BTEC Level 3 National Health and Social Care

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Vincent Nichols
Vincent Nichols

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Credit value: 10
in health and
social care
This unit is designed to help you develop your communication skills.
You will explore ways of overcoming barriers to communication and
develop your own skills in one-to-one and group interactions.
In order to work with people you must be good at communicating with them.
Effective communication requires advanced practical skills in much the same way as
driving a car does. Driving a car involves responding to changes in the road ahead,
as well as responding to other road users. Effective communication in care involves
being sensitive to feedback from others. Sometimes the people you meet may be
happy but often they may feel sad, afraid, upset or anxious. You need to be able to
recognise and respond appropriately to many different emotional situations. Different
contexts will require you to communicate in different ways. Skilled communication
requires you to make decisions as to what response would be most effective in the
situation you find yourself in. Effective communication involves much more than just
giving or receiving information.
Learning outcomes
After completing this unit you should:
understand effective communication and interpersonal interaction in health
and social care
understand factors that influence communication and interpersonal interaction
in health and social care environments
understand ways to overcome barriers in a health and social care environment
be able to communicate and interact effectively in a health or care
BTEC’s own resources
Assessment and grading criteria
This table shows you what you must do in order to achieve a pass, merit or distinction grade,
and where you can find activities in this book to help you.
To achieve a pass grade, the
evidence must show that you are
able to:
P1 Explain the role of effective
communication and interpersonal
interaction in a health and social
care context.
See Assessment activity 1.1,
page 17
P2 Discuss theories of communication.
To achieve a merit grade, the
evidence must show that, in
addition to the pass criteria, you are
able to:
M1 Assess the role of effective
communication and interpersonal
interaction in health and social
care with a reference to theories of
See Assessment activity 1.2,
page 21
See Assessment activity 1.2,
page 21
P3 Explain factors that may influence
communication and interpersonal
interactions in health and social
care environments.
See Assessment activity 1.3,
page 28
P4 Explain strategies used in health
To achieve a distinction grade,
the evidence must show that, in
addition to the pass and merit
criteria, you are able to:
D1 Evaluate strategies used in health
M2 Review strategies used in health
and social care environments to
overcome barriers to effective
communication and interpersonal
See Assessment activity 1.4,
page 40
M3 Assess your communication and
D2 Evaluate factors that influence the
and social care environments to
overcome barriers to effective
communication and interpersonal
See Assessment activity 1.4,
page 40
and social care environments to
overcome barriers to effective
communication and interpersonal
See Assessment activity 1.4,
page 40
P5 Participate in a one-to-one
interaction in a health and social
care context.
See Assessment activity 1.5,
page 42
P6 Participate in a group interaction in
a health and social care context.
See Assessment activity 1.5,
page 42
interpersonal skills in relation to
each interaction.
See Assessment activity 1.5,
page 42
effectiveness of each interaction.
See Assessment activity 1.5,
page 42
Unit 1 Developing effective communication in health and social care
How you will be assessed
You will need to produce written evidence of examples of the role of communication and
interpersonal interaction in health and social care. You will also need to explain theories
of one-to-one and group communication. You will need to demonstrate your own skills
both in one-to-one and in group interaction situations. Varied assessment tasks are
included throughout this unit to help you prepare your work.
Daniel, 17 years old
This is a very practical unit. Although there’s quite a lot of theory, I
found that I ‘sort of knew’ some of the ideas, although I had never
put them into words before.
The great thing about studying this unit is that it enables you to
explain what’s going on in one-to-one and group situations. The
unit changes the way you understand conversations and the way
people behave when they are in groups. Whenever I see people talking,
I start to work out what their body language might mean. I now realise that there are
special communication skills that you can use in care work. Sometimes the way you say
something can be more important than what you say. There are a lot of barriers in care
situations that can stop people from understanding each other. But the unit explains
ways of overcoming these problems.
The assignment work is all very practical. To begin with, I had to set up a logbook to
record examples of the theory we were studying. We had to study practical examples
of the communication cycle and group formation. I went on to explore barriers to
communication and how to overcome barriers. I found my supervisor at my practice
placement was very helpful in getting me to understand how to overcome barriers.
Finally, I had to explore my own skills in one-to-one communication and group
situations. I tried analysing several situations that I had experienced before going on to
complete my final assignment work.
Over to you!
1 Why is skilled communication so important in health and social care work?
2 Do you think effective group or effective one-to-one communication will be the
hardest to demonstrate?
3 What part of the practical work for this unit do you think will be most enjoyable?
BTEC’s own resources
Understanding effective communication
and interpersonal interaction in health and
social care
Changing the way you communicate
Imagine that you have to interview people in a youth club in a distant city as part of
a project. You do not know the members of this club. The members speak English
but they are very different from your friends in your local area. The people you are
interviewing don’t have to answer your questions.
How would you act to get these people to like you and listen to you?
The way you communicate with other people always depends on the situation
or the context you find yourself in. You will have developed effective ways of
communicating and interacting with your friends. But if you find yourself in a
different context you will need to be able to change the way you act in order to get
a good response from people.
1.1 Contexts of communication
One-to-one communication
When you start a conversation with someone you
don’t know well, you should always try to create the
right kind of feeling. It is important to create a positive
emotional atmosphere before you go on to discuss
complicated issues or give people information. The
other person needs to feel relaxed and happy to talk to
you. Very often people will start with a greeting such as
‘Good morning’. You can help other people to relax by
showing that you are friendly and relaxed.
1. Greeting
or warm-up
Fig 1.1: Interaction often involves a three-stage process
Imagine a care worker in a day centre for older
people walking around and sharply asking
each person: ‘You want tea or coffee?’ Without
any other conversation, this behaviour would
probably come across as ‘mechanical’. The care
worker would just be carrying out a practical task
– getting fluid into the bodies of these people.
However, some older people might find this
behaviour disrespectful, and others might find it
cold and unfriendly.
How would you offer a choice of drinks to people
in a warm and friendly way?
2. Conversation
or information
3. Farewells or
Unit 1 Developing effective communication in health and social care
Once you have created a good feeling, you can move
on to the business – the things you want to talk about.
When it is time to finish the conversation, you want to
leave the other person with the right kind of emotions
so you might say something like ‘See you soon’ to
show that you value them. Formal conversations often
follow a three-stage model, with an emotional ‘warmup stage’ at the beginning, a ‘business’ or ‘exchange
of information’ stage in the middle, and a ‘winding
down stage’ at the end.
Group communication
Taking part in a group discussion involves the same
issues as one-to-one communication as well as some
additional issues.
How does it feel to be in the group?
Group discussion only works well if people want to
be involved. Sometimes people feel threatened if
they have to speak within a formal group of people,
or they might stay quiet because they are worried
about other people’s reactions. It is important that the
group has the right emotional atmosphere. People
in groups often use humour or other friendly ways
of behaving to create the right group feeling, which
encourages people to talk. Creating the right group
atmosphere involves ‘maintaining’ the group so this
aspect of group communication is often called group
Is there a group leader?
Some groups, such as team meetings or classroom
discussions, have a leader or chairperson. Having a
leader is very useful because the leader can encourage
people to express their ideas and help them to take
turns when talking. Group leaders often encourage
people to focus on a particular task within a group.
Have you prepared what you are going to say?
When talking in a formal group you will need to think
through your points before sharing them with the
whole group. Because of this extra preparation, talking
to a group can feel very different from talking in a oneto-one situation.
Are you good at taking turns?
Group communication fails if everybody speaks at
the same time. It is harder to work out who should
be speaking in a group discussion than in a one-toone conversation. The skill of taking turns involves
identifying the following pattern. When a person is
about to finish speaking they usually signal this by
lowering their voice tone, slowing their pace of talking
and looking around at other people in the group.
The next person to talk knows that it is their turn by
watching the eyes of other group members. If people
fail to notice these patterns then too many people may
try to speak at the same time. If everybody is talking
then nobody is listening!
Can everybody see each other clearly?
If people sit in a circle then everyone can see everyone
else’s face. This is very important because positive
group feeling and successful turn-taking often depend
on people being able to understand the messages in
other people’s faces. If people sit behind each other
or in rows, then some of the group cannot see others’
faces. Bad seating or standing positions can make
group communication harder.
Activity 1: Record eye
contact and turn-taking
in group discussion
Get together with five or six colleagues and agree
on a current news topic that you would all enjoy
discussing for four or five minutes. One of you
should use a camcorder to record the eye contact
and speech of other group members. Analyse your
recording and work out how good people were at
taking turns in group discussion.
Independent enquirer: This activity will help you
demonstrate that you can analyse and evaluate
information, judging its relevance and value. The
activity may also help to develop team working and
participation skills.
Informal communication
We often use informal communication when we know
people well – for example, with friends and family.
Some friends or family members may use terms that
other people would not understand. Local groups
from particular places might also have their own ways
of speaking. For example, some people in southern
England might say things like ‘Hiya, mate. How’s it
goin’?’ If you belong to this group, you will appreciate
BTEC’s own resources
this as a warm, friendly greeting. But different groups
of people use different informal language so it can
sometimes be hard to understand the informal
communication of people from different social groups.
Formal communication
Health and social care work often involves formal
communication. For example, if you went to a local
authority social services reception desk you might
expect to be greeted with the phrase ‘Good morning.
How can I help you?’ This formal communication
is understood by a wide range of people. Formal
communication also shows respect for others.
The degree of formality or informality is called the
language ‘register’.
Imagine going to the reception desk and being
greeted with the phrase ‘What you after then?’ Some
people might actually prefer such an informal greeting.
It might put them at ease, making them feel that the
other person is like them. But in many situations, such
informal language could make people feel that they
are not being respected. Being ‘after something’ could
be a ‘put down’; you might assume that you are being
seen as a scrounger. So it is often risky to use informal
language unless you are sure that other people expect
you to do so. If you are treated informally, you may
I’m ’ere to assess
some geezer who lives
’ere – that you?
interpret this as not being treated seriously, or ‘not
being respected’.
So is there a correct way to speak to people when
you first introduce yourself? After all, if you are too
formal you may come across as pretentious or ‘posh’.
Usually care workers will adjust the way they speak in
order to communicate respect for different ‘speech
Communication between colleagues
Family and friends know you well and will usually
understand you, even if you communicate poorly or
very informally. Communicating with people at work is
different because:
• It is important that care workers communicate
respect for each other. Colleagues who do not show
respect for each other may fail to show respect to
the people who use care services.
• You may often have to greet colleagues by asking
if they are well and spend time on ‘warm-up talk’ in
order to show that you value them.
• You will need to demonstrate that you are a good
listener and can remember details of conversations
with your colleagues.
• Colleagues have to develop trust in each other. It
is important to demonstrate that you respect the
confidentiality of conversation with colleagues.
• Work settings may have their own social
expectations about the correct way to communicate
thoughts and feelings. These may differ from social
expectations when communicating with your friends
and family.
Although communication between colleagues may
often be informal it is important that care workers use
skilled communication in order to develop respect and
Independent enquirer: The following activity will
help you demonstrate that you can identify questions to
answer, and explore issues from different perspectives.
Fig 1.2: Informality can be seen as a sign of disrespect
Creative thinker: You may also be able to demonstrate
that you can connect your own and other people’s
experiences in inventive ways.
Unit 1 Developing effective communication in health and social care
Activity 2: Formal and
informal communication
Get together with a small group of colleagues
and imagine an introductory meeting between
a student and a care manager as part of a work
practice placement. One person should act as the
manager and another as the student. Work out
how the manager would welcome the student and
explain the work of the care centre. Then work out
what questions the student should ask. After you
have performed this simulation or role-play, two
other students should undertake exactly the same
task, but this time they should pretend that they are
close friends chatting about the situation.
The whole group should then discuss the
differences between these two simulations.
Functional skills
English: Your discussion activity may also contribute
towards English speaking and listening skills.
Communication between professional
people and people using services
Professional people, such as doctors and nurses, often
work within their own specialised language community.
A language community is a community of people that
has developed its own special words, phrases, social
expectations and ways of interacting that set it apart
from other groups of people. Professionals are usually
well aware of the need to translate technical language
into everyday language when they work with people
from other professions or people who use services.
It is important that professionals check that they are
not being misunderstood (see section 2 on the role of
Communication with professionals
When people who use services communicate with
professionals there is always a risk of misunderstanding
between people from different language communities.
It is important that people check that they are being
understood correctly. Professional health and social
care staff need to check their understanding of issues
with people who are communicating with them.
Multi-agency working
Health and social care professionals often have to
communicate with colleagues who work for different
organisations. For example, a home care organiser
might have to communicate not only with people who
use services and care workers but also with community
nurses, GPs’ surgeries, hospital services, occupational
therapists, voluntary groups, day care groups and
many other organisations. It is important not to assume
that people from different agencies will understand
Key term
Language community – A social community of people
that has its own special ways of using language in order to
communicate between group members.
Case study: Amber
The following conversation took place between
members of the same family:
Mother: How was your day at work?
Amber: OK, didn’t do much, walked about a bit.
Have to learn where everything is – like.
Mother: Did you enjoy it there?
Amber: Suppose it was all right. I had to listen
to a guy going on about stuff but it was boring.
Might be better tomorrow. I am going to ‘do’ the
residents tomorrow – they should be more fun!
1 If Amber had spoken to her colleagues
like this, would they have assumed that Amber
respected and valued them?
2 Can you explain why a conversation like this
might be acceptable within a family context but
not within a work context?
3 Can you explain how Amber should change her
comments if she was describing her first day at
work to a professional colleague?
BTEC’s own resources
the same terminology. Formal communication may
help to convey respect and avoid misunderstandings
when interacting with unfamiliar professionals in other
No one has ever written a rule book defining how
health and social care workers should behave in
all the different contexts listed above. One of the
reasons this has not been attempted is that every
interaction involves a feedback cycle (see section
2 in this unit). There may not be a single correct
way of handling each interaction.
Multi-professional working
Professionals from different backgrounds often have
to work together in order to assess and meet the
needs of people who use services. Multi-professional
working happens when many different professionals
work together. Communication will often need to be
formal and carefully planned in order to avoid barriers
to understanding.
Table 1.1: Degrees of formality in different contexts
Degree of formality
Key issues
Between colleagues
Often informal.
Must demonstrate respect for each
Between professionals and people
using services
Usually informal.
Professionals must adapt their
language (not use technical terms or
jargon) in order to be understood.
With professionals
People using services may
communicate informally.
Professionals may respond formally.
Professionals must take
responsibility for checking their
Multi-agency working
Usually formal – unless workers
know each other well.
Important not to make assumptions
or use technical terminology.
Multi-professional working
Usually formal – may need formal
planning to produce ‘agendas’ for
Different professional people must
be careful to check that they are
Case study: Karen
Karen is a home care worker.
Here are some statements
that people have made about
the way she works:
‘I always feel better when she
visits – she always smiles and
cheers me up if I feel down.’
‘She makes you feel important
– she always listens to you,
even when she is very busy.’
‘She is so easy to talk to – she takes an interest in
you. She is never ‘bossy’ or ‘posh’ – she’s like one of
my family’.
‘She makes you feel special – not just one of
the crowd.’
‘She is very kind and considerate. There aren’t very
many people like her – it’s a sort of magical touch –
you feel different when she is around.’
Karen has excellent interpersonal skills – a ‘magical
touch’. Karen’s skills enrich her own life and the lives
of other people.
1 Why do some people get on so well with other
2 What makes someone good at interpersonal
Unit 1 Developing effective communication in health and social care
1.2 Forms of communication
Communication between people enables us to
exchange ideas and information but it involves
much more than simply passing on information to
others. Communication helps people to feel safe, to
form relationships and to develop self-esteem. Poor
communication can make an individual feel vulnerable,
worthless or emotionally threatened.
There are many different types of communication as
shown in Fig. 1.3 below.
Activity 3: Communicating
Get together with a small group of colleagues and
discuss the relative importance of all the different
types of communication in Fig. 1.3 when you try
to communicate emotions such as feeling happy
or sad. Discuss whether or not spoken words are
usually the best way to communicate emotion.
1.3 Types of interpersonal
Different localities, ethnic groups, professions and work
cultures all have their own special words, phrases and
speech patterns. These localities and groups may be
referred to as different speech communities. Some
people may feel threatened or excluded by the kind of
language they encounter in these speech communities.
However, just using formal language will not solve
this problem. The technical terminology used by care
workers (often called jargon) can also create barriers for
people who are not a part of that ‘speech community’.
When people from different geographical areas use
different words and pronounce words differently they
are often using a different dialect. Some social groups
use slang – non-standard words that are understood
by other members of a speech community but which
cannot usually be found in a dictionary.
Key terms
Jargon – Words used by a particular profession or group that
are hard for others to understand.
Creative thinker: This activity will help you
demonstrate that you can generate ideas and explore
Independent enquirer: The activity may also lead you
to identify questions and problems to resolve.
One-to-one spoken
between individuals
Music and drama
have been called the
language of emotion.
Mime and drama
provide powerful ways
of communicating
Spoken (oral)
communication within
groups of people
communication using
facial expressions
Dialect – Words and their pronunciation, which are specific to
a geographical community. For example, people who live in
the north west of England might use a different dialect from
Slang – Informal words and phrases that are not usually found
in standard dictionaries but which are used within specific
social groups and communities.
Text messaging using
mobile phones
Types of
The use of signed
(visual) languages
Artwork, paintings,
sculptures, architecture,
ornaments and other
objects communicate
messages and
using information
technology, e.g.
emails and other
technological aids to
Braille communication
using raised marks
on paper that can be
Fig 1.3: Forms of communication
BTEC’s own resources
Case study: Professional jargon
The following conversation involves speech from
different speech communities.
for it?
If my mother needed care who would pay
Professional: Well the national framework for NHS
continuing health care and NHS funded nursing
care provides principles and processes for an
assessment process that will establish eligibility for
NHS continuing health care.
So the NHS would pay for care?
No, as I said, the framework provides
Did you know?
Teenagers can be thought of as a speech community
with their own slang. Lucy Tobin has published a book
called Pimp your vocab, which acts as a dictionary for
‘teek people’ – people who are outside the teenage
speech community. This ‘teenglish dictionary’ enables
others to understand teenage terminology.
Many people think the book is great fun, but some
critics argue that adolescent language changes so
rapidly that it is hard to keep up to date and to be
sensitive to local variations.
First language
The author and psychologist Steven Pinker (1994)
estimated that there may be about 600 languages
in the world that are spoken by more than 100,000
people. There are many more minority languages.
Some people grow up in multilingual communities,
where they learn several languages from birth. But
many people in the UK have grown up using only one
language to think and communicate. People who learn
a second language later in life often find that they
cannot communicate their thoughts as effectively as
they might have done using their first language. The
first language that people have learned to think in
usually becomes their preferred language.
for guidance that must be followed by all
PCTs to result in a national assessment process
supported by a checklist tool, decision support
tool, and fast track tool which are used to provide
clarity, transparency and consistency in the
decision-making process for eligibility.
1 Can you work out what the professional is talking
2 Can you see how technical and legal terminology
can exclude people?
3 Will the relative feel helped and respected by
such a technical answer?
Non-verbal communication
Within a few seconds of meeting an individual you will
usually be able to tell what they are feeling. You will
know whether the person is tired, happy, angry, sad,
frightened – even before they say anything. You can
usually guess what a person feels by studying their
non-verbal communication.
Non-verbal means ‘without words’, so non-verbal
communication refers to the messages that we send
without using words. We send these messages using
our eyes, the tone of our voice, our facial expression,
our hands and arms, gestures with our hands and arms,
the angle of our head, the way we sit or stand (known
as body posture) and the tension in our muscles.
The way you sit or stand can send messages. Sitting
with crossed arms can mean ‘I’m not taking any notice’.
Leaning back can send the message that you are
relaxed or bored. Leaning forward can show interest or
intense involvement.
Key term
First language – The first language that a person learns to
speak is often the language that they will think in. Working
with later languages can be difficult, as mental translation
between languages may be required.
Person 2
Person 1
Fig 1.4: You can see that person 2 is rejecting what person 1 is
Unit 1 Developing effective communication in health and social care
The way you move
As well as posture, your body movements will
communicate messages. For example, the way you
walk, move your head, sit, cross your legs and so
on will send messages about whether you are tired,
happy, sad, or bored.
Facing other people
The way in which you face other people can also
communicate emotional messages. Standing or sitting
face-to-face may send a message that you are being
formal or angry. A slight angle can create a more
relaxed and friendly feeling.
Fig 1.5: Square-on orientation can communicate aggression
Gestures are hand and arm movements that can
help us to understand what a person is saying.
Some gestures carry a common meaning in most
communities in the UK.
Fig 1.6: Common gestures for ‘good’ and ‘perfect’
Can you see how a person’s emotions
can often be interpreted from their facial
Facial expression
Your face often indicates your emotional state. When a
person is sad they may signal this emotion by looking
down – there may be tension in their face and their
mouth will be closed. The muscles in the person’s
shoulders are likely to be relaxed but their face and
neck may show tension. A happy person will have
‘wide eyes’ that make contact with you – and they will
probably smile. When people are excited they move
their arms and hands to signal this.
We can guess another person’s feelings and thoughts
by looking at their eyes, using eye-to-eye contact. Our
eyes get wider when we are excited, attracted to, or
interested in someone else. A fixed stare may send the
message that someone is angry. In European culture,
looking away is often interpreted as being bored or
not interested.
BTEC’s own resources
Most people can recognise emotions in the non-verbal
behaviour of others. You will also need to understand
how your own non-verbal behaviour may influence
other people.
Touch is another way of communicating without words.
Touching another person can send messages of care,
affection, power over them or sexual interest. The
social setting and a person’s body language will usually
help you to understand what their touch might mean.
But touch can easily be misinterpreted. You might try
to comfort someone by holding their hand but they
may interpret this touch as an attempt to dominate.
Sometimes it can be a good idea to ask if you may
Case study: Tonya
Tonya is 15 years old and attends meetings
of a youth group. She often sits with her arms
crossed and her head turned away, looking out of
the window. She avoids making eye contact with
people who are speaking to the group. When
asked if she feels OK, she does make eye contact,
changes her body posture and says she is happy to
be in the group.
1 What messages would crossed arms and
avoidance of eye contact normally send?
2 How many reasons can you think of to explain
why someone might sit with their arms crossed,
looking out of the window, while other people
are speaking?
3 How can you find out what an individual’s body
language means?
Fig 1.7: Gestures and words give a person the option of
refusing touch
touch, or gesture in a way that allows another person
to refuse your touch, before proceeding.
People may also look at, or feel, the degree of muscle
tension that you show when you communicate with
them. The tension in your feet, hands and fingers can
tell others how relaxed or tense you are. If someone
is very tense their shoulders might stiffen, their face
muscles might tighten and they might sit or stand
rigidly. A tense person may have a firmly closed mouth,
with lips and jaws clenched tight, and they might
breathe quickly.
One definition of friends is ‘people who can sit
together and feel comfortable in silence’. Sometimes
a pause in conversation can make people feel
embarrassed – it looks as if you weren’t listening or
you weren’t interested. Sometimes a silent pause can
mean ‘let’s think’ or ‘I need time to think’. Silent pauses
can be OK, as long as non-verbal messages that show
respect and interest are given. Silence doesn’t always
stop the conversation.
Voice tone
When you speak to other people, your tone of voice
is important. If you talk quickly in a loud voice with a
fixed tone, people may think you are angry. A calm,
slow voice with a varying tone may send a message of
being friendly.
The space between people can sometimes show how
friendly or ‘intimate’ the conversation is. Different
cultures have different customs regarding the space
between people when they are talking.
In Britain there are expectations or ‘norms’ as to how
close you should be when you talk to others. When
talking to strangers we usually keep ‘an arm’s length’
apart. The ritual of shaking hands indicates that you
have been introduced – you may come closer. When
you are friendly with someone you may accept them
being closer to you. Relatives and partners might not
be restricted at all in how close they can come.
Proximity is a very important issue in health and care
work. Many people have a sense of personal space.
A care worker who assumes it is fine to enter the
personal space of a person who uses services, without
asking or explaining why, may be seen as dominating
or aggressive.
Unit 1 Developing effective communication in health and social care
Reflective listening
We can often understand other people’s emotions just
by watching their non-verbal communication. However,
we can’t always understand someone’s thoughts
without good listening skills.
Listening skills involve hearing another person’s
words, then thinking about what their words mean,
then thinking about how to reply to the other person.
Sometimes this process is called ‘active listening’ and
sometimes ‘reflective listening.’ The word ‘reflective’
is used because the person’s conversation is reflected
back (like the reflection in a mirror) in order to check
understanding. As well as remembering what a person
says, good listeners will make sure that their non-verbal
behaviour shows interest.
Skilled listening involves:
• looking interested and communicating that you are
ready to listen
• hearing what is said to you
• remembering what was said to you, together with
non-verbal messages
• checking your understanding with the person who
was speaking to you.
We can learn about people who are different from
us by checking our understanding of what we have
heard. Checking understanding can involve listening to
what the other person says and then asking questions.
Reflection may also involve putting what a person has
just said into our own words (paraphrasing) and saying
it back to them, to check that we have understood
what they were saying.
When we listen to complicated details of other
people’s lives, we often begin to form mental pictures
based on what they tell us. The skill of listening
involves checking these mental pictures. Good
listening involves thinking about what we hear while
we are listening and checking our understanding as
the conversation goes along – we reflect on the other
person’s ideas.
Good listening can feel like really hard work. Instead
of just being around when people speak, we have to
build an understanding of the people we communicate
Message sent
Message is ‘reflected’
back like an image
in a mirror
Personal space
Close relationships
Personal space
with friends
Fig 1.9: Why is it important to see our understanding reflected
back to us?
Public space
Fig 1.8: There are different expectations about personal space
BTEC’s own resources
Case study: Sarah
Sarah is unemployed and is looking for work in a
specialised field. She looks worried and says ‘I don’t
know what to do. I keep looking for work and going
for interviews but I never get a job offer.’ Given that
you know nothing about the kind of job she is looking
for, how can you respond in a skilled way? Consider
some of the possibilities below:
• Try to be reassuring, e.g. ‘I’m sure you will get a job
Unless you are an expert with detailed knowledge
of the job market, reassurance is likely to sound
false. You may come across as trying to avoid the
topic or trick the person.
• Offer advice, e.g. ‘Why don’t you see a careers
Receiving unwanted advice can sometimes be very
irritating. The person may have already thought of
seeing an adviser. You might come across as trying
to sound clever and superior to Sarah. You might
be seen as trying to avoid the issue, i.e. ‘This is all I
can think to say, please don’t talk to me about this
any more.’
1.4 Communication and
language needs and preferences
Spoken and written English are not the preferred
system of communication for everyone. The first (or
main) language of many Deaf people may be a signed
language. People who are registered blind may use
Braille, as opposed to written text, in order to read
• Repeating what was said, e.g. ‘You never
get a job offer.’
Parroting some phrases back to a person may
sound mechanical. The person might say: ‘That’s
what I just said – didn’t you hear me?’
• Reflecting the other person’s message, e.g. ‘It must
be worrying when you can’t get a job.’
This shows that you have listened and it may be
seen as an invitation to keep talking. Being able to
talk to someone who is actively involved may make
the other person feel that they are being taken
1 What is the difference between saying things such
as ‘Why don’t you see an adviser’ or ‘I’m sure you
will get a job eventually’ and just saying ‘I don’t
want to talk to you about it’?
2 Can you explain the difference between just
repeating or parroting the words you have heard
and the idea of reflective listening?
3 Why might another person feel that you care
about them because you can reflect back what
they have said?
community should be identified as ‘culturally Deaf’ by
using a capital ‘D’ for Deaf. This emphasises that ‘Deaf’
people use another language system, as opposed to
‘Deaf’ people who are perceived to be impaired.
Further details of BSL can be found at
Details of signs and a finger spelling alphabet
can be found at and at
British Sign Language
British Sign Language is a language in its own right
– not simply a signed version of spoken English. The
British Deaf Association explains that British Sign
Language is the first or preferred language of many
Deaf people in the United Kingdom. The British Deaf
Association also explains that BSL was recognised as
an official British language in 2003 and the Association
campaigns for the right of Deaf people to be educated
in BSL and to access information and services
through BSL. Many Deaf people argue that the Deaf
Makaton is a system for developing language that
uses speech, signs and symbols to help people with
learning difficulties to communicate and to develop
their language skills. People who communicate using
Makaton may speak a word and perform a sign using
hands and body language. There is a large range of
symbols to help people with learning difficulties to
recognise an idea or to communicate with others.
Further information on Makaton can be found at
Unit 1 Developing effective communication in health and social care
Activity 4: Research
people’s understanding
of BSL
Do people understand what British Sign Language
is? Plan a short series of questions and ask people
who are not studying this course if they have
ever heard of British Sign Language and what
kind of language it might be? You may find that
the majority of people think that BSL is a way of
signing English words – in other words that to
sign in BSL you would first have to know English.
Only a few people might understand that BSL is
a separate language developed within the Deaf
community. Discuss what consequences your
research might have for both Deaf and hearing
Independent enquirer: This activity will help you
demonstrate that you can plan and carry out research
and appreciate its consequences.
Written communication
There is a Chinese saying that ‘the faintest ink is
stronger than the strongest memory’! Written records
are essential for communicating formal information
that needs to be reviewed at a future date. When
people remember conversations they have had, they
will probably miss out or change some details. Written
statements are much more permanent and, if they are
accurate when they are written, they may be useful
later on.
Pictures and objects of reference
Paintings, photographs, sculptures, architecture,
ornaments and other household objects can
communicate messages and emotions to people.
People often take photographs or buy souvenirs to
remind them of happy experiences and emotions.
Sometimes an object – such as a cuddly toy – can
symbolise important personal issues and provide a
source of meaning and comfort for an individual.
Key term
Braille (a system of raised marks that can be felt
with the fingers) provides a means of written
communication, based on the sense of touch, for
people who have limited vision. The communication
system known as Braille was first published by Louis
Braille, a blind 20-year-old, in 1829. This system is now
widely used, for reading and writing, by people who
cannot see written script.
Modern computer software can translate written
material into Braille, which can be printed out using
special printers. Further details on Braille can be found
Use of signs and symbols
Gestures made with hands or arms, written symbols
or diagrams (such as traffic signs) all communicate
messages to people.
Object of reference – An object of reference is a physical
object or picture that has become associated with an activity,
person or other special meaning.
Objects can sometimes be used to communicate
with people who do not use much signed or spoken
language. A child or adult with a learning disability
might understand that a cup stands for ‘would you like
a drink’. An object like a spoon tied to a card might
communicate that it is time for dinner when the spoon
is presented. A person without language might use
a patch of cloth to communicate that they wish to
sit in a favourite chair covered in that type of cloth.
Sometimes a person might learn a symbol, perhaps
a symbol like a horseshoe that can be used to label
possessions or identify his or her room.
Finger spelling
People who use a signed language, such as British
Sign Language, also use finger spelling. Finger spelling
enables signers to spell out words that do not have
a general sign, or words that may be misunderstood
such as the names of people and places.
Fig 1.10: What meanings do these signs communicate?
BTEC’s own resources
Imagine that you had to spell every word in
a phone conversation – it would take a long
time and the conversation would not be very
enjoyable. For this reason, people who use
signed languages do not generally use finger
spelling to communicate, other than for specific
Communication passports
Communication passports are usually small personalised
books containing straightforward practical information
about a person and their style of communication.
The passport may help health and care workers to
understand the needs of a person with communication
difficulties. Communication passports often include
photographs or drawings that may help care workers
to gain a better understanding of the person who owns
the passport. They are put together by working with
the person with communication difficulties and his or
her carers; the person tells their own story of their likes,
dislikes and communication styles.
Technological aids to communication
Information technology offers a wide range of facilities
to help with communication. It is possible to provide
enlarged visual displays or voice description for
people with visual impairment. Electronic aids – such
as the minicom for people with a hearing disability
or voice typing for people with dyslexia – can turn
Think about the way children communicate
through play using objects
speech into writing. Some electronic communication
systems can be activated by air pressure, so that a
person can communicate via an oral tube connected
to computerised equipment. At a simpler level, aids
such as flash cards or picture books can also improve
communication with people who do not use a spoken
or signed language. Text messaging, using a mobile
phone, provides an effective way of staying in touch for
many people. For people with a hearing disability, text
messaging may provide a major form of communication.
Did you know?
In August 2009 a Roman Catholic Archbishop, Vincent
Nichols, was reported as saying that ‘too much
exclusive use of electronic information dehumanises
what is a very, very important part of community life
and living together... We’re losing social skills, the
human interaction skills, how to read a person’s mood,
to read their body language.’
How far do you think email and text messages may
spoil or improve relationships between people?
When you send text messages to friends, do you
use symbols and shortened words that would not be
acceptable in more formal academic work? If you send
emails, do you use abbreviations, symbols and special
terms or do you only use formal English? Do you think
it should be acceptable to use ‘texting’ symbols and
abbreviations for academic work? How formal should
English be?
Human aids to communication
Many people have specific communication needs. It
may be important to employ an interpreter if a person
uses a different language such as BSL. Some carers
learn to use communication systems, such as Makaton,
in order to help them communicate with people.
If you are communicating with a person with a hearing
impairment you should make sure that the person
can see your face clearly so that they can see your
expressions and the way your lips move. Sometimes
people use clues from facial expression and lip
movement to interpret what you might be saying. It
is also important to speak in a clear, normal voice. If
you raise your voice, your face and lips will become
distorted. A person with a hearing impairment may
realise that you are shouting and may assume that you
Unit 1 Developing effective communication in health and social care
are angry! It is also important to try and speak in an
environment with little background noise.
If people have limited vision, it may be important
to use language to describe issues that a sighted
person might take for granted, such as non-verbal
communication or the context of certain comments.
Touch may be an important aspect of communication.
For instance, some registered blind people can work
out what you look like if they can touch your face in
order to build an understanding of your features.
It is always important to choose the right style of
language in order to communicate with people from
different language communities.
Variation between cultures
No one can learn every possible system of cultural
variation in non-verbal behaviour but it is possible
to learn about the ones that are used by the people
you are with! You can do this by first noticing and
remembering what others do – in other words, what
non-verbal messages they are sending. The next step
is to make a guess as to what messages the person is
trying to give you. Finally, check your understanding
(your guesses) with the person. This involves reflective
listening and thinking carefully about the person’s
Key term
Skilled carers use a range of conversational techniques
when working with others. These include being
sensitive to variations in culture.
Cultural variation – Communication is always influenced
by cultural systems of meaning. Different cultures interpret
verbal and non-verbal communication behaviours as having
different meanings.
Culture means the history, customs and ways of
behaving that people learn as they grow up. People
from different regions of Britain use different
expressions. Non-verbal signs vary from culture to
culture. White middle-class people often expect
people to ‘look them in the eye’ while talking. If a
person looks down or away a lot, they think it is a sign
that the person may be dishonest, or perhaps sad
or depressed. In some other cultures – for example,
among some black communities – looking down or
away when talking is a sign of respect.
Care workers must be careful not to assume that
statements and signs always have the same meaning.
Cultural differences and different settings can alter
what things mean. A vast range of meanings can be
given to any type of eye contact, facial expression,
posture or gesture. Every culture, and even small
groups of people, can develop their own system of
meanings. Care workers have to respect differences
but it is impossible to learn all the possible meanings
that phrases, words and signs may have.
Assessment activity 1.1
Explain, using examples you have observed, the role
of communication and interpersonal interactions in
health and social care.
Grading tip
P1 Maintain a logbook to record notes of
interactions you have observed in class role
plays, informally with your peers, with others at
work and in school/college or in public spaces
and particularly in health and social care settings
when visiting or in placements. Note behaviours,
non-verbal communication skills and how the
communication cycle is/is not demonstrated.
Remember that your notes should maintain
the anonymity of individuals and any details
that might enable individuals or settings to be
Consider what is meant by ‘effective’ when
discussing communication and interpersonal
interactions in health and social care.
Consider formal and informal communication,
differences between different language
communities and cultures and the role of verbal
and non-verbal communication in interpersonal
Include examples of different language needs
and preferences in your explanation.
BTEC’s own resources
2 Understand factors that influence
communication and interpersonal interaction in
health and social care environments
2.1 Theories of communication
The communication cycle
Effective communication involves a two-way process in
which each person tries to understand the viewpoint
of the other person. Communication is a cycle
because when two people communicate they need to
check that their ideas have been understood. Good
communication involves the process of checking
understanding, using reflective or active listening.
Michael Argyle (1972) argued that interpersonal
communication was a skill that could be learned and
developed in much the same way as learning to drive
a car. Argyle emphasised the importance of feedback
in skilled activities. When you drive a car you have
to change your behaviour depending on what is
happening on the road. Driving involves a constant
cycle of watching what is happening, working out how
to respond, making responses and then repeating this
cycle until you reach your destination.
According to Argyle, skilled interpersonal interaction
(social skills) involves a cycle in which you have
to translate or ‘decode’ what other people are
communicating and constantly adapt your own
behaviour in order to communicate effectively.
Verbal and non-verbal communication is not always
straightforward. The communication cycle involves a
kind of code that has to be translated. You have to work
out what another person’s behaviour really means.
Key term
Communication cycle – Most important communication in
care work involves a cycle of building understanding using an
active process of reflecting on, and checking out, what the
other person is trying to communicate.
One way of looking at this cycle might be:
1 An idea occurs: You have an idea that you want to
2 Message coded: You think through how you are
going to say what you are thinking. You put your
thoughts into language or into some other code
such as sign language.
3 Message sent: You speak, or perhaps you sign or
write, or send your message in some other way.
4 Message received: The other person has to sense
your message – they hear your words or see your
5 Message decoded: The other person has to
interpret or ‘decode’ your message (i.e. what you
have said). This is not always easy, as the other
person will make assumptions about your words
and body language.
6 Message understood: If all goes well then your
ideas will be understood but this does not always
happen first time!
4. Message perceived
2. Message coded
1. Ideas
3. Message sent
6. Feedback –
what was
Fig 1.11: What are the stages in the communication cycle?
5. Message
Unit 1 Developing effective communication in health and social care
Case study: Karen
Karen is talking to Jasmin,
whose partner has died.
Jasmin: I can’t believe it.
I don’t know how I’m going
to cope on my own, I can’t
sleep or eat.
Karen: You must feel awful,
it must have been a terrible
Jasmin: I’ll say it was – I just feel so anxious. I know I
won’t be able to cope.
Karen: Can you tell me a little about your life
Activity 5: Observe the
communication cycle
Work in a small group and plan how to record the
speech and faces of two people talking. Agree on
a topic of conversation and record pairs of people
talking to each other for up to five minutes. Analyse
your recordings in terms of the six stages of the
communication cycle.
In this brief example, there is no helpful advice or
information that Karen can offer. Karen is careful to
reflect back what Jasmin has said. This results in a
communication cycle in which Jasmin can begin to
share her feelings.
1 Can you explain why it is so important for care
workers to say back what they understand?
2 What might have happened if Karen had
responded with ‘Don’t worry, you’ll feel better as
time goes by’?
3 How can understanding the communication
cycle help care professionals to develop skilled
through a process of group formation. Many groups
may experience some sort of struggle before people
unite and communicate effectively. One of the bestknown theorists to explain group formation stages is
Tuckman (1965). Tuckman suggested that most groups
go through a process involving four stages. These are:
1 forming
2 storming
3 norming
4 performing.
Independent enquirer: This activity may help you
demonstrate that you can analyse and evaluate
Functional skills
ICT: Discussing this activity may help you demonstrate
that you can evaluate the selection and use of ICT
tools and facilities used to present information.
The first stage (forming) refers to people meeting for
the first time and sharing information. The second
stage (storming) involves tension, struggle and
sometimes arguments about the way the group might
function. The third stage (norming) sees the group
coming together and consciously or unconsciously
agreeing on their group values. Once they have
established common expectations and values, the
group will reach the fourth stage of being an effectively
performing group.
Key term
Tuckman’s stages of group interaction
Communication in groups can also be influenced by
the degree to which people feel they belong together.
When people first meet in a group they often go
Group values – Group members need to share a common
system of beliefs or values in order for the group to
communicate and perform effectively. You may be able to
identify these values when you watch a group at work.
Jea Black
Day centre team leader
is a day centre for adult people
with learning disabilities. Jenna is the team leader
for a new group of care workers who have only been working
together for the past two weeks. They have regular team meetings
and this is an extract from their third meeting in which they are
discussing the activities that they lead with day centre members.
Jenna: Let’s talk about the cookery sessions. I think that members are
really enjoying learning to cook.
Carly: Maybe, but I worry about what we’re doing. We don’t
watch people carefully enough. For example, Drew nearly
burned himself last Tuesday because nobody was
watching what he was doing.
André: Yes, but he didn’t burn
himself and he is learning to become independent. I
think it’s important to let people take risks. I could never have become
independent if my parents hadn’t let me take risks!
So it’s all right for Drew to burn himself, is it? Is that what you’re saying?
Shanice: I can’t believe you just said that! André is talking about the importance of independence
and you turn that round to saying he doesn’t care about people burning themselves. That’s not what he
said – you didn’t listen!
Deja: Now you listen to me! What I am saying is that we don’t take safety seriously enough. These
people are vulnerable, they can hurt themselves if we don’t take proper care.
Jenna: OK, we all know that both safety and independence are central to our work here. So why are
we talking as if we can’t have both?
Deja: Well, I agree that both are important, but safety comes first as far as I’m concerned.
Shanice: Well I don’t think things are that simple. It is possible to concentrate
too much on safety and then we might stop people from reaching their
potential of independence. It’s a matter of getting the
balance right.
Think about it!
1 Using Tuckman’s theory, can you identify which stage of group formation this group is at?
2 Can you identify different norms that are being argued about in the group?
3 Can you identify the different ‘sides’ being taken in the discussion and how Jenna is starting to use
her group leader role to get the team to focus on common values?
4 If this group is to succeed in working they will have to share common ‘norms’. Can you guess on
what norms the group might eventually agree?
5 If you were in Jenna’s position, how would you lead the conversation on from Shanice’s last
comment in order to reach the ‘norming stage’ of team working?
Unit 1 Developing effective communication in health and social care
Assessment activity 1.2
Using examples from your experience, discuss
theories of communication. This assessment could be
integrated with Assessment Activity 1.1.
For M1, you should also include an assessment of the
role of effective communication and interpersonal
interaction in health and social care.
Grading tips
P2 Consider how communication theory helps to
explain effective communication in health and
social care contexts.
Consider one-to-one and group interactions,
formal and informal communication, different
types of communication and different forms of
interpersonal interaction in your discussion.
Reviews of filmed class role-plays in which
you and your peers have participated would
be helpful to gain understanding of the
communication cycle.
2.2 Environmental factors that
influence communication
It is very hard to hear what someone is saying if there
is a lot of background noise. It is also very difficult
to make sense of other people’s facial expressions
if you can’t see their faces properly due to poor
lighting. Rooms with awkward seating positions might
mean that a group of people cannot see each other
comfortably. People sometimes feel uncomfortable if
they are trying to communicate with a person who is
too close or at a distance. A room that is too hot, stuffy
or cold may inhibit communication if it makes people
feel tired or stressed.
The environment also plays an important role in the
effectiveness of communication aids. For instance,
hearing aids will amplify background noise as well as
the voice of the speaker. A noisy environment may
therefore be difficult and unpleasant for someone who
is using a hearing aid. Good lighting will be critical for
someone who supports their understanding of speech
with lip reading. Time limits on how long you can use a
room can also interfere with communication.
P2 M1
Participation in a series of group tasks with
the same group of individuals over a period
of several weeks and an analysis of how your
work with each other changes over time could
provide useful understanding of Tuckman’s
theory. This could involve group work in class
with your peers or how you settle into working
with a group of individuals in a work experience
placement or any employment.
M1 Integrate your assessment by using the
examples explained for P1 and discussed in P2.
The assessment should consider strengths
and weaknesses of communication and
interpersonal interactions you have observed
in relation to theories relating to the
communication cycle and group formation
Remember to consider a range of health
and social care contexts, different forms
of communication and different types of
interpersonal interaction in your assessment.
Activity 6: Plan a good
environment for group
Get together with a group of colleagues and make
a list of what an ideal environment for videoing a
group discussion would involve. Work out what
practical changes you may be able to introduce
into your own working environment.
Creative thinker: This activity will help you
demonstrate that you can generate ideas and explore
possibilities and perhaps try out alternatives.
2.3 Barriers to communication
A barrier blocks things and stops them ‘getting
through’. There are different types of communication
barrier that stop communication from being effective.
Three types are shown in Table 1.2 on page 22.
Where the first and second types of barriers exist, it
will usually be obvious that communication has failed.
However, distorted understanding is not always easy
to identify. Skilled use of the communication cycle may
help you to check what has been understood or what
communication barriers may exist.
BTEC’s own resources
Table 1.2: Communication barriers
Type of barrier
1 Communication is not
Not responding to language needs or preferences. Not understanding sensory
impairment or disability.
Examples: Speaking to a Deaf person who uses a signed language. The sounds are
not received.
Environmental barriers:
Background noise can stop you from hearing a message. You can’t receive full
non-verbal communication if you can’t see a person’s face or body.
2 Communication is received
but not understood
A person using slang, jargon or complex technical terminology can be heard, but
their message may not be understood.
3 Understanding is distorted
A wide range of emotional and psychological factors can act as barriers, resulting
in distorted understanding of communication.
Key term
Communication barrier – Anything that stops the
development of understanding when people interact.
Fig 1.12: Consider why barriers can mean that no information
is communicated
Fig 1.13: How can psychological factors create communication
barriers by distorting perception of a message?
Unit 1 Developing effective communication in health and social care
Case study: Karen
Interviewer: Some people who need care have
problems with understanding and memory. How do
you know if a person has understood what you are
talking about?
Karen: It’s not easy but sometimes you can tell from
a person’s face. When a person looks puzzled, or if
they don’t respond, then you know you’ve got to try
and explain something in a different way.
But some people will nod
and smile although they
haven’t really understood
you. So I try to keep
the conversation going
and find a way to check
understanding. For example,
I had to explain I would
come on a different day.
Now, I couldn’t ask the
person a direct question like
Types of communication: difficult,
complex or sensitive
Some communication between people is simply
about sharing or ‘transmitting’ information. For
example, someone might want to know what number
bus to catch, or they might ask for a drink of water.
Sometimes communication will be complex. For
example, a relative may want to know about funding
arrangements for care. A communication about
funding might involve a great deal of complex
information. In this situation it would be important
to check what the relative already knew, and whether
or not the individual understood the information you
were providing.
A great deal of communication in care work involves
building an understanding of another person and
providing emotional support. Burnard and Morrison
(1997) argue that caring and communicating are
inseparably linked. Communication that involves
emotional issues is often experienced as being difficult
or sensitive.
There is no advice or information that is likely to be
very useful to a person who is overwhelmed by grief,
but many people do want someone to be with them.
Communication in this difficult or sensitive situation
‘Can you remember what I told you?’
If I did that, the person might feel I was treating
them like a child. So instead I asked them about
what they would be doing on the day that I had
changed from. They said that I would be coming
to see them – and that was wrong – and so I was
able to remind them of the change. One way
of preventing misunderstanding is to just keep
somebody talking.
1 Can you explain why Karen does not like to ask
direct questions such as ‘What did I just tell you?’
or ‘When am I coming next then?’
2 Can you think of some reasons why people
might nod and smile as if they understand, even
if they don’t understand what you have tried to
3 In the example above, how is Karen using the
communication cycle?
What can you say to a person who is upset and
crying because they can’t cope, following the
death of their partner?
should focus on emotional needs, rather than giving
out information.
Engebretson (2003) uses the idea of a caring presence
to explain what is needed in these situations. Creating
a caring presence is about sharing an understanding
of the feelings that other people may be experiencing.
Sometimes simply being with a person who is lonely,
anxious or depressed can provide comfort. If you
believe that your carer understands your needs and
is concerned about you, then just knowing that they
are near you can help you to feel supported. Nonverbal communication may sometimes communicate
emotions and feelings more effectively than words.
Key term
Caring presence – Being open to the experience of another
person through a ‘two-way’ encounter with that person.
BTEC’s own resources
If you can support people just by the way you are
‘present with them’ this may be because you are
developing empathy with them.
Empathy involves a caring attitude where someone
can see beyond his or her own assumptions about
the world and can imagine the thoughts and feelings
of someone else. A professional care worker who
can empathise will be able to imagine the emotions
associated with the pain and grief that another person
is experiencing.
Did you know?
Empathy is often regarded as a skill that can be
developed through training but Carl Rogers, a famous
counsellor, argued that empathy was a state of being.
This means that you have to experience your self
and other people in a special empathetic way. In
Rogers’ view you couldn’t simply use empathy as a
communication tool or technique – you had to ‘live’
Language needs/preferences
Most people will have a preferred first language. And
this preferred language will sometimes be obvious
to you. But language needs go beyond the choice of
a preferred language. Different communities use a
given language in different ways. People use different
degrees of formality and informality, depending on the
context. For example, people may use jargon, dialect
or slang to communicate effectively with people in
their own speech community. These differences can
create barriers to understanding.
Sensory impairment and disability
A sensory impairment means that a person’s senses
do not work effectively. Impairments create the first
kind of communication barrier, where information is
not fully received.
Disability is not the same as impairment. Some people
experiencing barriers because of their difference
may have a communication disability. For example,
a ‘Deaf’ person, whose preferred language is BSL,
experiences no problems communicating with another
person who is good at signing with BSL. This person
may not be able to communicate with people who
use spoken English without the aid of an interpreter.
Key terms
Empathy – The ability to develop a deep level of
understanding of another person’s experience.
Communication disability – Difference that may create
barriers between people with different systems of
Sensory impairment – Damage to sense organs such as eyes
and ears.
However, in this case, the disability is a social issue (to
do with needing an interpreter), rather than a sensory
impairment issue.
Barriers associated with personality, selfesteem, anxiety and depression
Sometimes care workers can create their own barriers
because they feel stressed by the emotional needs
of the people they work with. Listening to others can
involve hearing about frightening and depressing
situations. Carers sometimes stop listening in order
to avoid painful emotions. Tiredness, lack of time or a
desire to avoid emotional stress can create a barrier to
providing caring communication.
Building an understanding of another person and
establishing a ‘caring presence’ can be very difficult
when their personality or self-esteem needs create a
barrier. Many people who are depressed or anxious
experience negative thoughts that ‘just come to them’.
Attempting to understand these thoughts and feelings
can feel like trying to find a way through a brick wall. It
may feel as if there is an emotional barrier preventing
the person from experiencing any positive emotions.
The case study on the next page illustrates this type of
The carer in the case study opposite is not ‘just
talking’ – she is trying to steer the conversation
round to positive memories. The worker is using
her understanding of Liam’s past to try and lead the
conversation around the barrier of negative and
depressed thoughts. If the worker is successful, the
conversation might lead to Liam having positive
thoughts and feelings and increasing his level of selfesteem.
Asking questions
Talking through difficult, complex or sensitive issues
will involve the verbal skills of asking open questions
and using probes and prompts within the conversation.
Unit 1 Developing effective communication in health and social care
Case study: Liam
Liam: You can’t possibly understand what it feels
like to be me. Absolutely everything is wrong with
my life, I’ve got no reason to be alive and you can’t
help me – what’s the point of talking?
Carer: But perhaps I could be useful if I knew more
about your life?
Liam: What do you want to know? I’ve got no
money, no job, no future, no one cares about me –
there’s no point in going on.
Carer: Right, so it feels really terrible, really bad, but
was there a time before things went wrong – a time
when you were happy?
Liam: Yes, a few years back everything was good –
but now I feel even more miserable because you
are reminding me of how much I’ve lost!
There is no simple way of removing this emotional
barrier but some skilled workers might try to keep
the conversation going so that they could continue
to learn about the person. It might be possible to
positively influence the person’s self-esteem as the
conversation continues.
• Open questions: These cannot be answered with a
yes or no response – they require a person to think
about their answer. Open questions are likely to
involve a complex communication cycle in order to
discuss issues. They include questions such as ‘How
would you describe your quality of life?’
• Probes: These are very short questions such as ‘Can
you tell me more?’ Probes are used to dig deeper
into the person’s answer – they probe or investigate
what the other person has just said.
• Prompts: These are short questions, which you
offer to the other person in order to prompt them
to answer. Prompts are questions such as ‘Would
you do it again?’
Barriers associated with aggression and
When a person experiences strong emotions or
their self-esteem is threatened, that person may
become aggressive or withdrawn, creating barriers to
See pages 30–33 for further information on aggression
and submissiveness.
Carer: So when you ran your own taxi business
you were on top of everything – nothing could get
you down?
Liam: Yeah – but I’ve got health problems now, I’m
finished, that time is all gone.
Carer: Yes, I know it feels terrible, but tell me about
the good times. You dealt with problems then. I’d
like to understand how you made it all work back
Read the information on probes and prompts below
and answer the following questions.
1 Can you identify how the carer has used
questions, probes and prompts in order to keep
the conversation going?
2 Can you explain how the carer may have
used reflective listening in order to build an
understanding of Liam’s situation?
3 Can you explain the importance of building an
understanding of another person during a difficult
and sensitive interaction?
Barriers associated with assumptions
Building an understanding of other people’s needs
takes time and effort. Jumping to conclusions and
making assumptions can save mental effort and time,
but assumptions may cause us to misinterpret what
another person is trying to communicate. For example,
you might believe that you don’t need to listen to a
person because you already know what their needs
are. But care workers who use the communication
cycle are less likely to make assumptions because they
check their understanding. Assumptions can create a
barrier because people stop listening and checking
their understanding of other people’s communication.
Some people make assumptions that people who
have a disability are damaged ‘normal’ people. When
disabled people are seen in this way, they might
be pitied or ignored. People with communication
Key term
Assumption – An idea that people think is true or correct
without bothering to check.
BTEC’s own resources
differences are sometimes assumed to be mentally
impaired. Older people are sometimes seen as
demented or confused if they do not answer questions
quickly, correctly and clearly. If care workers do not
bother to check their assumptions about people, these
assumptions can turn into prejudices. And a prejudice
or pre-judgement can result in discrimination.
Barriers associated with cultural variation
Barriers associated with values and belief
Words and non-verbal communication can be
interpreted differently depending on the context
and on the culture of the person using them. For
example, the word ‘hot’ can have different meanings
depending on the context in which it is used and the
culture of the person using it. In a formal context,
‘hot’ refers to having a high temperature. But in other
speech communities an object might be ‘hot’ if it has
been ‘stolen’ or if it is perceived as ‘very desirable’.
A hot person might be very good at something, or
be someone who is overcome with sexual desire! If
communication is interpreted only from a fixed cultural
standpoint, serious misunderstandings can arise. To
make sense of spoken and non-verbal language, you
need to understand the context of the interaction and
the intentions of the person communicating.
People have different belief systems – about what is
important in life and how people should live their lives.
Values are the principles that we think of as being
important or valuable, in terms of how we live our lives.
Key terms
Belief systems – The assumptions we use to make sense of
our lives. Our belief systems often include our values.
Values – What we think of as being important or valuable in
terms of how we live our lives.
When people have different belief systems and
values it is easy for them to misinterpret one another’s
intentions when attempting to communicate. Like
assumptions, belief systems and values can therefore
create barriers to understanding. It is important to
try to learn about other people’s beliefs and values
in order to make sense of what they are trying to
Culture refers to the different customs and
assumptions that communities of people adopt.
Different ethnic and religious groups may have
different cultures, but different age, occupational
and geographical groups also make different cultural
Think of some words that can mean different
things depending on the cultural context in
which they are used. ‘Chilling’ is one example.
Fig 1.14: Why does learning about other people’s beliefs help to avoid barriers to
Unit 1 Developing effective communication in health and social care
An example of a non-verbal cultural variation might
be the hand gesture in which the palm is held up and
facing forward. In Britain this means ‘Stop, don’t do
that’, whereas in Greece it can mean ‘You are dirt’ and
is considered a very offensive gesture. Why do the
same physical movements have different meanings?
One explanation could be that the British version of
the palm-and-fingers gesture means, ‘I arrest you, you
must not do it’, whereas the Greek interpretation goes
back to medieval times when criminals had dirt rubbed
in their faces to show how much people despised
It is important not to make assumptions about nonverbal messages – they should always be checked.
Non-verbal messages can mean different things
depending on the circumstances of the people who
are sending them.
Case study: Gerard
Gerard is a tall, muscular, middle-aged man
who regularly talks to staff about his son’s care.
He prefers to stand squarely face-to-face and
speaks quickly, using a loud voice. Staff say that
they feel uncomfortable talking to Gerard because
he sometimes ‘stares at you’ with a fixed gaze.
Staff say ‘He is in your face’ because they feel that
he stands too close to them. Some staff think that
Gerard is aggressive and demanding because of
the way he acts.
1 Can you identify how ‘cultural variation’ might
be important when trying to understand this
2 Can you think of possibilities, other than being
demanding and aggressive, that might explain
the non-verbal behaviours described above?
If you cannot control and make decisions about your
own life you may fail to develop, or you might lose
your sense of being a worthwhile person. If care
workers control and manipulate you, your self-esteem
may be damaged.
Care workers should seek to empower people who
use services. Empowerment means giving power to
others. People who use services should be empowered
to believe that they can make their own choices and
take control of their lives.
Key terms
Empowerment – This enables a person who uses services to
make choices and take control of their own life.
Power – In the context of interpersonal behaviour, ‘power’
means the ability to influence and control what other people
In order to empower others, care workers need to
understand and value each person’s unique story.
Care workers must support the people they work
with, in taking control of important decisions. Care
workers must also carry out their work on the basis that
everyone is of equal status. The care worker does not
have higher status than people who use services.
Fixed eye contact
Difference in height
Inappropriate use of touch
Worker ignores feedback
3 How could you check what certain non-verbal
behaviours might mean during a conversation?
Use and abuse of power
The General Social Care Council (GSCC) Code of
Practice for Social Care Workers (2002) requires all
workers to respect individuality and support people
who use services to control their own lives. However,
there is always a danger that, if a care worker is short of
time, they will seek to control people who use services.
It is an abuse of power if care workers deliberately
control and manipulate others.
Fig 1.15: How do these non-verbal messages express power
and domination?
BTEC’s own resources
Barriers associated with the effects of
Alcohol and drugs can influence a person’s ability to
send clear verbal and non-verbal messages. Drugs that
affect the functioning of the central nervous system
can easily result in messages not being received or
understood and also in distorted interpretations of the
message. Alcohol and drug abuse can therefore create
all the barriers to communication shown in Figure 1.16
on page 29. People with a distorted perception of
other people’s communication may be more likely to
become frustrated or aggressive.
Case study: Karen
Interviewer: Why do a lot of
people worry about having care
Karen: Some people are afraid
that you will come in and take
control of their lives, boss them
about, and make them feel stupid.
Interviewer: But care work is all about giving power to
people who use services, making sure people are in
control of their own lives – so why do people worry?
Karen: Well, I am always short of time and it is
tempting to just take over and do everything my
way to get it done quickly. It’s easy to think you
know best – but if you make that assumption, you
upset people and make them feel powerless.
Interviewer: Don’t some people like to sit back and
let you be in control?
Karen: Some people say, ‘You do what you like,
buy me whatever you think I need – I don’t care.’
But that is a problem too. Sometimes people lose
control of their lives and give up – they become
‘helpless’. They want you to make all the decisions
– have all the power. I still try to encourage them to
make choices.
Interviewer: There is so much to think about when
you are working with people. How do you manage?
Karen: You have to have the right attitude – it’s a
sort of feeling. If you’ve got the right attitude you
tend to say and do the right things anyway. I enjoy
meeting people and getting to know them.
I value everyone I work with; I think of them as
important. I am interested in their lives and I listen
to what they tell me. I think values – what you
believe in – are at the heart of how you work with
Interviewer: So do you really need theories like
reflective listening and the communication cycle to
be a good carer?
Karen: These ideas can help you to be more
sensitive and to understand what might be going
on. But care work is really about values, attitudes
and feelings. Technical knowledge on its own,
without the right values, isn't enough if you want
to enjoy caring for others and if they are going to
enjoy working with you.
1 Why should care workers not aim to control the
lives of the people they work with?
2 Why does Karen try to encourage people to make
choices, even if they appear not to want to?
3 Can you explain what is meant by power in the
context of interpersonal behaviour?
4 Can you identify what values Karen uses when she
talks to people who use care services?
5 What does Karen mean when she says ‘If you’ve
got the right attitude then you tend to say and do
the right things anyway’?
6 Explain why Karen thinks technical knowledge,
without the right values, isn’t enough?
Assessment activity 1.3
Again, use the examples used in
the previous assessment activities
to explain the factors that influence
communication and interpersonal
Grading tip
P3 Integrate the evidence for this task with that for assessment
Activities 1.1 and 1.2.
Consider both positive and negative influences.
Consider one-to-one and group interactions, different forms of
communication and different types of interpersonal interaction.
Unit 1 Developing effective communication in health and social care
3 Understand ways to overcome barriers in a
health and social care environment
3.1 Communication and
interpersonal interaction
national standards, codes of practice and legislation.
People who use services may be seen as having the
following rights.
Staff training
Many skills, such as communicating effectively with
anxious, depressed or aggressive people, cannot be
developed simply by obtaining information. Instead,
people often develop their skills by reflecting on their
own practice experience and discussing thoughts and
experiences with colleagues. Formal training courses
usually provide opportunities to practise important
skills as well as theories about how to overcome
communication barriers.
Assessment of need and using preferred
methods of communication
It is important to build an understanding of the needs
of people you work with in health and social care.
Very often, people will make their preferred method
of communication obvious. Sometimes a professional
social work or medical assessment may be needed in
order to clarify the person’s needs and their preferred
method of communication.
Promoting rights
As well as general human rights, people who use
services have a range of rights that are established in
Confidentiality is an important right for all people who
use services because:
• People may feel confident about sharing
information if they know that their care worker won’t
pass things on. They may not trust a carer if the
carer does not keep information to themselves.
• Keeping information confidential demonstrates
respect for people who use services. A lack of
confidentiality may threaten people’s self-esteem.
• A professional service, which maintains respect
for individuals, must keep private information
confidential – in the same way that medical
practitioners and lawyers have always maintained
• There are legal requirements (data protection) to
keep personal records confidential.
• A person’s safety may be put at risk if details of
their property and habits are shared publicly. For
example, if your home was empty and other people
knew where you kept your money, someone might
be tempted to break in.
To be treated as an
To be treated
in a dignified way
To be protected
from danger or harm
To be respected
A service
user’s rights
To be cared for in a
way that meets their
needs and takes
account of choices
To be given privacy
To be allowed access
to information about
To be treated equally
and not discriminated
To be able to
communicate using their
preferred method
Fig 1.16: What are the rights of people who use services?
BTEC’s own resources
To be assertive, a person usually has to:
Fear and aggression are two basic emotions that we
all experience. When we feel stressed, it is easy to
give in to our basic emotions and be either submissive
or aggressive. Assertion is an advanced skill, which
involves controlling the basic emotions that usually
prompt you to run away or fight. It involves a mental
attitude whereby you try to negotiate, and try to solve
problems rather than give in to emotional impulses.
• understand the situation they are in (including facts,
details and other people’s perceptions)
During an argument, an aggressive person might
insist that they are right and other people are wrong.
They will want to win, while others lose. The opposite
of aggression is submission. A submissive person
accepts that they will lose, get told off, or be put down
emotionally. Assertive behaviour is different from both
these responses. In an argument, an assertive person
will try to find an answer that means no one has to lose
or be ‘put down’. Assertion is a skill that helps create
‘win-win’ situations.
Key term
Assertion – Assertion is different from both submission and
aggression. It involves being able to negotiate a solution to a
• be able to control personal emotions and stay calm
• be able to act assertively, using the right non-verbal
• be able to communicate assertively, using the right
words and statements.
Some of the emotions, attitudes and behaviours
involved in assertion are summarised in Table 1.3 on
page 31.
Staying calm and in control of your emotions,
displaying respect for others, using reflective listening
and building an understanding of another person’s
viewpoint are all part of being assertive. Assertion
is the skill of being able to understand another
person’s viewpoint, while being able to help them to
understand your viewpoint. Assertion skills create a
situation where negotiation is possible.
Assertion does involve a special kind of attitude. You
are going to stick up for yourself – but you are not
trying to dominate or get power over other people.
You are trying to reach the best outcome for everyone.
It is very easy to be aggressive – it is in our ‘animal
nature’ to attack people who cause us problems.
Case study: Justin and Tyler
The manager of a care centre has asked that either
Justin or Tyler should stay for an extra half-hour at
the end of their shift to complete some paper work.
Neither Justin nor Tyler want to do this work, so Justin
could argue, using:
Aggression: Don’t think I’m going to do it. I need to
get away early and you’re not going to stand in my
way. I don’t care what you say – either you do it or
nobody does.
2 Justin will not necessarily win using aggression.
Both people could become trapped in a cycle of
aggressive responses. If one person does force
the other to give in, will they be able to trust each
other later?
Assertion: Look – neither of us wants to stay late,
but one of us has to stay. Let’s work out a fair way
to decide which of us stays.
3 Assertion is the most skilful response. Can you
identify the skills that Justin would need in order
to make this approach work?
Submission: I didn’t really want to stay late, but if
you don’t want to stay, then I suppose I’ll have to.
1 With a submissive response, Tyler will get
what he wants and Justin will lose. But what are
the likely consequences for their ability to work
together in the future?
Unit 1 Developing effective communication in health and social care
Table 1.3: Differences between aggressive, assertive and submissive behaviours
Aggressive behaviour
Assertive behaviour
Submissive behaviour
Main emotions
Control of own behaviour
Fear – wanting to please
Trying to win
Wanting your own way
Making demands
Trying to create a situation in
which everyone wins
Negotiating with others
Trying to solve problems
Accepting that you will lose
Letting others dominate
Agreeing with others
Not listening to other people
Putting other people down
Shouting or talking very
Listening to other points of
Showing respect for others
Keeping a clear, calm voice
Not putting your own views
Withdrawing or showing fear
Speaking quietly or not
speaking at all
Body language
Fixed eye contact, tense
muscles, waving of hands and
arms, looking angry
Varied eye contact, relaxed
face muscles, looking ‘in
control’, keeping hands and
arms at your side
Looking down, not looking
at others, looking frightened,
tense muscles
Case study: Karen
Interviewer: You must have
to deal with some rude and
aggressive people?
Karen: Yes, the first thing I
do is to think to myself ‘stay
calm – don’t feel threatened’.
Very often people are rude
or aggressive because
they feel threatened. They
are upset that you are in
their home – they want to control you, to make
themselves feel safe. For many people the only way
they know to defend themselves is to get angry.
Thinking this way helps me to stay calm.
Interviewer: That’s a wonderful attitude – but don’t
people take advantage of you if you think like that?
people to talk to you. You have to show that
you’re not going to try and dominate or threaten
them. But you can’t let yourself be pushed around
either. When people cross the line, I will talk firmly
about how they make me feel, and what the
consequences might be for them. Services can be
withdrawn from really offensive people. Usually
I think you get respect if you can put yourself in
other people’s shoes, but if you also stick up for
1 Do you think Karen has good assertiveness skills?
2 If Karen did behave aggressively towards people
who use services, what would be the risks for her
and the people she works with?
3 Why does Karen believe it is important to ‘put
herself in other people’s shoes’?
Karen: No, you have to have the right attitude,
you have to be patient, stay calm and try to get
BTEC’s own resources
Defusing aggression and staying confident
People do not always plan or choose to be aggressive.
In health and social care contexts, a great deal
of aggression is caused by stress, often because
people feel powerless and out of control. Aggression
sometimes results from frustration; aggression can be a
last-ditch emotional response when a person feels that
he or she is losing control.
Have you ever seen a person shouting or
swearing at a computer, or hitting the keyboard
because the machine was not doing what they
wanted? Do they really think the computer will be
People can become frustrated when they cannot
control events, and aggressive behaviour is a
natural emotional response.
Activity 7: Discussing
sources of stress
Get together with a small group of colleagues and
make a list of some of the stresses that people
who receive care services might experience. Think
about situations in which people may feel that they
are out of control. Think about ways in which illness
or pain might create stress. Think about barriers to
understanding and how these might create stress.
When people become aggressive, care workers are
likely to feel threatened. We all have a natural, animal
response to run away or fight when we feel threatened.
An unskilled response is to fight aggression with
your own aggression – to ‘get your own back’ on
someone who is threatening you. Within health and
social care, this is wrong because it can increase the
level of aggression or violence in someone who is
stressed. A care worker could be injured in a violent
outburst. Alternatively, your aggression could punish a
person so that he or she gives up and withdraws from
contact with you or your services. Being aggressive
towards a person who is vulnerable will increase his
or her problems and could result in helplessness and
Key term
Helplessness – People can give up and become helpless
when they learn that they cannot control or influence
important personal events. Helpless people can become
withdrawn and depressed.
Table 1.4: Skills for defusing aggression
1 Stay calm
Show that you are not going to
become aggressive. Avoid a tense
body posture, a tense face or
clenched fists. Avoid fixed, staring
eye contact. Breathe normally.
2 Communicate
Use your listening skills to show
that you are taking the other
person seriously. Use non-verbal
skills to communicate respect.
3 Create trust
Try to meet the other person’s
self-esteem needs. Try to make
the other person feel valued and
important, without agreeing to
everything they say.
4 Try to solve
You can only discuss issues or
problems in detail after the other
person responds to your listening
and calming behaviour. You will
note that the other person’s
non-verbal behaviour shows less
Work out ways in which care workers could prevent
the stresses from resulting in aggression.
Independent enquirer: This activity will help you
demonstrate that you can identify questions to answer,
and consider the influence of circumstances on events.
When people feel stressed, emotions and tension
often build up. Just one little misunderstanding can
be enough to cause this tension to explode into an
aggressive outburst. When a person becomes angry
they may decide that it is someone else’s fault that
they have been made to be aggressive. Sometimes a
person will have multiple aggressive outbursts as they
struggle with their emotions.
Unit 1 Developing effective communication in health and social care
Care workers are likely to break professional codes
of conduct if they allow themselves to become
aggressive. Instead it is vital that care workers learn the
skills needed to defuse aggression.
It is not easy to stay calm if someone is threatening
you. You will need to feel confident that you know
how to work with the other person. If you have
already established a sense of trust, it may be easier
to cope with their aggression than with aggressive
behaviour from a stranger. You will need to be sensitive
about possible misunderstandings and barriers to
understanding when you start to work with an angry
person. You must avoid any spark that could light the
fuse leading to an angry explosion.
All the skills of recognising and overcoming barriers
to communication will be useful in helping you to
avoid triggering aggression. Reflective listening skills
are vital in order to make the other person feel
Building relationships and appropriate
verbal and non-verbal communication
Building relationships with people who use care services
involves skilled listening, together with appropriate
verbal and non-verbal communication. It may be
important to use warm, friendly non-verbal behaviour
that expresses interest in another person such as:
• making effective eye contact (varied and
appropriate contact with another person’s eyes)
• adopting a relaxed and calm body posture
• smiling – looking friendly rather than ‘cold’ or frozen
in expression
• using hand movements and gestures that show
• nodding your head slightly while talking to
communicate messages such as ‘I see,’ or ‘I
understand,’ or ‘I agree’
• using an appropriate gentle tone of voice.
Case study: Bill and Tony
Bill is a resident in a care home, who has been
diagnosed with dementia. Tony is a care worker who
knows Bill well. Bill will sit for long periods of time and
then become agitated. While sitting in his chair he has
started to shout angrily at other residents.
Bill (very angry): You lot can get out of here, I don’t
want you round here anymore.
Tony (calm and gentle tone of voice): Hello Bill, I
am going to bring some coffee around in a minute.
Would you like a cup?
Bill (raising his fist): You can get out of here too. Go
on, get off or I’ll have you!
Tony (stepping back and lowering his head in a nonthreatening way): Bill, you remember me. You told
me about your time in the Merchant Navy back in
the fifties.
Bill (still angry): Don’t remember you – you weren’t
Tony (calm, gentle, serious): No – but you told me all
about your time on the Sea Princess. How you went
to South America, how you met your first wife.
Bill (less angry but accusing tone): How do you know
all that about me? Have you been spying on me?
Tony (serious, sincere but calm): No Bill, honest,
I would never spy on you. We had a long talk
yesterday and I really enjoyed hearing about all the
things you used to get up to. I was really interested
– you’ve lived an exciting life. I was wondering
whether you might have time to tell me a few more
Bill (calmer tone of voice): Well, what about all these
people in here?
Tony (expressing genuine interest): We could leave
them for the moment – tell me more about your
time in South America.
Bill (calm): Not sure I can remember, what were we
talking about?
1 What might have happened if Tony had
confronted Bill and told him to stop shouting at
the other residents?
2 Can you explain how Tony showed respect and
created trust?
3 Why did Tony avoid talking about the other
4 How did Tony use his personal knowledge of Bill
to help defuse aggression?
BTEC’s own resources
Appropriate environment
The following ideas can help to reduce communication
barriers in the environment:
• Improve the lighting.
Table 1.5: Aspects of communication that increase self-esteem
Appropriate nonverbal behaviour
• Using correct level of
• Using language appropriate
to speech community
• Using appropriate preferred
• Using technological aids
Listening skills
• Using reflective listening
• Having an appropriate
attitude and valuing other
• Being willing to build an
understanding of another
person’s views
• Reduce any noise.
• Move to a quieter or better-lit room.
• Work with smaller groups to see and hear more
• Organise any seating so that people can see and
hear each other.
Meeting self-esteem needs and
maintaining an appropriate attitude
People who use services are often vulnerable. Many
vulnerable people do not have the emotional security
that comes from a high level of self-esteem. If a
person feels dominated or threatened he or she may
develop low self-esteem. If children don’t feel valued,
they may not develop self-esteem. Adults who do not
feel valued may have difficulty in maintaining a high
level of self-esteem.
Your communication with people in care settings
should involve understanding and responding to their
emotional needs.
Relaxed body posture
Looking interested
Being calm
Key term
Self-esteem – This is how you value or feel about yourself.
Case study: Karen
Interviewer: You talk about
having the right attitude and
‘putting yourself in other
people’s shoes’ but doesn’t
that often make you feel sad
and depressed?
Karen: No, you can
understand how someone
might feel without becoming
overwhelmed. I always try to
leave feeling happy or at least a little bit happier
than when I arrived.
So how do you do that?
Karen: Well, keep people talking – most people
have some happy memories. I try to get them to
talk about some of the good things. I try to get a
positive feeling going. Sometimes, if it feels right,
I mention happy things in my life or else talk about
about some of the good things in the news –
soaps and things like that! I try to create a happy
atmosphere because that can sometimes make a
person feel included and valued and increase their
Interviewer: So just talking through positive things
in your life might make life seem more worthwhile –
you value yourself more.
Karen: Yes, thinking over the good things is often a
way to increase self-esteem.
1 What is self-esteem?
2 Why would talking about positive past life
experiences help some people to increase their
3 How is Karen likely to know if she has been
successful in making an individual feel happier
after working with them?
Unit 1 Developing effective communication in health and social care
Whether you work with children, older people or
people with health needs, or physical or learning
disabilities, it is always possible to think of ways to help
increase another person’s self-esteem.
3.2 Aids to communication
Human aids
There are several services that may assist people
to communicate or help to remove the barriers to
effective communication.
Case study: Karen
Interviewer: You
talked about creating
‘positive feelings’ – is
there any more to this,
other than just talking
about positive past
Karen: Well, sometimes
it’s little things that make
people feel good. First,
you have to make the
right relationship. I think it’s important to be
cheerful. I always think this is ‘their time’. I have
to be cheerful for them – and very often when
I come out from a visit being cheerful with that
person has made me feel better too. Then I
always try to remember the little details from a
previous visit. I think people often feel valued
if you remember things about them. It always
helps to give people a choice about how they
want work done, what products they want and so
on. I think people need to feel in control of their
lives in order to maintain a sense of self-esteem.
Then I think it’s important to listen to people. If
people listen to you then you matter, don’t you?
If people cut you short – well, then, perhaps
you’re not worth much.
1 What verbal and non-verbal behaviours might
help to create a cheerful atmosphere?
2 Why does choice have anything to do with selfesteem?
3 Why is listening to people linked to selfesteem?
Sometimes, when people have a very serious learning
disability or illness (such as dementia) it is not possible
to communicate with them. In such situations, care
services will often employ an advocate. An advocate
is someone who speaks for someone else. A lawyer
speaking for a ‘client’ in a courtroom is working as an
advocate for that person. In care work, a volunteer
might try to get to know someone who has dementia
or a learning disability. The volunteer tries to
understand and then communicate the person’s needs
and wants. Advocates should be independent of the
staff team and therefore able to argue for people’s
rights without being influenced by what is the easiest
or cheapest thing to do.
Key term
Advocate – Someone who speaks for someone else.
Advocacy is not straightforward; volunteers may not
always understand the feelings and needs of the
people for whom they are advocating. Some people
argue that it would be better if people who use
services could be trained and supported to argue their
own case. Helping people to argue their own case is
called self-advocacy.
Interpreters, translators and signers
Interpreters are people who communicate meaning
from one language to another. This includes
interpreting between spoken and signed languages
such as English and British Sign Language. When an
interpreter works with people, they become part of a
communication cycle with that person.
Translators are people who change recorded material
from one language to another. Translating and
interpreting involve communicating meaning between
different languages. Translating and interpreting are
not just technical acts of changing the words from
one system to another. Many languages do not have
simple equivalence between words. Interpreters and
BTEC’s own resources
translators have to grasp the meaning of a message
(decode the message) and find a way of expressing it
in a different language system. This is rarely easy, even
for professional translators.
Activity 8: Exploring ICT
Use an automatic language translation system to
translate a website that is written in a language
other than English. You may find examples
of confusing or even funny mistakes that the
system makes. Compare your results with your
colleagues’ research and discuss the problems
that can arise when words are simply changed to
another language without any input from a human
Functional skills
ICT: This activity may help you demonstrate ICT skills
associated with presenting information and English:
skills associated with reading and understanding text.
Interpreters may be professional people who are
employed by social services or health authorities in
order to communicate with people who use different
spoken or signed languages. They may also be friends
or family members who have sufficient language
ability to be able to explain messages in different
When people do not use English as their first
language, they may experience difficulty accessing
health or care services, unless they are supported by
translators and interpreters. People who use signed
languages may also need assistance from interpreters
and translators – see page 14 for further details of
signed languages.
Mentors are usually people who are highly
experienced in a particular job or activity; they advise
others who are new to the activity or less experienced.
Mentors need effective communication skills, coupled
with some ability to explain issues and provide
guidance. If a person is referred to as a mentor, it
might be assumed that they will provide guidance
based on their experience and knowledge of an issue.
Table 1.6: Important issues in interpretation
Knowledge of the
subject matter
A professional interpreter may be able to explain details of legislation or procedures
for claiming benefit because they understand the issues. If a relative or friend is acting
as an interpreter, they will have to make sense of the technical details before they can
communicate clearly.
People must have confidence in their interpreter. Some people may find it hard to trust
a member from a different community. Many women may not feel safe and confident
discussing personal issues using a male interpreter. The issue may not be about the
interpreter’s language competence, but about the interpreter’s ability to understand and
correctly convey what a person wants to say.
Social and cultural
The choice of an interpreter must support the self-esteem needs of people who need to
access interpretation services. Many people may feel that it is inappropriate to discuss
personal details using an interpreter of the opposite sex. Some Deaf people do not feel
confident using interpreters who have not experienced deafness themselves.
Confidentiality is a right. Professional interpreters are likely to offer guarantees of
confidentiality. Using a relative or volunteer may not necessarily provide people with the
same guarantee of confidentiality.
Appropriate attitude
A professional interpreter is likely to offer advanced interpersonal skills, which include
the ability not to judge what is being said. Volunteers, relatives and friends may have
language competence, but these people may not be able to interpret without involving
their own values, attitudes and beliefs.
Unit 1 Developing effective communication in health and social care
Case study: Jasu
operator hears the reply and types what is said so that
the Deaf person can read the typed message.
Jasu is 10 years old. Her father does not
speak English although Jasu has grown up to
be multilingual. Jasu’s father is in poor health and
needs to explain his problems to a health worker.
Loop systems
If Jasu had to interpret her father’s problems in
1 How might she be affected emotionally while
explaining her father’s illness to someone she
does not know?
2 Would Jasu be likely to find the right
terminology to explain complex health issues
to a professional?
3 Why might the services of a professional
interpreter be more appropriate in this
A loop system enables people who use hearing aids
to hear sounds more clearly. A cable surrounds a given
area such as a public area, room or even a car. Sound
from a TV, microphone or music system can then
be amplified into the loop. People with appropriate
hearing aids can switch their aid to a special setting,
enabling them to hear the amplified signal from the
Voice-activated software
Voice-activated software enables a person to use
speech commands to get their computer to perform a
What qualities do you think a befriender
should have?
Befrienders seek to create a supportive relationship
with others. A befriender will have good
communication skills that enable them to listen to, and
build an understanding of, another person’s views and
feelings. A befriender will work ‘as if’ he or she was a
friend. Befrienders will not be assumed to have any
particular professional knowledge.
Technological aids
Hearing aids
Hearing aids are battery-powered electronic devices
with small microphones to pick up and increase the
volume of sound received by a person. Hearing aids
will often amplify background sounds as well as the
voice or other signal that the person wants to hear.
For this reason, a hearing aid will not always work
effectively in a noisy environment.
Text phones, relay systems and minicoms
Text phones and minicoms have a small screen and a
keyboard to enable messages to be typed. The reply
can then be seen on the screen. The Royal National
Institute for Deaf People (RNID) operates a text relay
service, whereby an operator can enable conversations
between speech phones used by hearing people and
text phones used by people who may be Deaf or hard
of hearing. A person can text their message to the
operator, who will read it to the hearing person. The
BTEC’s own resources
variety of tasks. Some people use speech recognition
software to type messages without using a computer
keyboard and this facility is particularly useful for
people with dyslexia, who may find it harder to
communicate using typing or writing.
Independent enquirer: This discussion and thinking
activity may help you demonstrate that you can
support conclusions, using reasoned arguments and
Activity 9: Discussing
barriers to communication
Think of particular examples of barriers to
communication (perhaps taken from the
table opposite) and discuss the strengths and
weaknesses of different strategies to overcome
them. Your discussion activities may help you to
work out some reasoned arguments for using
particular strategies within your work
Case study: Gloria
Gloria grew up in the Caribbean and came to the UK
60 years ago. She now lives in a residential care home
because she has developed some memory loss and
disorientation associated with Alzheimer’s disease.
Gloria also has some hearing loss and uses a hearing
aid. Gloria’s first language is English but care workers
sometimes have difficulty understanding her speech.
and that trying to communicate with her is a
waste of time. Gloria sometimes becomes distressed
because she is lonely and there is no one to talk to.
Sometimes Gloria will talk about places and events
from the past that care staff have difficulty identifying
with. Some care staff think that Gloria is ‘confused’
3 How could you use communication skills in order
to increase Gloria’s self-esteem?
1 Can you list the barriers to communication that
Gloria is experiencing?
2 Can you list ideas for overcoming these barriers?
Table 1.7: Ideas for reducing barriers to communication where people have a disability
• Don’t shout. Use normal clear speech and make sure your face is visible for people who can
• Show pictures or write messages.
• Learn to sign (for people who use signed languages).
• Ask for help from, or employ, a communicator or interpreter for signed languages.
• Check that hearing aids and equipment are working.
Physical and
Use language to describe things.
Assist people to touch things (e.g. they might want to touch your face to recognise you).
Explain details that sighted people might take for granted.
Check what people can see (many registered blind people can see shapes, or tell light from
• Check glasses, other aids and equipment.
Increase your knowledge of disabilities.
Use pictures and signs as well as clear, simple speech.
Be calm and patient.
Set up group meetings where people can share interests.
Check that people do not become isolated.
Use advocates – independent people who can spend time building an understanding of the
needs of specific individuals to assist with communication work.
Unit 1 Developing effective communication in health and social care
Table 1.8: Strategies for overcoming communication barriers
Type of barrier
Possible strategies
Communication that involves
difficult, complex or sensitive
Use listening skills/skilled use of the communication cycle. Develop a ‘caring
presence’. Professional workers may develop empathy.
Unmet language needs or
Assessment of needs. Staff training to enable assessment of need. Use of
preferred language. Training to learn to communicate using different languages
or systems.
Sensory impairment
Use human or technological aids to compensate for impairment.
See Table 1.7 on page 38 for strategies.
Communication involving
personality or self-esteem
needs, or anxiety or depression
Use listening skills/skilled use of the communication cycle. Try to make the other
person feel valued. Develop a ‘caring presence’. Use open questions, keep the
conversation going. Avoid focusing on/discussing emotionally negative issues.
Stay calm, show respect. Use skills associated with assertion and defusing
aggression (see pages 30–33).
Assumptions, values or beliefs
Use listening skills/skilled use of the communication cycle to detect barriers. Use
reflective learning skills to question own values, beliefs or assumptions. Staff
training to develop reflective learning skills.
Use listening skills/skilled use of the communication cycle to detect barriers. Use
appropriate language for other people.
Cultural variations
Use listening skills/skilled use of the communication cycle to detect barriers and
check your understanding. Learn about the cultural variations among people
you work with. Staff training to learn about cultural variations. Avoid making
assumptions about people who are different. Consider involving advocates who
will represent the best interests of others.
Abuse of power
Try to empower others. Reflect on and question own assumptions. Avoid
behaviours aimed at controlling or manipulating other people.
Alcohol or drugs
Stay calm, show respect. Use appropriate non-verbal behaviour, avoid making
demands. Assess risk of assault.
BTEC’s own resources
Assessment activity 1.4
Using examples from class activities, your placement
or visits to health and social care environments,
explain how barriers to effective communication and
interpersonal interaction may be overcome in health
and social care. For M2, review these strategies against
best practice in communication and interpersonal
interactions, particularly in relation to overcoming
barriers. For the D1 evaluation, you will need to include
judgements about the effectiveness of different
strategies for overcoming barriers to communication
and support these with suitable explanations using
theories of communication and comparisons between
different health and social care environments.
Grading tips
P4 Use examples already explained and discussed
in the previous three assessment activities, plus
others as appropriate, to explain the strategies
Continue to use the notes in your logbook as a
source of examples to illustrate points you make.
P4 M2 D1
A strategy is a plan of how things are
intended to be done but actual practice may not
be the same. Comparison of what is intended
and what actually happens could be helpful.
M2 Consider strengths and weaknesses of observed
interactions and communication practice and
compare these with theories.
In preparation for the assessment, take part in
role-plays designed to simulate possible barriers
to communication and discuss in class the
effectiveness of how they were overcome.
D1 An evaluation requires both a judgement to be
made eg whether something is or is not effective
in overcoming barriers and a justification or
explanation of how this judgement has been
Your evaluations should include references to
relevant published sources in addition to your
log book evidence or understanding gained
from this book.
4 Be able to communicate and interact effectively
in a health or care environment
4.1 Contexts
You will practise interactions and discuss their
effectiveness before you present evidence of your own
practical work. To begin with, you might watch videos
or film clips of interpersonal interactions. You should
practise identifying and describing different behaviours
that you have seen and/or heard in recorded material.
As you become more confident, you can role-play or
simulate communicating in various contexts including:
formal; one-to-one; group; with people using services;
with professionals/colleagues.
This section of the unit is about your own skills in
communicating in interpersonal interactions. It is your
opportunity to demonstrate your ability to apply what
you have learned from the unit.
4.2 Communication skills and
To begin with, you might demonstrate your
communication skills using role-play or simulation.
In role-play you have to behave in such a way that
other people can – at least temporarily – believe in
the character you are portraying. Simulation does not
require you to use acting skills or portray a character.
If you simulate a conversation, you simply say (or sign)
the appropriate responses. You do not expect people
observing your behaviour to perceive you as anyone
but yourself. Both simulation and role-play involve
thinking through appropriate responses but role-play
involves a greater level of acting skill.
To demonstrate your communication skills, you will
need to cover verbal and non-verbal skills such as
listening and responding, tone, pace, language,
appropriate environment, proximity, clarifying or
repeating, questioning, responding to difficult
situations and defusing anger.
Unit 1 Developing effective communication in health and social care
Table 1.9: Checklist for analysing communication and interpersonal interaction
One-to-one interaction
• How did you start and finish your interaction? Did you try to meet the person’s
emotional needs?
• Could you identify a communication cycle involving feedback on your understanding
of the other person’s ideas?
Group interaction
• Were you able to take effective turns in speaking?
• Could you identify group values and/or purposes within the group?
• Was there a group leader? How was the interaction managed?
• Who was involved in the interaction? People who use services? Professionals?
Colleagues? What role did you play?
Verbal listening and
responding skills
• How effective was your use of language, pace of speech and level of formality? Was
there any use of specialist language? How far did you encourage others to talk?
Non-verbal listening
and responding skills
• How appropriate was your voice tone, posture, facial expression, eye contact and
Reflective listening
• How did you use reflective listening and the communication cycle? Can you identify
examples of clarifying your understanding or repeating important ideas?
Questioning skills
• Did you keep the conversation going using open questions? Can you identify probes
and prompts that you used?
• Did the environment create any barriers? Could everybody see and hear each other
• What barriers did you detect? Were there any barriers to interpreting communication,
such as language differences?
• Were there any barriers to understanding, such as cultural differences, assumptions
values or beliefs?
Difficult situations
• Did you act in a calm and respectful way? What skills did you use to interact with
people with strong emotions?
Defusing anger
• Were you able to act in an appropriate, calm and respectful way? Were you able to
avoid triggering aggression? Were you able to use assertive skills appropriately?
BTEC’s own resources
4.3 Effectiveness
interpersonal skills, attitudes, overcoming barriers,
adjusting interactions, and your own assertiveness.
You should demonstrate effective communication in
both group and one-to-one situations including an
awareness of the needs and preferences of others,
The checklist in the table below may be useful as a
starting point for assessing role-plays and recordings
of real interactions.
Assessment activity 1.5
For P5 take part in a one-to-one interaction. For
P6 take part in an interaction with a small group of
individuals in a health and social care environment. At
least one of the interactions should be with individuals
using services although one could involve a specific
interaction with a professional in the environment
relating to an important aspect of care.
For both interactions produce evidence to
demonstrate your role in each interaction. This should
include a witness testimony from a professional in the
environment who has been present whilst you have
carried out the interactions. You should also provide
your own account of each interaction.
For M3 you will need to include a detailed description
of the skills you used in the interactions and how
these related to the context of each interaction and
the responses made by the individuals involved. For
both interactions, you should explain how and why
you applied theory, took account of influences on the
interactions and minimised or overcame any barriers.
For D2 the account of the interactions should also
include an evaluation of each and of the skills you
Grading tips
P5 P6 Gain written consent to carry out the
interactions from a suitable professional in the
health and social care environment and include
this in your assignment.
Both interactions need to be specific planned
activities for the purpose of the assessment
and you should obtain confirmation from your
tutor that the plans are appropriate before
carrying out the interactions. It is not possible
to achieve these criteria from casual, ongoing
day-to-day interactions in a placement. If you
P5 P6
P2 M2
M3 D2
are not in placement, you may need to visit the
environment in advance to better understand
the context and likely influences so you can
take these into account when preparing for the
interactions. The interaction may be focused on
a specific activity eg a creative activity or other
care task and your preparation would include
appropriate planning for this activity as well as
the communication skills you will use.
Your contributions to the interactions do not
necessarily need to be transcribed but your
evidence should consider the skills you used,
influences and context of the interactions
and you should demonstrate respect for the
rights and confidentiality of the individuals
involved in all records/notes you do make of the
interactions and in your assignment evidence.
M3 To achieve a merit grade, you must reflect on
your own communication and interpersonal
skills and provide an analysis, preferably
including your strengths and weaknesses within
each interaction. This reflection should cover
both one-to-one and group interactions. You
could discuss the notes you have made on your
one-to-one and group observations with your
supervisor or tutor to help you develop the
ability to analyse your own interpersonal skills.
D2 At this level, you need to go further and
evaluate the quality of your communication
and interpersonal skills in one-to-one and
group interactions. Your evaluation will involve
a more in-depth discussion of the factors that
have influenced the effectiveness of your own
interaction. Emphasise your good points and
also those skills which you find difficult and
need to practise more often.
Self-manager: This activity will enable you to demonstrate
your ability to organise your own time and resources.
Reflective learner: This task will enable you to demonstrate
the ability to assess yourself and review progress.
You may evaluate your experience and learning and
communicate what you have learned in different ways.
Unit 1 Developing effective communication in health and social care
Resources and
further reading
Argyle, M. (1972) The Psychology of Interpersonal
Behaviour, second ed. Harmondsworth: Pelican
Burnard, P. (1996) Acquiring Interpersonal Skills,
second ed. London: Chapman & Hall
Burnard, P., Morrison, P. (1997) Caring and
Communicating Basingstoke and London:
Macmillan Press Ltd
Useful websites
British Sign Language
Signs and finger spelling alphabet
and at
Engebretson, J. (2003) ‘Caring presence: a case
study’ in Communication, Relationships and Care
Robb, M., Barrett, S., Komaromy, C., Rogers, A. (eds)
London & New York: OU & Routledge
Pinker, S. (1994) The Language Instinct
Harmondsworth: Penguin
Tuckman, B. (1965) ‘Development Sequence in
Small Groups’, Psychological Bulletin, Vol. 63, No. 6
BTEC’s own resources
Just checking
Why is tone of voice categorised as a non-verbal rather than a verbal issue?
Is it true that effective, caring, communication can be defined as ‘clear, concise transmission of
information between people’?
What is reflective listening and why is it important?
Rachel says, ‘I never let anyone else win an argument with me – I always get my own way!’ Is it
correct to describe Rachel’s attitude as being assertive?
If you met a person who said, ‘I can’t hear you, I need to put my glasses on’ what sense could you
make of this communication?
Is it possible for a person who has no knowledge of the English language to be able to sign using
British Sign Language?
What problems might arise if a relative (with the necessary language skills) acts in place of a
professional translator?
Assignment tips
1 Before you start to make logbook records you might like to state how you will record details of
conversations and other interactions. You could include a statement about how you will respect
confidentiality, respect the rights of others, and show respect for other people. You must also be
sure that if you take notes about people who use services your note-taking will not create any
misunderstandings or cause any stress to these people.
2 Use video recording of role-plays or simulations to help you identify how theories of communication
work before attempting to analyse workplace interactions.
3 A range of potential barriers and misunderstandings can influence communication in care settings. Very
often there will be a number of issues that are relevant to any particular observation you have noted.
4 Use role-play and simulation followed by discussion to help you develop skills for reviewing and
evaluating strategies to overcome barriers.
5 It may be a good idea to record a practice one-to-one and group interaction and discuss your
performance with colleagues, supervisors and/or tutors before undertaking the observation that you use
for your assignment. If you practise taking notes and discussing the quality of your interaction you may
pick up some good ideas that you can incorporate in your final assignment.
6 When you make notes about a one-to-one or group interaction you should make your notes
immediately after the conversation or meeting. These notes will help you describe your interactions at
a later date. You will not be able to remember everything that you said or did, or that other people did.
You should aim to recall some of the key things you said and to remember the responses others made.
You should also make notes about some of the non-verbal behaviours you saw in others as well as your
own non-verbal behaviour.

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