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02

UNDERSTANDING OURSELVES

AND OUR IMPACT ON OTHERS

KEY THEMES:

 Intrapersonal communication

 Self-awareness

 How external and internal factors affect the ‘self’ that we bring to our practice

 Values and beliefs

 Reflection and reflective practice.

In order to be effective communicators we need to know ourselves and be aware of how our communication impacts on others. In understanding ourselves we are more able to adapt our behaviour and change the effect that we have on others. The much-quoted Socrates said “My friend, care for your psyche, know thyself, for once we know ourselves, we may learn how to care for ourselves”; this chapter encourages you to spend some time thinking about and ‘caring’ about yourself so that you can become better at thinking about and caring for others.

INTRAPERSONAL COMMUNICATION

The way we communicate with others is known as interpersonal communication and we will look at that process in Chapter 3, but first we will look at this notion of intrapersonal communication. Intrapersonal communication is the communication that we have with ourselves, the self-talk that we engage in on an hour-by-hour basis. As we experience those inner thoughts we also experience feelings which in turn affect how we behave when communicating or making contact with someone else. We have all been in the situation where someone says something to us and it sparks a thought which stops us from listening to the other person because the voice inside our head seems to be talking more loudly.

All of our communication is influenced by how we feel at the time and how we perceive ourselves to be. Intrapersonal communication is a cognitive function in that it relates to our thoughts, but it also plays a significant part in our emotions and how we understand the world to be and our place in it. As humans we self-regulate our behaviour, and the way in which we self-regulate and respond to our innermost feelings and thoughts has an impact on how we present ourselves to the world. Whatever we see, hear, smell or feel as part of that communication is:

• evaluated by our brains based on past knowledge and experience

• reviewed by our senses

• and then evaluated again.

This inner process often continues even after the ‘physical communication’ has ended. An example of this is when we replay a conversation time and time again in our heads, imagining the different responses that we, and the other people involved, could have made. We often imagine not just what might have been said, but the looks that might have been exchanged, the gestures that we might make, even the emotions we or the other person might feel. The outcome in our head may be completely different from the outcome that was achieved. We have the potential to change the meaning of a comment or interaction completely because we have convinced ourselves of a meaning that makes sense to us and fits with our view of ourselves and others. As professionals we have a responsibility to recognise and understand our intrapersonal communication so that we can better reflect on our interpersonal communication. We do this by becoming more self-aware and knowing our strengths and limitations.

SELF-AWARENESS

To be self-aware is to be able to recognise our character traits, our feelings and thoughts and to have insight into how our behaviour is affected by them. Individuals are ultimately responsible for their own input, and developing the skills of self-awareness is the first step to the development of good communication and interpersonal skills. We need to know and understand our own self and to be able to view ourselves from other people’s perspectives. We need to be willing to recognise those parts of ourselves that are more or less helpful in our professional roles and be able to change those aspects which get in the way of good communication. There are two important aspects of self-awareness which will be focused on separately; these are awareness of external influences on our sense of self and awareness of internal influences on our sense of self.

DEVELOPING AWARENESS OF HOW EXTERNAL FACTORS IMPACT ON THE SELF

Often workers in health and social care settings will feel completely exhausted, physically and emotionally and often both. We need to be able to recognise times when we find it hard to communicate effectively because we are feeling physically or emotionally overloaded and unable to give the space and time to someone in our care because we are too full of our own concerns. Physical exhaustion is easier to identify – we usually know when we are tired and hungry, but sometimes it is only when our mood changes and we become less patient and more careless that we realise that our physical needs are being neglected. Unfortunately those around us will have been affected by our short temper or lack of concentration and the quality of our interactions with them will have suffered. It is important for us to be able to pick up on the signs of hunger and tiredness and make sure that we eat regularly and take rest when we can.

If we have behaved in an insensitive or careless way to those we are caring for or working with, we need to have the awareness to recognise it and take steps to repair the relationship. It is not difficult to approach someone and say “I’m sorry I was so short with you this afternoon, I was tired and hungry and I wasn’t focusing on your needs.” Sometimes a slight rupture in a relationship and the repairing of it can strengthen it; when we know that someone is real and genuine and able to recognise when they have made a mistake, we can feel more trusting of them than if they were perfect all the time.

When the exhaustion is emotional it can be more difficult to recognise. The very nature of the work in health and social care settings is emotionally draining. The people we are caring for need our help, understanding and compassion and sometimes, when we spend all day, every day giving this, we find we might become overwhelmed by the emotional and physical needs of others. We might find that we are unable to listen effectively or compassionately; we get irritated and annoyed easily; we find ourselves crying or shouting at inappropriate times. Health and social care professionals are often surrounded by a supportive and empathic team who are alert to each other’s needs, but in busy environments, unless we recognise we are struggling and ask for help directly, our needs sometimes go unnoticed.

In order to minimise the potential for poor communication because of emotional overload, we need to become better at noticing how we are feeling. If we are more aware of what is going on for us emotionally, we are more able to notice when our interactions with others are being affected. Here are some ways in which you can become more aware:

• Take time at the beginning of the day and whenever you have a break to sit and ‘check in’ with yourself. Breathe deeply and focus on which parts of your body feel tension. Take notice of it and if you know it relates to particular issues which can’t be resolved immediately, try to put it somewhere safe (in your mind) to be dealt with later. Very useful techniques for focusing ourselves come from ‘mindfulness’ and ‘mindful practice’. With its roots in Buddhist meditation, mindfulness has entered the mainstream in many diverse settings through the work of Jon Kabat-Zinn (2004). Mindfulness helps us to deal with emotional overload by becoming more aware of our thoughts and feelings so that instead of becoming overwhelmed by them, we’re better able to manage them.

• Talk to someone about your concerns. You should have a colleague, mentor or supervisor with whom you can discuss what you are feeling and the difficulties that you are facing. As we will see in Chapter 5, having someone listen to you and focus on you and your concerns can help even if there are no solutions.

• Keep a journal, particularly when you are training, in which you write about your day, the stresses and fun or interesting times. Reflect on how certain situations made you feel and think and reflect on why you might have responded the way you did and how you might respond differently next time. Reflective practice, focused on later in this chapter, is an excellent way to grow in self-awareness.

REFLECTION 2.1

Imagine this scenario. A worker in a residential care home is half way through her third night shift in a row. She is particularly exhausted because her 5-year old daughter has been home unwell so she hasn’t been able to get much sleep during the day. Her husband has had to cancel his plans so that he can stay at home with their daughter and he is annoyed with her. Her own mother is also unwell and is in hospital having tests. The care home is short staffed so she is having to do more than the usual amount of work. She is called for the fifth time into the room of a new resident who is finding it hard to sleep. It is clear that the resident is physically all right but she is tearful and anxious. The care worker checks on her again and when the resident asks her to stay with her for a few moments, she says “No, I haven’t got time, I’m rushed off my feet, there’s nothing wrong with you, you aren’t the only person I have to look after.”

 What are the physical pressures for both the carer and resident?

 What are the emotional pressures for both the carer and resident?

 How have they impacted on the way that the carer communicates?

 What could she have done instead?

Knowing our limitations

Self-awareness means that we are able to recognise when we are not in a position to do our job as we would like to, or carry out our responsibilities as we are expected to. A typical personality trait of people working in health and social care is a desire to be helpful to others. We have to know when we are not able to help someone in the way that they need and be able to talk to them about alternatives, without feeling that we are letting them down. We also need to be able to tell our colleagues and managers when we feel unable to carry out a particular task or fill a particular role. Muddling through and making do can have damaging consequences for you, the service user and the organisation you are working in. Self-awareness and openness will help you to recognise when you have reached your limits and need to talk to someone else.

DEVELOPING AWARENESS OF HOW INTERNAL FACTORS IMPACT ON THE SELF

So far we have focused on how an awareness of our physical and emotional needs can help us to think more carefully about how we interact with others. Equally important and influential are more deeply rooted traits which come from our values and beliefs and how they affect our attitudes. Carl Rogers, the father of the person-centred approach to helping relationships, in writing about his own self-awareness said: “The most curious paradox is that when I accept myself just as I am, then I can change.” (Rogers, 1961, p. 17.) So, in the spirit of Rogers, this part of the chapter will encourage you to explore who you are and how you came to be you.

Values and beliefs

A value is something that is worth something or is important to us. Values can have financial or emotional worth and they can be important personally and/or professionally. They can be important to us as individuals or as part of a group. In health and social care we hopefully value ways of being, such as kindness and respect, and values like these guide us in our decision-making, our actions and the way that we interact with others. Values are often formed by certain beliefs that we hold.

Beliefs are assumptions that we make about ourselves, others and the world around us. Many beliefs are held by most cultures in the world: for example most people believe that it is wrong to take another human life or to steal, but all beliefs are dependent on environment and experience. So, there may be some cultures in which individualism and power are valued more than kindness, and these values are held dear by some individuals, families or groups of people within that culture. Whatever our values and beliefs are, they will inevitably affect the way that we communicate with others.

Cuthbert and Quallington (2008) cite Beauchamp and Childress (2001, p. 30) who highlight the values and virtues often associated with healthcare practitioners:

• compassion

• empathy

• sincerity

• discernment

• trustworthiness

• integrity

• conscientiousness

• benevolence and non-malevolence (doing good and not harming)

• truthfulness

• respectfulness.

If these virtues were skills, we could learn and perfect them and we would all be excellent practitioners, but the majority of them are dependent on our own personal beliefs and values; they are often deeply rooted within us and all we can do is become more aware of how they affect us. Sometimes our personal values clash with the professional values we need to uphold. We might all aspire to hold these values but at times they escape us and we feel irritation, anger, impatience or boredom. We might be so exhausted that all we value is sleep and food. There are times when we find it difficult to communicate because we find it hard to like or get on with someone, because their values and beliefs are at such odds to our own. In order to work ethically and to communicate effectively we need to be able to recognise when we find our values and beliefs challenged.

Our values and beliefs are not fixed, they are formed and change throughout our lives and are dependent on where we come from, who we grew up with, who influences us at different times and what happens to us. From the beginning of life we are influenced by family and culture and later we are also influenced by our education, both formal and informal, and by our friends and peer groups.

From the moment we become aware of the messages we are given, we start to form our values. Before we are even verbal we pick up on what is important to our parents. Vygotsky, a theorist who believed that children construct knowledge through social interaction, stated that “through others we become ourselves” (Vygotsky, 1966, p. 43). So, through observation and experience we pick up on our parents’ values and they become part of our makeup. For example, a child whose parents value cleanliness has her hands and face wiped many times a day. She is told not to pick things up and not to put them in her mouth, she is encouraged not to make a mess with her toys and not to get her clothes dirty. It is easy to see why cleanliness becomes a deeply rooted value and how that child, on becoming a community nurse in adulthood, might find it very challenging to visit a patient in their home which is messy, chaotic, dusty and dirty. She might find it hard to hide her shock or disapproval and communicate this clearly to the patient, who then feels judged and uncomfortable.

REFLECTION 2.2

How would you, as an interested observer, respond to the following situations?

 The daughter of an elderly man in a care home phones once a month to check how her father is.

 A father tells his 6-year old son that he has to practise the violin for at least three hours a day.

 A child comes to school with a creased and dirty uniform most days.

 A family have a picnic by the side of a river and leave their rubbish there when they leave.

If possible, discuss these situations with other people. How much do your responses differ? What do you notice about your own values and how similar or different they are to the values of others?

Values are not static, they are influenced by experiences throughout our lives and can change significantly as we grow up and form our own identities. Some are deeply entrenched and we defend them fiercely. As we grow up our values are influenced by our culture, which might be shared by those of our family but might be very different. Our cultural identity may be based on heritage, individual circumstances and personal choice and is affected by many different factors: our age, gender, ethnicity, religion, language, country of origin, sexual orientation, socioeconomic status, occupation and more (AAMC, 1999). All these factors influence our values and in turn influence the way that we communicate with others.

It is more often in the workplace that we find our values are challenged, as in our personal lives we are more able to choose to spend time with people who are similar to us. Think about a gay male nurse who has, through experience, fought hard for acceptance and equality in both his family and professional life. He values tolerance and acceptance, the freedom to choose and to express himself as he wishes to. He comes across a patient who uses unpleasant and homophobic language. How might his values be challenged? How far should he tolerate the intolerant and how should he communicate with this patient in an ethical and effective way? Unfortunately there are no definitive answers to these questions but they are always present and must be considered when working in any profession that requires us to form good relationships with others. Chapters 5 and 6 will offer some ideas about how to deal with situations like these.

Our education, friends, peer groups and our workplace play a significant part in the forming of values which might be different from those of our culture and family. When children reach two or three years of age they often start nursery and so voices outside the family start to be heard. Whereas they have until then been influenced perhaps solely by their family, nursery workers and other children start to become important. Sharing and caring for others will be values promoted strongly in early years settings and if these are similar to those promoted at home, they become assimilated into the child’s way of being even when these values are at odds with the child’s natural egocentricity. Schools and work settings tend to value hard work, conscientiousness and being a team player and students/workers who adhere to those values tend to do well and receive positive feedback.