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Use and Develop Systems that Promote Communication College

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1. Be able to address the range of communication requirements in own role 1.1 Review the range of groups and individuals whose communication needs must be addressed in own job role. The people that I deal with on a daily basis are staff, residents, relatives and multi disciplinary team members. The ways in which I communicate are by e.mail, on the phone, in person, 1-2-1 or in groups both formally and informally depending on the circumstances. These people come from a variety of settings, countries, education and qualifications/life experience. The age range is from 18-104 yrs. Some of these people may have sight, hearing or speech difficulties and find it hard to communicate. Some staff have difficulties reading or writing (e.g due to Dyslexia) as well as having cultural and language barriers.

Many of our staff come from other countries, one of our residents is French. 1.2 Explain how to support effective communication within own job role. Effective communication involves ‘active’ listening and observational skills. It primarily involves passing and receiving information between two or more places in order to achieve something. I find it helpful to check that you or others have understood what is trying to be communicated. I ask for clarification if any areas are unclear. I am patient and understanding and look to the ‘receiver’ to give you acknowledgement and understanding either verbally and physically (by nodding/saying yes, smiling etc). I ask for the message or instructions to be re read or repeated back to me for secondary clarification if in any doubt.

I try to ensure that what and how I am communicating is realistic and responsive to the ‘receivers’ needs (e.g explain slowly/clearly, use gestures, show the person, translate for them). I feel that if you are passionate and enthused in your manner, people are much more likely to be interested in you and what your are saying. Thus being much more likely in following what you ask. I try to be approachable and give time to others to respond to me. I am clear about details e.g time, place, route, reasons, people or equipment required etc. I like to be firm and focused and organised, people will naturally listen and be more inclined to follow someone knowledgeable and appearing to be in control and those that show an interest in the team around them. It is important to follow up (if required) by writing an e.mail or letter to confirm where necessary. I use diaries/organisers to plan and guide people. I hold regular meetings (team/relative meetings) and supervisions with people who live and work in our service. I try not be defensive, listen to others and give constructive feedback where needed either in planned sessions or ad hoc if the situation allows.

I like to give praise and gratitude where appropriate and involve people in decision making processes when applicable (e.g at handovers or during care planning). I know that as humans, people like to feel important and be involved. Our staff receive a lot of training (mandatory/non mandatory) in order to equip them with suitable knowledge levels and to communicate in an ‘informed’ way. I feel it is important to be professional and lead by example and treat others as you wish to be treated. I aim to keep up to date on current affairs and policies and procedures in order to work in line with current best practice. 1.3 Analyse the barriers and challenges to communication within own job role. I work in a complex setting caring for staff complex needs that are also looking after residents/families with complex needs. These needs change regularly and need to be managed safely and effectively. Time can be a barrier as the environment is often very busy and fast paced. Stress at work or home can hamper your mood and your ability to concentrate. Staffing levels and skill mixes can increase complications with communication especially when new.

Language and cultural barriers can crop up as many of our staff come from different countries. Many of our residents, staff and visitors have speech, reading, writing and hearing difficulties which can cause issues at times. Sometimes people make assumptions about other people or the situation at hand and can lead to mis communication. A lack of personal or organisational planning can lead to difficulties as people do not understand their role or direction of the service. Poorly trained or inexperienced managers and senior staff can hamper effective communication. Resources not being available or not working correctly such as telephone and computer systems. Sometimes people use shorthand or ‘text’ style abbreviations or medical jargon which can be unhelpful. 1.4 Implement a strategy to overcome communication barriers. My strategy to overcome barriers is to be open and honest in my approach. Treat others with respect and be patient. Communicate to others in a way that is acceptable to them and in accordance with their needs (person centred) and as the situation may dictate (it may be confidential). I try to remove distractions to eliminate confusion and give time to others where possible. I am clear in my communication and expectations of others and what they can expect from me and the service I am running.

I check for understanding and willingness to comply as assumption can lead to error. I try to be organised, plan my days ahead, I help others to plan ahead and be organised to. I like to evaluate my days and tasks I have achieved (as well as others) and roll over items that may be outstanding. I meet with my management team every day to plan and discuss and review issues within the home. I like to involve my team and promote their sense of achievement. I hold regular appraisals and supervision sessions for all staff to support and monitor their progress and development at work. Our staff are well trained and monitored in the execution of their work and given ad hoc feedback in private. There are times where extra time, equipment or support are needed in order to help others to understand or do something. Due to attitudinal, cultural, psychological and systematical barriers, issues may need to be re visited sensitively and professionally in order to achieve the desired results.

Use different means of communication to meet different needs. If I am dealing with a resident I check that they are alert and ready for me to communicate with them. I ensure that they have their glasses/hearing aids, if they have Dementia and need extra support or time, I try to provide this. Some people require Braille or talking aids, others need to write or point to pictures etc. Some people that are deaf or have a Learning Difficulty require the use of Makaton or British Sign Language. Some staff and residents do not have English as a first language. We use books or pictures or translating services online to aid effective communication. Communication can be verbal, physical, written, technological, pictorial, musical and more. Communication given with passion and enthusiasm will be more interesting and more likely be followed and understood. Some people learn or understand by explanation and training, others prefer to be shown, others prefer to ‘do’ and be observed. Some like individual support, others like groups and company. Some like written guidance others don’t. It really depends on the situation at hand as to how I deal with it.

Communication can be verbal, non verbal, written and more and can present itself in different styles such as passive (reserved and soft ‘sits on the back seat’), aggressive (harsh, dominant) or assertive (confident but fair). Some of our residents now use technology such as laptops, mobile phones and tablets to communicate with family and friends and sometimes need to be facilitated to do this due to physical or psychological barriers. 2. Be able to improve communication systems and practices that support positive outcomes for individuals. 2.1 Monitor the effectiveness of communication systems and practices. It is crucial to monitor how people communicate including yourself. I try to reflect on my own interpersonal skills as well as others. Did I handle that well, what could I have done better? I also encourage others to do this as often as possible. I also ask myself questions such as do people get along here, do they help and respect each other?. Do staff consult each other or ask for advice and support. Are our Managers and Nurses approachable and accessed by staff? Do residents and relatives feel the home is ’open’ and well run?

What do my audits tell me? Do staff follow my lead and carry out requests? Do they attend meetings and follow agendas and participate in the running of the home. Do staff understand their job roles and work in line with them? Do staff follow policies and procedures? Are staff and residents happy where they work and live? What do your questionnaires and feedback forms/forums tell you? Do your audits show compliance or deterioration of services? Do staff use planners and diaries or communication books? Are they accessed and completed regularly. Does the home access outside support services readily and competently? Do staff know their limitations? Reflective practice as individuals and as an organisation will help to review what worked well and why? We have daily team meetings to discuss the day or week events which helps our team to gel, understand what is expected and assist people in achieving their personal and organisational goals. I talk to our residents and staff every day and view the home regularly. I monitor what is happening and how people are feeling by observing them and asking them whilst working and living within their environment. I make notes if needed and delegate any issues to the relevant team members.

Evaluate the effectiveness of existing communication systems and practices. I carry out audits, meetings, supervisions/inductions and appraisals which are a good way to review if communication is effective. If performance is good, communication is likely to be so too as one helps to lead to the other. I observe and listen to those around me, asking questions about the workplace. I check daily that communication tools are being used, and training is being provided. By carrying out daily ‘walk rounds’ I can see if the home is functioning and flowing well. I hold bi-annual forums and clinics for relatives and residents and staff to give me feedback which helps me to understand how the home is communicating. I check care plans are reviewed regularly and that residents and relatives involved and informed. I check staff understand their roles during induction, supervision and appraisals. Do they know where to access policies and procedures, where the complaints folder is and how it works? Are staff inductions taking place, how well are they being done? Do staff stay in their role and feel happy at work? Do residents and relatives feel involved and informed?

Propose improvements to communication systems and practices to address any shortcomings. I commenced an early morning management meeting to instill trust and improve communication. I communicate my expectations to my managers and help them to improve their fulfillment within their role and to improve their effectiveness. I also ask for managers plans for their day and if there are any issues within their departments to discuss. I commenced weekend notes for the Duty Manager to complete in order to pass on crucial information throughout the week. I also commenced afternoon team meetings for carers and nurses to catch up and communicate together and evaluate the day so far. I reviewed and improved our current care planning system to increase the ease and speed of completion. To include a more person centred approach and to make it clearer to follow and use. The kitchen staff did not have a communication diary to pass on information to the kitchen manager when off, this has now changed and staff use a book and a diary to write in. Supervisions and appraisals were not regular or consistent enough. I have now actioned this regularly and we have since accessed training for staff to help them to improve their skills and role enjoyment. The proprietor and myself designed and delivered in house training sessions to aid staff understanding of the homes philosophy and goals.

Lead the implementation of revised communication systems and practices. If there are changes to communication systems and practices, I try to ensure people are informed ahead of time, maybe even consulted to gain feedback prior to going ‘live’. People like to feel empowered and in control, knowing what is going to happen, when and how will aid the implementation process. Where applicable I will explain why changes are being made and how it will benefit people. There will be increased understanding and awareness which will encourage participants to carry out the changes. Instructions need to be clear and concise, show people the changes where possible as some learn better this way and will appreciate your time in showing them. It will have more meaning and give a more positive impact in getting results. I select key or senior members of staff in whom I trust and have a natural ability to lead. These people can act as a catalyst or be a ‘go to’ person for those that are unsure or need encouragement. I follow up on requests and changes I have made, to ensure the success of change, you need to commit to persistence.

People naturally, do not like change and will need monitoring and supporting through the stages. I praise people that do as you ask, reward is a good motivator. I gain feedback and listen to those who are involved. Sometimes things need tweaking to further improve the changes. I review and evaluate the changes made to check I achieved what I set out to achieve, if not, why not? 3. Be able to improve communication systems to support partnership working 3.1 Use communication systems to promote partnership working Communication can come in different forms and systems. Choosing the correct method and using it consistently will promote effective ways of working. We use diaries and communication books. E.mail, letters, telephones, group or 1-2-1 meetings. Memo’s and calendars to run the staff training board. We are ‘informed’ by our in house policies and procedures and training. We also use referral mechanisms such as for the Dietician, Tissue Viability services.

These methods provide many outlets to ensure the smooth passing on of information from one area to another. Documented/recorded communication can also act as evidence if needed. Inducting staff well (and new relatives and residents) is the key to ensuring things are done in the way the home wants. Systems need monitoring intermittently to ensure the effectiveness. It may be necessary to provide people with translated forms of communication. Compare the effectiveness of different communications systems for partnership working It is important to monitor the effectiveness of the chosen method of communication. Is it cost effective? is it fast and efficient enough? does it cater for all those that need to use it? is it confidential? How is it stored or transferred? Does it give you the results you need? can it be done in a different way? It is important that you personally understand how the current system works and what is being required to ensure it is appropriate. Gain feedback from others who use it, do they have any suggestions or preferences? Propose improvements to communication systems for partnership working.

I have recently implemented a morning Management planning meeting at the start of the day. This gives us a chance to bond, discuss topical issues, make plans and be more effective at work. The home operates a Duty Management system at weekends. There was a lack of communication between the weekend manager and the General Manager. Weekend notes are now completed in order to promote continuity of service and has had a positive impact. The staff that work long days were not communicating with those that work half days. This lead to poor teamwork and dissatisfaction. There is now a brief daily p.m meeting which has also helped. Be able to use systems for effective information management. 4.1 Explain legal and ethical tensions between maintaining confidentiality and sharing information.

Within the healthcare environment we are governed by the Nursing and Midwifery Council, Care Quality Commision and Data Protection Act and more. We are duty bound to keep staff and residents records confidential (unavailable and inaccessible to those who do not need to see them). It is however, at times, necessary to share information to and with others. This person or organisation must be identified as having rights to the information being shared. Some do not find this easy to ask and those being asked do not always like being challenged. Ask for I.D badges, business cards, follow up and check out address and contact details. Delay the request until you are sure of ID. Some places of work, wards and nurseries use codes or passwords to help them to identify parents or multi disciplinary team members over the phone. Ask visitors to sign and and check the person is happy to be seen. Sometimes the work environment is busy and staff have to be reminded to share information to each other about their residents in a more respectful and confidential manner.

At times, staff may leave care plans unattended or not put them back into the locked storage cabinet. The person about whom the information is concerned should also be asked permission to share the information and why (if they have capacity to do so, otherwise their advocate should be consulted). This can take time and is sometimes overlooked but shouldn’t be. Professionals can forget that the person for whom they are caring should be involved in as many aspects as possible (where appropriate) including recording, storing and sharing information about them. Residents family and friends often feel that they have a right to information about their loved one. This is not necessarily the case. This can be difficult to stick to as families can put pressure on staff to reveal records that they are not entitled to see. Refer to company policy and external local procedures for guidance. In the event of sharing information, all steps should be taken to confirm identity and necessity. Consent should be gained from the person concerned. Lock files and drawers, use secure e.mail only. Mark post as ‘Confidential’ and keep it covered. Do not store paperwork or laptops in unattended vehicles in case of theft. 4.2 Analyse the essential features of information sharing agreements within and between organisations.

Confirm identity, gain consent, share only when and where necessary i.e the information which is being requested is relevant to the that persons job role or treatment plan. Share and store and send in a secure environment such as encrypted e.mails. Do not store in unlocked or unattended environments. Do not use any confidential information other than for its intended use. Do not alter, sell or pass on confidential information to any 3rd party. Social media and mobile phones are prohibited in our workplace. Staff face disciplinary action if found in breach of our company policies. Our staff are also restricted in taking personal information home concerning our residents. 4.3 Demonstrate use of information management systems that meet legal and ethical requirements.

Some care homes use computer based care and home managements systems that meet NMC, CQC and Data Protection requirements. We looked into this but currently are a paper based system. These are stored in a locked facility with very few key holders. We also have an encrypted internal and external e.mail system. Consent is gained from the resident to take photos of them and to plan their care with them in a way that they are happy with. Residents are met with monthly or more often if required with consent. Some of our residents have advocates (solicitors, Independent Mental Capacity Advocates, powers of attorney) which are asked if the resident lacks capacity. Staff wage slips are now sent on line using Sage computer systems. This avoids the risk of lost pay slips and confidential information and also saves paper. Staff files are locked away too. Confidential paperwork that needs to be destroyed is shredded prior to disposal.

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