Communicating with clients

It is important to remember that there is no substitute for face-to-face interaction, particularly on important issues, but only if this is undertaken with thought, using appropriate strategies following a full assessment of the client’s ability to communicate.

Appropriate and effective communication helps to establish a therapeutic helping relationship, enables us to determine a client’s care needs, promotes trust and confidence, and facilitates good multidisciplinary team working. Good practice is outlined below.

Procedure	Procedure
Prepare the environment, creating a climate of warmth and acceptance	To facilitate communication
Sit squarely in relation to the client, adopt an Open posture, Lean in towards the client slightly, maintain comfortable Eye contact and Relax	The acronym SOLER, outlining 5 steps to good communication was first coined in the 1980s by Gerard Egan (2002) to help us to remember how using body position can improve our communication and help us to listen more effectively
Ensure that the client is comfortable, relaxed and if possible pain free and, if desirable and appropriate, arrange for a relative or significant other to be present	To promote client participation. To prevent misunderstandings and reduce the potential for collusion
If the content is likely to be of a confidential nature or has the potential to cause embarrassment find a private location acceptable to the client	To maintain confidentiality and self-esteem
Minimize the potential for interruptions	So that you can concentrate fully on the interaction
Review client information already available	To demonstrate good multidisciplinary team working
If possible, prepare what you want to say thoroughly beforehand	To keep the interaction focused
Determine how you are going to get your message across and how the client is going to communicate with you	Not all clients can hear or speak; it is therefore crucial that you establish effective means of communication. This may mean providing writing materials, arranging an interpreter or person to sign, or obtaining picture books, etc.
Make sure you allocate an adequate amount of time	To prevent you giving off a sense of urgency or rushing the client
Be prepared to adjust the time allowed if necessary	If the client is finding the interaction cathartic, they may open up about other issues. Whilst it may be appropriate to arrange a further meeting to discuss these or to refer the client to another party, sometimes the moment can be lost forever if the issue is not addressed at the time
Introduce yourself and address the client by their preferred name	Common courtesy
Explain the purpose of the interaction and encourage the client to participate freely	Provides clarification and promotes equality
Check whether the client would like anyone else present	To provide support. NB If a non-consenting child, that is, one who is considered in law to be unable to legally give consent to care or treatment, it may be essential that a parent or guardian is present
Or conversely if anyone is present, does the client wish them to stay or leave?	To maintain privacy and confidentiality
Use questioning appropriately; ask one question at a time; give the client time to answer; use both open and closed questions; avoid questions such as ‘Why?’	To avoid barriers to communication and to increase the likelihood that you elicit an appropriate response
Engage in active listening, displaying empathy and/or sympathy appropriately, and allow silence	To engender a sense of value, to demonstrate caring and to prevent misunderstanding
Keep your message simple – don’t hide behind long words or jargon. Be clear, concise and completely honest	Helps gain the trust and confidence of the individual and ensure understanding
Use the full range of techniques such as:	To enhance the effectiveness of the interaction and ensure understanding
Clarifying observations and statements	If with a child, make sure you are aware of their understanding of different words to avoid anxiety and distress. For example, a child’s understanding of ‘being put to sleep’ by the
Information giving Non-verbals, for example gestures, touch Paraphrasing Validating Summarizing	anaesthetist may be never waking up again, as recently happened to the pet dog. ‘Stink coming’ may mean they want to defecate. As you discover the child’s range of vocabulary it is useful to document this in the care records to inform other members of the multidisciplinary team and prevent repetition
Be consistent	If you frequently change your mind or your views appear to conflict, this will weaken your message
Keep focused on current concerns	To avoid inappropriate distractions and therefore failings to achieve the purpose
If you promise to do something, make sure you deliver	Otherwise your credibility will be damaged
Provide opportunities for the client to ask questions	To decrease the potential for any feelings of powerlessness
Summarize the discussion and gain feedback from the client	To confirm understanding of the key points and to give a sense of closure
Record the interaction in the client’s records and refer to a more senior member of staff or other agencies as appropriate	To promote multidisciplinary team working and continuity of care
If the communication has involved information giving, it is recommended that you also furnish the client with a copy of the information in written form following the interaction	To promote retention and sharing with significant others and to reduce potential misunderstanding and misconceptions