The basis:
Open honest and direct communication

4 basic components of the assertive response or approach

1. having empathy
2. describing one’s feelings or the situation
3. clarifying one’s expectations
4. anticipating consequences

Characteristics of self-presentation
1. confident, open body posture
2. eye contact
3. use of clear, “I” statements
4. ability to share honestly one’s thoughts, feelings and emotions

Conversation skills:
Control your tone of voice
Be knowledgeable about the topic of conversation and have accurate information
Be flexible. Follow the patient’s lead whenever possible
Be clear and concise; make statements as simple as possible
Avoid words that might have different interpretations
DO NOT give out false information. BE TRUTHFUL
Keep an open mind.
Listening Skills:
Sit when communicating with a patient
Be alert and relaxed so that the patient is at ease
Maintain eye contact without staring
Be attentive to both your own and the patient’s verbal and nonverbal communication
Think before

Delusional: (TEMPORARY) mental state in which a person cannot tell what is real from what is imagined. The main feature of this disorder is the presence of delusions, which are unshakable beliefs in something that is untrue. People with delusional disorder experience non-bizarre delusions, which involve situations that could occur in real life, such as being followed, poisoned, deceived, conspired against, or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, however, the situations are either not true at all or highly exaggerated. An example is someone with schizophrenia.

The Cleveland Clinic © 1995-2008

Dementia: (CHRONIC) organic impairment of intellectual functioning gradually leading to interference with social or occupational functioning, memory, and often personality integration.

How do we speak to someone with Dementia?

Get the persons attention before talking to them, identify yourself and orientate them to what is actually going on. Focus on the abilities of the person, help them communicate with you by eye contact, never asking open ended questions or more than two topics or options in each question, and repeat or rephrase question if needed. An example is someone with Alzheimer’s Disease. In this case (any organic brain disease) you do not re-orient them or contradict them because it confuses them more and frustrates them.

How do we speak to someone who is Delusional?

You introduce yourself and re-orientate them into reality. Help them understand that their visions or voices they hear are not real. Correct them and just reassure them that what is happening in their mind is not actually happening. Do not go along with their stories for this will frighten them more

“No hugging, dear. I’m British. We only show affection to dogs and horses”
Personal space: The area around the person regarded as the person, individualized to each person or cultural group

Ex: Arabic and African culture often stand closer when they are talking to one another
Asian and European cultures are not as comfortable with space.
Hispanic and Italian cultures hug and kiss upon greeting
Puerto Ricans: consider manners and chivalry. Ie: shaking hands and standing up to greet.

Touch is viewed as one of the most effective non verbal ways to express feelings of comfort, love, affection, security…

Eye Contact: American’s view eye contact as nonverbal communication that reveals a persons true nature. It suggests respect and a willingness to keep communication open. Asian and native American cultures view eye contact as an invasion of privacy, a sign of disrespect, impolite, and aggressive.

Native Americans will look at the floor during conversation to show that they are listening.
Hispanic look down depending on status, age, gender, and authority
Muslim and Arab women avoid eye contact with men as a sign of modesty
Hasidic Jewish men avoid direct eye contact with women

Age/ generation: The younger you are the more open you are to change. Vocabulary depends on generation. Some older generations expect younger generations to respect their authority and wisdom

Forms of Nonverbal communication:
• Posture- how a person holds their body conveys messages. For example. Slouching may show a negative image; on the other hand sitting straight up may show confidence and convey a more positive image.
• Gait- A person who bounces while walking may convey a positive message, whereas a person with a less purposeful shuffling while walking may show negative message.
• Touch- Personal behavior has different meanings based on different people.
• Eye Contact- Depending on culture, eye contact may be offensive if used too often, whereas in other cultures, eye contact may be used to keep an audience engaged.
• Facial Expressions- Faces may show many expressions and is the most effective way of reading emotions.
• Physical appearance- Many illnesses may affect physical appearances of a person. For example, a dehydrated person may show dry skin, dry mucous membrane, and poor skin turgor.
• Dress and grooming- Healthy people have better energy, therefore showing more care for self-image.
• Sounds- oral, but nonverbal communication that can have different meanings. For example, a person crying may show signs of sadness or joy.
• Silence- Silence may mean understanding, anger, or thinking between two parties.
• Gestures- Various parts of the body can carry out numerous messages. For example, thumbs up means victory, kicking expresses anger, clapping may express joy,

When there is a language barrier, communication relies more on gestures if no translator may be present. A translator must be present in order to avoid any confusion between communications. The nurse’s responsibility is to provide a credible translator for the patient and communicate through this method as a reliable way of communication.