SCIE Practice guide 09: Dignity in care

Communication

Key points from research and policy
Practice points
Ideas from practice
Other resources

In order to maintain control and independence, older 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.

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 service users’ 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 service user 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.

Key points from research and policy

Dignity is threatened by 'treating adults "like babies” because of actual or assumed incapacity... using patronising tones of voice’. (Research overview).
Using respectful language and gestures promotes dignity (Tadd, 2005).

Consistent assignment of workers can improve communication and facilitate the building of positive relationships between service users and staff (PG Professional and the English Community Care Association, 2006).
The national minimum standards for domiciliary care (249kb PDF file) require that: 'The skills and experience of care staff are matched to the care needs of each service user and they are able to communicate effectively with the service user using the individual’s preferred method of communication’ (DH, 2003b).
Essence of Care (384kb PDF file) gives an excellent breakdown of things to consider when communicating with hospital patients (DH, 2003c).

Practice points

Ensure that service users are asked how they would like to be addressed and that staff respect this.
Ensure older people are given all the necessary information on the service, in the appropriate format and, wherever possible, in advance.
When recruiting staff, ensure acceptable levels of both spoken and written English.
Consider the specific training needs of overseas staff.
Where service users do not speak English, provide translation services in the short term and seek culturally appropriate services in the long term.
Care planning should include opportunities for service users to talk with staff regularly.
Don’t make assumptions based on culture, ability or any other factor about what people want; they should always be asked.
Ensure staff have appropriate training to enable them to communicate with service users with cognitive or communication difficulties.
Ensure that time for proper handover of information, written or spoken, is scheduled in for staff.
Involve older people in the production of information resources.
Facilitate ways of getting the views of service users, such as through residents’ meetings.

Ideas from practice

Practice examples are self-reported and have not been evaluated.

Other resources

Sense have produced some materials for the relatives and support workers of older people with hearing and sight loss.

Seeing Me, a guide for people working in residential and domiciliary care for older people.
The Good Life, for people with older relatives who don’t see and hear too well.
Fill in the Gaps, for older people’s teams in social services.

Link: Fill in the gaps.

Not on their way out (DVD) - People from Hertfordshire give their views on communication in the Customer Care section of the DVD. Supporting material is available in the Discussion Points document.

Link: Not on their way out
Link: Discussion Points

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