Effective workplace communication with employees with acquired brain injury
- Implementation guide
- Acquired Brain Injury (ABI)
- Talking about talking and listening
- Talking about learning
- Talking about the job
- Talking about tools
- Talking about safety
- Talking about quality and quantity
- Talking about teams and workmates
- Talking about problems
- Talking about changes
- Talking about futures
Talking about the job
Giving instructions that have meaning and relevance is a critical skill when you are supporting employees with ABI.
Giving instructions that have meaning and relevance is a critical skill when you are supporting employees with ABI. They may have difficulty following instructions or completing tasks because of:
- memory problems
- poor concentration
- slowed responses
- poor planning and problem solving
- lack of initiative
- inflexible thinking
- problems in receptive language
- problems in expressive language.
Supported employees with ABI (like all workers) need to know what they are required to do. They need to know and understand:
- what their task is
- how it has to be done
- why they need to do it that way
- how much or how many they need to aim to do in a time period
- how much or how many their team needs to aim to do
- what standards are expected – and why.
Employees with ABI need to be given this information in specific and individual ways, depending on their cognitive needs.
This may include being shown as well as told what to do, needing very concrete information (bend your knees when you pick up the box), not abstract statements (remember the manual handling rules) or being left with ongoing reminders like a sample to copy (this box has the toys in it in the order you have to put them in).
You need to be aware of the person's receptive language skills (their level of understanding of what you say), and their visual-spatial skills (recognition of and ability to analyse and remember visual information).
Very often, people with ABI seem to understand more than they actually do. You need to test their understanding frequently, particularly in relation to any new task they are learning.
To check that your message about the work has been received, ask the supported employee to feed back what they have heard. This can be verbal or, particularly for people with limited verbal skills, a demonstration of the task.
The ability of an employee with ABI to use verbal or written skills to express themselves may appear unaffected but there can often be subtle and hidden problems that cause them difficulty on the job. These can include:
- problems remembering words
- incorrect use of language
- talking about unrelated topics
- making up stories
- minimal responses when detail is required in an answer
- poor spelling and problems remembering new words
- rapid or non-stop talking – particularly when an explanation is required.
Annika, aged 53, had a stroke four years ago. Her speech and physical function are unaffected, and she lives independently in her own home. Annika is a widow with two adult children. She started work at Merrinvale a couple of years ago, wanting something to fill her day and to provide company. Her supervisors consider her one of the most competent employees and she fulfils a very important role in the Frame Up workshop, ensuring orders for steel shelving components are correctly selected and packed ready for shipping.
There have always been difficulties with this task in Frame Up. A significant number of orders are returned by customers because the wrong components have been supplied, and the business has suffered because of this. Although Annika seems to be the 'best' person to do the orders, in fact her stroke has left her with sensory and perceptual problems which mean she makes many errors. Annika has visual-spatial deficits which cause her severe problems drawing or copying objects, recognising them, telling left from right, and organising most visual information.
The order filling task is a minefield for someone with Annika's problems because it depends so much on being able to analyse and recognise objects.
From Paul's notebook
I had to go out to Beeson's again today. They were fuming because they said the shelving order was completely messed up again. I went right through it and, sure enough, I found there were too many 300mm shelves and no 200s. And no left hand brackets had been packed. I can't understand it. Annika is in charge of the packing and she checks each part as it goes onto the pallet. She really knows what she's doing and is the only employee who can read the orders correctly, and get things organised so they're out on time. Any of us can go up to her at any time of day and she can tell you exactly what's going on. She's really smart.
I had to grovel quite a bit to Reg Beeson, and we'll lose another half day redoing the order for them at our cost. I just can't figure it out.
- Present task instructions step by step. Check that the employee understands each instruction by getting them to demonstrate what is required. Provide lots of opportunities for practising the task steps.
- Make sure any written or visual information is in the language and of the font and point size that best suits the employee's needs.
- Use additional support services when they are needed. For example, employees for whom English is a second language may remember the name of an object or follow instructions more easily if they are given in their first language. Use interpreter services or community members to provide information.
- Organise the job environment so that the employee has less need to rely on their memory. Try things like:
- putting clear, simple directions on a notepad
- using a notice board or planner
- having a place where the employee stores all their equipment and returning any things that may go missing to that place
- labelling or colour coding storage areas
- keeping all the things needed for a task together – for example, tie the marker pen to the order form pad and fix the pad to the desk by the phone
- developing routines to use the memory aids you have established, and regularly assessing whether or not they are being followed.
- Acknowledge the employee's difficulty with expressive language and be supportive of it.
I can see you're finding it hard to say what you want; we'll take it slowly.
- Use simple workplace checks to work out how well a task will match a particular employee's ability and needs, particularly if they have any perceptual problems. For example:
- see if they can draw or copy an object
- check their recognition of objects – including colour, size, shape, sound, etc
- check whether they can tell left from right
- if mathematical skills like measurement are required, check the employee's abilities with these
- observe their manipulation and construction of objects – are they able to orient, place, assemble according to design, etc?
- Prompt the employee to evaluate their own performance on the task.
- Avoid being judgemental.
- Use active listening:
- meaningful eye contact and supportive body language
- reflection of content and feeling
- paraphrasing and summarising of what the employee is saying.