Communication
Speaking to people respectfully and listening to what they have to say; ensuring clear dialogue between workers and services.
When new staff start, they always say what their name is and ask me what I like to be called. It's a small thing but I appreciate it
Communication in practice
- Ask people how they prefer to be addressed and respect their wishes.
- Give people information about the service in advance and in a suitable format
- Don't assume you know what people want because of their culture, ability or any other factor – always ask.
- Ensure people are offered 'time to talk', and a chance to voice any concerns or simply have a chat.
- If a person using the service does not speak English, translation services should be provided in the short term and culturally appropriate services provided in the long term.
- Staff should have acceptable levels of both spoken and written English.
- Overseas staff should understand the cultural needs and communication requirements of the people they are caring for.
- Staff should be properly trained to communicate with people who have cognitive or communication difficulties.
- Schedules should include enough time for staff to properly hand over information between shifts.
- Involve people in the production of information resources to ensure the information is clear and answers the right questions
- Provide information material in an accessible format (in large print or on DVD, for example) and wherever possible, provide it in advance.
- Find ways to get the views of people using the service (for example, through residentsʼ meetings) and respect individualsʼ contributions by acting on their ideas and suggestions.
What others are doing – Ideas you could use
- Use advice posters to remind staff about better communication
- Create a team of people to provide a multi-racial outlook
- Ask people for their opinions when making changes to your service
- Use the right equipment to meet people’s communication needs
- Provide menus in different formats
- Develop a card or booklet to help communicate people’s needs
- Look below the surface when communication is a problem
- Use video or dvd to communicate people’s individuality
- Use the single assessment process to deliver person-centred care
- Improve practice using the Essence of Care benchmarking tool
- Listen to and support carers
- Aid communication for hearing impaired people through text
- Use a calendar to communicate vital information
These practice examples are self-reported and have not been evaluated.
Care Quality Commission - what the regulator says
The CQC is the independent regulator for health and social care services. They have set out Essential Standards of Quality and Safety (CQC, 2010) for all those registered to provide health and social care services. There are 28 outcomes relating to the different aspects of care provision.
What CQC outcomes say about CommunicationOpen
The outcomes that relate to communication are set out below.
Providing information to people who use services means that it must be given in a way they can understand, whatever their communication needs may be.
Outcome 4: Care and welfare of people who use services - Effective communication between all of those who provide care and support to ensure effective, safe and appropriate, personalised care,
Outcome 7: Safeguarding people who use services from abuse - People who use services receive care, treatment and support from staff who, in relation to responding to behaviour that presents a risk to themselves or others, Understand the value of a stimulating environment, meaningful activity and effective communication in preventing behaviour that presents a risk, taking into account that over-stimulation can sometimes adversely impact the behaviour of people who use services.
Outcome 12: Requirements relating to workers - Workers should have a good understanding of the communication needs of the people who use the service.
Outcome 14: Supporting workers - The induction for new staff includes information on the people whose care, treatment and support the staff member will be involved in providing and any specific communication needs
Outcome 21 Records - Verbal communications about care, treatment and support are documented within personal records as soon as is practical.
See all outcomes in the Care Quality Commission Essential Standards of Quality and Safety (PDF file)
Communication and dignity - key points from policy and research
- Dignity is threatened by 'treating adults 'like babies' because of actual or assumed incapacity... using patronising tones of voice’. (see Research overview).
- Using respectful language and gestures promotes dignity (Tadd, 2005).
- Consistent assignment of workers can improve communication and make it easier for the users of services to build positive relationships with staff (PG Professional and the English Community Care Association, 2006).
- Essence of Care (384kb PDF file) gives an excellent breakdown of things to consider when communicating with hospital patients (DH, 2003c).
- Older people want to be cared for by staff who are patient, take the time to listen to them, and do not rush their care (DH, 2006d).
- Getting to know service users as individuals, as people with a history, is key to providing person-centred care (Randers and Mattiasson, 2004, Jacelon, 2004, Owen, 2006, PG Professional and the English Community Care Association, 2006)
Communication and dignity - policy and research in more detailOpen
In order to maintain control and independence, people need information about what they are entitled to and what they can expect from services, and they need it at the right time. The Department of Health (DH) online survey (DH, 2006d) indicated that the way in which information is communicated, and the way in which day-to-day communications take place, will have an impact on the maintenance of dignity.
Respect has been summarised in terms of courtesy, good communication and taking time (Davies et al., 1997, Woolhead et al., 2004, Woogara, 2005, Calnan et al., 2005, Birrell et al., 2006, Bayer et al., 2005). Older people want to be treated with respect and part of this includes the way they are addressed and the way they are spoken to. A number of studies have highlighted concerns about 'staff and family attitudes, and patronising and disrespectful ways of addressing older people’ (Bayer et al., 2005).
In a DH survey, culminating in the report Now I feel tall (522kb PDF file) (DH, 2005b), good patient experience was seen as synonymous with 'having information to make choices, to feel confident and to feel in control’.
Essence of Care (384kb PDF file) (DH, 2003c) defines communication as: 'a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings or other information through both verbal and non-verbal means, including face to face exchanges and the written word'.
In the DH survey on dignity in care (DH, 2006c) people raised concerns about acceptable levels of English among health and social care staff and a small study into care homes (PG Professional and the English Community Care Association, 2006) found that relatives of residents had concerns about the language barrier between residents and staff caused by the numbers of overseas workers.
Even where staff are fluent in English, strong accents may affect the older person's ability to understand, particularly for people with dementia, communication difficulties or hearing impairments. Difficulties with staff recruitment and retention in health and social care are widespread and the value of overseas workers cannot be underestimated, but it is important to ensure that they receive the appropriate support and training to ensure that their communication skills are adequate.
Good written communication between workers is also vital to providing a consistent service in line with peoples’ needs and preferences. Again, employers should ensure that workers have adequate literacy skills in English to facilitate good communication.
There may be difficulties where a person who uses services is unable to speak English. Where there are no staff who speak the same language, translation services should be provided. Where the care is provided on a long-term basis, culturally appropriate services should be sought.
Issues of continuity - a key aspect of good communication - have also been highlighted in relation to staff retention: 'Staff retention is important, residents feel more secure by seeing the same faces every day’ (PG Professional and the English Community Care Association, 2006). In a study into the views of health and social care staff on dignity, staff raised some problems associated with the use of agency staff: '... expense, a lack of continuity of care, and a lack of interest in and personal involvement with patients' (Calnan et al., 2005).
Good communication is vital in ensuring person-centred care and this presents particular challenges for managers, in terms of recruitment, retention and training for frontline staff.