Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 1 of 40
Module 3: Communication/Interpersonal Skills
Minimum Number of Theory Hours: 2
Recommended Theory Hours: 6
Recommended Clinical Hours: 0
Statement of Purpose:
The purpose of this unit is to introduce concepts and skills required for the Nurse Assistant to communicate effectively and interact
appropriately with patients/residents, patient’s/residents’ families and guests, and other members of the health care team.
Terminology
1. Anger
2. Aphasia
3. Basic human need
4. Body language
5. Communication
6. Conflict
7. Conversion
8. Defense mechanisms
9. Denial
10. Displacement
11. Dyslexia
12. Dysphasia
13. Empathy
14. Family
15. Identification
16. Medical chart
17. Message
18. Myth
19. Non-verbal communication
20. Personal space
21. Physiological
22. Projection
23. Psychosocial
24. Rationalization
25. Receiver
26. Regression
27. Report
28. Repression
29. Sender
30. Sublimation
31. Substitution
32. Sympathy
33. Verbal communication
34. Voice pitch
35. Voice tone
Patient, resident, and client are synonymous terms referring to the person receiving care
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 2 of 40
Performance Standards (Objectives):
Upon completion of two (2) hours of class plus homework assignments and clinical assignments, the learner will be able to:
1. Define key terminology.
2. Identify and discuss the five basic physiological and psychosocial needs of all humans, as described by Maslow’s Hierarchy of
Needs.
3. Recognize and report patient/resident behaviors that reflect unmet human needs.
4. Define communication and therapeutic communication and identify two routes of communication.
5. Describe the key steps involved in the communication process and methods used in communication.
6. Describe reasons for communication breakdown.
7. Describe effective communication/interpersonal skills used with patients/residents, their families and guests.
8. Describe conflict and measures for conflict resolution.
9. Discuss touch as a form of communication, including body language and personal space.
10. Identify common psychological defense mechanisms.
11. Describe family communication/interaction patterns and the role of the Nurse Assistant.
12. Describe social and cultural factors influencing communication and emotional reactions to illness and disability.
13. Describe communication between the members of the health care team.
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 3 of 40
References:
1. Acello, B. & Hegner, B. (2016). Nursing Assistant: A Nursing Process Approach. (11th ed). Boston, MA. Cengage Learning.
2. Acello, B. (2016). Workbook to accompany: Nursing Assistant: A Nursing Process Approach. (11th ed). Boston, MA. Cengage
Learning
3. Carter, P. J. (2017). Lippincott Essentials for Nursing Assistants: a Humanistic Approach to Caregiving. (4th ed.) Philadelphia, PA.
Lippincott Williams & Wilkins
4. (2017). The New Nursing Assistant: Measuring Vital Signs. [DVD]. Medcom Trainex
5. (2014). The New Nursing Assistant: Moving and Turning. [DVD]. Medcom Trainex
6. (2014). The New Nursing Assistant: Transfer and Ambulation. [DVD]. Medcom Trainex
7. (2014). The New Nursing Assistant: Personal Care. [DVD]. Medcom Trainex
8. (2018). The New Nursing Assistant: Providing Oral Care. [DVD]. Medcom Trainex
9. (2009). The New Nursing Assistant: Essential Elimination Skills. [DVD]. Medcom Trainex
10. (2015). The New Nursing Assistant: Techniques in Toileting and Incontinent Care. [DVD]. Medcom Trainex
11. (2014). The New Nursing Assistant: Range of Motion Exercises. [DVD]. Medcom Trainex
12. (2018). The New Nursing Assistant: Bedmaking. [DVD]. Medcom Trainex
13. (2018). The New Nursing Assistant: Measuring Weight. [DVD]. Medcom Trainex
14. (2018). The New Nursing Assistant: Positioning. [DVD]. Medcom Trainex
15. (2018). The New Nursing Assistant: Ostomy, Urinary Drainage, and Catheter Care. [DVD]. Medcom Trainex
16. (2014). The New Nursing Assistant: Bathing Part 1: The Bed Bath. [DVD]. Medcom Trainex
17. (2014). The New Nursing Assistant: Perineal Care, Tub Bath, Shower, and Shampoo. [DVD]. Medcom Trainex
18. (2014). The New Nursing Assistant: Recognizing Abnormal Signs and Symptoms. [DVD]. Medcom Trainex
19. (2018). The New Nursing Assistant: Serving a Meal. [DVD]. Medcom Trainex
20. (2014). The New Nursing Assistant: Infection Control Skills for the Care Provider. [DVD]. Medcom Trainex
21. Deck, M. L. (2004). Instant Teaching Tools for the New Millennium. St Louis, MO. Mosby
22. Hedman, S. A., Fuzy, J., & Rymer, S. (2018). Hartman's Nursing Assistant Care: Long-Term Care (4th ed.). Albuquerque, NM.
Hartman Publishing, Inc.
23. Hartman Publishing. (2018). Workbook for Hartman's Nursing Assistant Care: Long-Term Care (4th ed.). Albuquerque, NM.
Hartman Publishing, Inc.
24. Haroun, L. & Royce, S. (2004). Teaching Ideas and Activities for Health Care. Albany, NY. Delmar Publishers
25. Pearson Vue (2018) California Nurse Assistant Candidate Handbook for National Nurse Aide Assessment Program. Philadelphia,
PA. Pearson Education, Inc.
26. Regional Health Occupations Resource Center (2003). Preceptor Workbook. Chancellor’s Office, CA Community Colleges,
available at www.ca-hwi.org
27. Sorrentino, S. A., Remmert, L., & and Kelly, R. (2018) Workbook and Competency Evaluation Review for Moby’s Textbook for
Nursing Assistants (9th ed.) St. Louis, MO. Mosby Company
28. Sorrentino, S.A. & Remmert, L. (2018) Mosby’s Textbook for Nursing Assistants. (9th ed.). St Louis, MO. Elsevier
29. Weaver, L. & Wilding, M. (2013) The Dimensions of Engaged Teaching: a Practical Guide for Educators. Bloomington, IN. Solution
Tree Press.
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 4 of 40
Content Outline
Recommended Teaching
Strategies and
Assignments
Clinical Demonstration/
Method of Evaluation
Objective 1
Define key terminology
A. Review the terms listed in the terminology section
B. Spell the listed terms accurately
C. Pronounce the terms correctly
D. Use the terms in their proper context
A. Lecture/Discussion
B. Games: word searches,
crossword puzzles,
Family Feud, Jeopardy,
bingo, spelling bee,
hangman, and
concentration
C. Encourage use of
internet, medical
dictionary, and
textbooks
D. Create flashcards for
learning purposes
E. Handout 3.1a-
Communication Skills
Crossword
F. Handout 3.1b-
Communication Skills
Crossword- KEY
A. Have students select
five words from the list
of key terminology and
write a sentence for
each defining the term
B. Administer vocabulary
pre-test and post-test
C. Uses appropriate
terminology when
charting and reporting to
licensed personnel
Objective 2:
Identify and discuss the five basic physiological and
psychosocial needs of all humans, as described by Maslow’s
Hierarchy of Needs.
A. Basic human needs and how they can be met by Nurse Assistant
1. Physiological
a. Oxygen, food, water, elimination, shelter, sleep, sex
b. Example: Delivers meal trays, assists patient/resident with
set-up and feeding as needed
2. Safety and Security
a. Clothing, protection from harm or danger, freedom from
A. Lecture/Discussion
B. Handout 3.2- Examples
of Human Needs as
Related to Maslow
C. Group Activity: in groups
of 3-5, ask students to
identify and categorize
A. Written test
B. Identifies actions by
Nurse Assistant to assist
in meeting each of the
five basic human needs
for one or more
patients/residents
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 5 of 40
fear, stability and order, family, economics
b. Example: Responds promptly to patient/resident ‘s call light
3. Belonging
a. Meaningful relationships with others, acceptance by peers
and community, love, intimacy, and formal and informal
social and work groups
b. Example: Encourages family and friends to visit
patient/resident
4. Esteem
a. Respect, recognition, approval, self-confidence, self-
respect, self-esteem
b. Example: Addresses each patient/resident by the
name they prefer
5. Self-actualization
a. Achievement, creativity, success, full use of individual
talents
b. Example: Sincerely acknowledges a
patient’s/resident’s accomplishments
B. Value of using Maslow’s Hierarchy of Needs
1. Satisfactory achievement of each level is based on meeting
the needs of prior levels
2. Meeting basic physiological needs is essential to life
3. Provides a way to set priorities and organize activities
4. Encourages a holistic approach to patient/resident care planning
5. Increases awareness of reasons for patient/resident behaviors
6. Unmet basic needs may result from and/or contribute to
illness, disease, or injury
additional examples of
how Nurse Assistants
meet patient/resident
needs
C. Uses hierarchy to
prioritize
patients/residents’
activities to meet needs
Objective 3:
Recognize and report patient/resident behaviors that reflect
unmet human needs.
A. Behaviors that demonstrate unmet human needs
1. Physiological needs unmet
a. Irritability, weakness, complaints of hunger, complaints of
being cold or too warm
b. Changes in vital signs and level of consciousness
2. Psychosocial needs unmet
a. Anxiety, depression, anger, withdrawal, isolation
A. Lecture/Discussion
B. Have students identify
and discuss examples of
observations or
experiences in which
physical or psychosocial
needs were not met for
A. Written test
B. Recognizes behaviors
that may express a
patient’s/resident’s
unmet needs and
reports to licensed
nurse
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 6 of 40
b. Physical ailments with no apparent cause
c. Expressions of feelings of loneliness and worthlessness
B. Responses to patient/resident behaviors suggesting unmet basic
needs
1. Look beyond uncooperative, demanding, and rude behavior
2. Recognize that a patient/resident has underlying needs for
comfort and understanding
3. Respond with patience, caring, concern, kindness, and
empathy
4. If problem continues, ask licensed nurse for assistance
self or others
Objective 4
Define communication and therapeutic communication and
identify two routes of communication.
A. Communication is a sharing of ideas, thoughts, information, and
feelings with at least one person
B. Communication may be verbal or non-verbal
C. Therapeutic communication is used to promote optimum wellness
1. Patient/resident-centered and goal oriented
2. Can be verbal or non-verbal
D. Two routes of communication
1. What is seen, heard, touched - internal senses
2. What is spoken, written, or gestured - external senses
A. Lecture/Discussion
B. Group Activity: How to
fold a Napkin
1. Give each student a
cloth napkin-
Preferably at least 12
x 12 inches
2. Divide the class into
three groups
3. Ask that students not
look at what will be
handed out, not
discuss the activity
with other classmates,
and wait for directions
4. Each Group will
have different tasks
a. Group 1- give each
student a copy of
the written
directions for
folding a napkin
(Handout 3.4a)
A. Written test
B. Applies appropriate
verbal and non-verbal
actions to facilitate
therapeutic
communication with
patients/residents
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 7 of 40
This group will do
the napkin fold
individually and
without talking
b. Group 2- Give
each student a
copy of the
directions with
pictures for folding
a napkin (Handout
3.4b) This group
will do the napkin
fold individually
and without talking
Group 3- Give two
students a copy of
the directions with
pictures for folding
a napkin (Handout
3.4b) One student
will give the
directions verbally
while the other
demonstrates how
to fold the napkin to
the rest of Group 3
The students who
are folding will be
allowed to ask
questions while in
the folding process
Note: Group 3 will
need to work with
students so they
know how to fold
the napkin
Module 3: Communication/Interpersonal Skills
Model Curriculum for Nurse Assistants - Revised September 2013
Page 8 of 40
d. Stop the activity
after 5 minutes
(A shorter time
may work also)
e. Look at
everyone’s
folded napkins
5. Topics for
discussion:
a. Differences
between
working alone
and with two
people?
b. Any differences
between written
and picture
directions?
c. Amount of
questions asked
and directions
repeated with
Group 3?
d. How can
communication
be improved?
e. Application to
clinical setting
&communicating
with
patients/residents,
families, guests,
and other
members of the
health care team
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 9 of 40
C. Handout 3.4a- How to
Fold a Napkin Written
Instructions
D. Handout 3.4b- How to
Fold a Napkin with
Pictures
Objective 5:
Describe the key steps involved in the communication process
and methods used in communication.
A. Important steps in communication
1. Message
2. Sender
3. Receiver
4. Interpretation
B. Methods
1. Verbal; Spoken words
2. Non-verbal; Conscious and unconscious
a. Types
1) Body language
2) Touch
3) Eye contact at patient’s eye level
b. Written
1) Labels; stickers or armbands for patient/resident
precautions, room numbers, unit signs
2) Visual labels; name tag, picture, uniform, picture
board
3. Electronic
a. Devices to create sounds of words (verbal)
4. Computers/touch pads to type words/phrases onto screen(non-
verbal)
5. Specialized communication skills
a. Dementia-related communication skills including person-
centered care, validation therapy, gentle orientation to time
and place, reassure with words and touch
b. Use of a continuum of verbal and non-physical techniques,
such as redirect for combative patients
A. Lecture/Discussion
B. Group Activity
C. Telephone Game
Create message that
is at least three
sentences long and
contains several
points of information
2. Have students form
a line or divide into
groups of 5-8
3. First student in line
whispers the
message to the
second student who
whispers what was
heard to the third
student, etc.
4. Final student in line
reports what was
heard as the
message
5. Discuss what
occurred where the
message changed,
how message
changed
A. Written test
B. Identifies all methods
used by the facility and
unit to communicate
patient/resident
information and
precautions
C. Correctly follows
confidentiality and
precaution measures
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 10 of 40
Objective 6
Describe reasons for communication breakdown.
A. Verbal Factors- can be the patient/resident or health care worker
1. Criticism
2. Value statements
3. Interruptions
4. Judgment
5. Language differences
6. Changing subjects
7. Excessive talking
8. Cliché and automatic answers such as “Don’t worry” – “It will
be OK” – “I know how you feel”
B. Non-verbal factors; can be the patient/resident or health care
worker
1. Body language
2. Eye contact
3. Cultural beliefs, customs, and practices
4. Environmental-time and space
C. Physiological and aging factors
1. Hearing loss
2. Vision loss
3. Slowing of response time
4. Medication
5. Cognitive changes
6. Speech loss
D. Not listening; can be either the patient/resident or health care
worker
1. Lack of concentration
a. Preoccupied
b. Distracting noises
c. Monotone voice
d. Negative attitude
2. Selective hearing – what one wants or expects to hear
C. Emotional - verbal or non-verbal responses to words or situations
A. Lecture/Discussion
B. Have students recall
Napkin Folding and
Telephone Game
Discuss factors that led
to miscommunication
and ways to avoid future
miscommunication
C. Discuss the role of
listening in
miscommunication
A. Written test
B. Identifies verbal and
nonverbal behaviors and
actions in self and in
patients/residents that
may block effective
communication
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 11 of 40
Objective 7:
Describe effective Communication/Interpersonal Skills used with
patients/residents, their families and guests.
A. Communication/Interpersonal Skills for use with a patient/resident,
family, or guest
1. Introduce self
2. Use the patient’s/resident’s formal name initially
3. After initial introductions, ask patient/resident how he or she
would like to be addressed. Add this information to the
nursing care plan so all staff members have the information
4. Explain all tasks to the patient/resident before doing them
5. Be patient and a good listener
6. Use short sentences, ask for feedback
7. Use eye contact
8. Speak clearly, avoid criticizing, and avoid interrupting
9. Clarify information or conversation as needed
10. Be aware of body language of self and others
11. Verbal and non-verbal messages should agree
12. Use words that are easily understood
13. Show interest and respect
14. Use a friendly tone of voice
15. Be positive while being appropriate to each interaction
16. Ensure confidentiality
A. Lecture/Discussion
A. Written test
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 12 of 40
B. Additional skills when communicating with patients/residents
with special needs
1. Language/cultural differences
a. Ask for an interpreter if the patient/resident or family
speaks little or no English or the language of the Nurse
Assistant
b. Know cultural beliefs and practices for word meanings and
uses, personal space, time and timing, gestures, and
touching
2. Visual impairment
a. Describe surroundings to a visually impaired
patient/resident
b. Encourage use of other senses
c. Identify self when entering patient’s/resident’s room
d. Speak aloud before touching patient/resident
e. Explore the room with patient/resident
f. Do not rearrange the room
g. Provide patient/resident with explanations about what will
be and is being done
h. Let patient/resident know when you are entering and
leaving the room
i. Keep doors open
j. Assist as needed with meal set-up and eating
k. Speak in a normal tone of voice
3. Hearing impaired
a. Gain the attention of the patient/resident, using
touch as appropriate
b. Determine which ear has hearing loss. It may be both
ears
c. Check to see if hearing aids are in, turned on and working
d. Face the patient/resident directly
e. Do not block/cover your mouth or chew gum
f. Reduce/eliminate background noise and other
distractions
g. Speak slowly, directly, and clearly when addressing a
hearing-impaired patient/resident. Do not speak loudly
B. Role play activity:
Communication
Challenges
1. Divide into groups of
4-5 students
Assign each
member of the
group to one of
these challenges-
one visually
impaired, one
hearing impaired,
one unable to
speak, one
confused, and one
with Hemiplegia
3. Assign a topic to be
discussed, including
a written component
(terminology,
reviewing theory
content)
4. Allow at least 15
minutes for group
interaction
B. Demonstrates use of
effective communication
strategies and actions
with patient/resident,
families, guests, and
other healthcare
workers
C. Provides care for
patient/resident with a
hearing, visual, or
cognitive impairment
Creates picture board
for a patient/resident
who has impairment in
verbal and written
communication
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 13 of 40
h. Use short sentences and simple words
i. Repeat and rephrase statements as needed
j. Ask the patient/resident to repeat instructions to
ensure understanding
k. Be aware of messages sent by facial expressions and
body language
4. Speech impairment (dysphasia, aphasia)
a. Provide writing materials and assistance as needed
b. Let patient/resident use own words – Allow sufficient
time for response
c. Use picture boards or point boards
d. Stand in front of patient/resident
e. Avoid finishing words and sentences for the patient/resident
5. Mental impairment (confusion, dementia)
a. Keep directions simple
b. Repeat information as needed
c. Offer frequent general reassurance
d. Always have patient’s/resident’s attention before speaking
Objective 8
Describe conflict and measures for conflict resolution.
A. Definitions
1. Conflict
a. A disagreement or controversy
b. When what a person has and what a person wants is
different
c. A pattern of energy
d. Nature’s primary motivation for change
2. Conflict resolution; a range of processes aimed at alleviating
or eliminating sources of conflict
B. Conflict Myths
1. Conflict is a negative
2. Conflict is a contest
3. The presence of conflict is a sign of poor management
4. Conflict, if left alone, will take care of itself
5. Conflict must be resolved
A. Lecture
B. Discussion
C. Handout 3.8a- Myths
about Conflict
D. Handout 3.8b- Conflict
Self-Assessment Activity
E. Handout 3.8c- Five
Conflict Handling
Modes
F. Handout 3.8d- 4 E’s of
Constructive Feedback
A. Written test
B. Recognizes indications
of potential and actual
conflict for a
patient/resident and
reports information
clearly and accurately to
licensed nurse
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 14 of 40
C. Conflict handling modes, characteristics, and uses
1. Competing
a. Assertive and uncooperative
b. Power-oriented
c. Uses
2. Accommodating
a. Unassertive and cooperative
b. Self-sacrifice
c. Uses
3. Avoiding
a. Unassertive and uncooperative
b. Doesn’t address conflict
c. Uses
4. Collaborating
a. Assertive and cooperative
b. Seeks mutual satisfaction
c. Uses
5. Compromising
a. Somewhat assertive and cooperative
b. Mutual satisfaction
c. Middle ground
d. Uses
D. Potential Areas of Conflict for Nurse Assistant
1. Attendance
2. Punctuality
3. Safety
a. Personal
b. Patient/resident
4. Professional behavior
5. Attitude
6. Appearance and hygiene
7. Performance
8. Confidentiality
E. Constructive Feedback
1. Definition
2. Use
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 15 of 40
F. The 4 “Es” of giving constructive feedback
1. Engage
a. Prepare
b. Link feedback with goals
c. Focus discussion
2. Empathize
a. Environment
b. Timing
3. Educate
a. Describe observations
b. Identify impact of behavior
c. Remain objective
4. Enlist
a. Elicit response
b. Guide toward solution
Objective 9
Discuss touch as a form of communication, including body
language and personal space.
A. Cultural beliefs regarding touch
1. Modesty; covering of head, face, arms
2. Gender of care giver
3. Touching of body after death
4. Hugging and kissing
B. Observing body language
1. Hands and extremities
2. Eyes
3. Gestures
4. Posture
5. Regression to child-like postures or behaviors
C. Personal space
A. Lecture/Discussion
B. Activity:
1. Create a list of
cultures and
religious practices of
students and
instructors
2. Add cultures and
religions not
represented in the
class
3. Identify specific
information about
touching, body
language, and
personal space
for each culture
A. Written test
B. Appropriately gathers
information about
patient/resident
preferences
regarding touch and
personal space
C. Provides culturally
appropriate care for all
patient’s/resident’s
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 16 of 40
Objective 10
Identify common psychological defense mechanisms.
A. Denial
B. Projection
C. Anger
D. Rationalization
E. Regression
F. Displacement
G. Conversion
H. Repression
I. Sublimation
J. Substitution/compensation
K. Identification
A. Lecture/Discussion
B. Flashcards for terms
C. Handout 8.10- Defense
Mechanisms
A. Written test
B. Recognizes possible
reasons for a
patient’s/resident’s use
of defense
mechanisms
C. Identifies and applies
appropriate therapeutic
communication
techniques with
patients/residents who
are angry and/or
experiencing regressive
behaviors
Objective 11
Describe family communication/interaction patterns and the role
of the Nurse Assistant.
A. General principles when communicating with patient/resident
families
1. Show respect for all family structures and members
2. Listen to family members
a. Show courtesy, respect, and support
b. Allow uninterrupted time
c. Provide privacy as indicated
3. Avoid involvement in family matters
4. Maintain patient/resident confidentiality
5. Encourage family to participate in care planning and care as
allowed by facility policy
B. Provide information about the facility
1. Telephone numbers
2. Cell phone regulations
3. Visiting hours
4. Location of cafeteria/vending machines
5. Business office
A. Lecture/Discussion
B. Have group share
examples of
communication
difficulties
C. Role play examples of
providing clear and
concise information to
another student playing
the role of a family
member. Have the
student playing the role
of the family member
give feedback regarding
the communication. Use
one of the Mandatory
A. Written test
B. Interacts appropriately
with others at all times
when in the clinical
facility. Maintains
confidentiality
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 17 of 40
6. Gift shop
7. Public restrooms
8. Orient to patient/resident activities
9. Social Services
10. Chaplain
C. Encourage family to provide information about
patient/resident preferences
Skills as an example
Objective 12
Describe social and cultural factors influencing communication
and emotional reactions to illness and disability.
A. Culture
1. Shared, learned customs, beliefs and values of a group of
people
2. Includes attitudes, beliefs, religion, values, likes and dislikes,
rituals, celebrations, food, and language
3. Culture influences the reaction of residents and families to
health and health care services
4. Rituals –ceremonies to cure or protect from disease based on
beliefs about health, health care, and causes of illness
B. Physical and psycho-social reactions to illness and disability
1. Stress responses
a. Common physiological responses vary with each
individual
b. Can become a pattern of responses based on
experiences
c. Have desirable and undesirable effects
2. Physical loss or disability
a. Loss of spouse, family, friends
b. Loss of homes, employment, economics, security
c. Loss of control of life, independence, driving
d. Loss of control and function of body and mind
e. Fewer choices and options
3. Emotional reactions
a. Anger
b. Uselessness
c. Fear
A. Lecture/Discussion
B. Activity: Using the
cultures and religions
identified in Objective 9,
discuss health, illness,
and health care beliefs
and practices
C. Have students share
strategies for relieving
stress
A. Written test
B. Recognizes
patient/resident
behaviors that may be
influenced by cultural
beliefs and practices.
Reports information
appropriately
C. Recognizes
patient/resident
behaviors that may be
influenced by physical,
social, and/or emotional
factors. Reports
information
appropriately
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 18 of 40
d. Grief
e. Feelings of damage
f. Dependency
g. Depression
h. Suspicion
i. Sense of helplessness
j. Loneliness
k. Anxiety
l. Guilt
m. Frustration
C. Helpful Nurse Assistant actions
1. Observe patient/resident for indications of emotional stress
2. Be a good listener; take time to visit
3. Be patient and understanding; meet needs promptly
4. Help patient/resident function as independently as possible;
focus on abilities not disabilities
5. Let patient/resident know that staff cares about his or her well-
being
6. Be non-judgmental
7. Always treat all patients/residents with dignity
8. Be respectful of all cultures and belief systems
9. Take time to learn about cultures and practices
Objective 13:
Describe communication between the members of the health
care team.
A. Health Care Communication
1. Methods of communicating
a. Verbal
b. Non-verbal
c. Written: chart, patient summary/care plan, report sheets,
Activity of Daily Living form, and weight and vital signs
forms
d. Electronic: computer, fax, telephone, intercom system
2. Legal aspects of communications
a. Must document what has been reported verbally to
licensed nurse
b. Must document statements heard from the
patient/resident and family that are important
A. Lecture/Discussion
B. Activity: Create a list of
simulated
patients/residents with
various diagnoses,
ADLs, etc. Divide class
into small groups. Have
students take turns
giving report
A. Written test
B. Interacts appropriately at all
times with unit staff and
other members of the
health care team
C. Communicates
patient/resident information
accurately and clearly both
verbally and in writing
D. Follows unit policy
regarding answering
telephone and intercom
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 19 of 40
B. Rules for effective communication
1. Identify self by name and title in any form of communication
2. Verbal reports should be
a. Brief
b. Organized
c. Appropriate and focused
1) Diagnosis
2) Allergies
3) Activity and tolerance
4) Elimination
5) Special needs
6) Diet and appetite
7) Vital signs and weight
8) Code status
d. Timely
e. Respectful of patient/resident confidentiality
3. Telephone communication
a. Take notes during the call
b. Name of person the message is for
c. Verify correct spelling of caller’s name
d. Indicate time of call
e. Clarify the message with the caller by repeating it and
repeating the telephone number
f. Clearly sign full name and title to the message
4. Answering a patient/resident call signal
a. Answer promptly, quietly, and in a friendly manner
b. If an intercom is used, call the patient/resident by name,
identify self and politely inquire as to the
patient’s/resident’s need
c. Make sure the patient/resident can always reach the call
light
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 20 of 40
Sample Test- Module 3- Communication/Interpersonal Skills
1. Which of the following is a physiological need?
A. Employment
B. Friendship
C. Water
D. Love
2. Which of the following would be a barrier to effective communication?
A. Listening to a patient/resident tell stories about his or her past
B. Letting a patient/resident express his or her fears and concerns about dying
C. Changing the subject each time a patient/resident brings up an uncomfortable topic
D. Allowing a patient/resident to talk freely about his or her health problems
3. Avoiding eye contact when talking to another person is an example of which type of communication?
A. Verbal
B. Non-verbal
C. Written
D. Electronic
4. A charge nurse uses a medical word that the Nurse Assistant does not understand. What should you do?
A. Pretend to understand
B. Look the word up in a medical dictionary
C. Ask the nurse to explain the meaning
D. Ask another Nurse Assistant what the word means
5. A patient/resident asks to see his chart. What is the correct action for the Nurse Assistant?
A. Give the chart to the patient/resident
B. Report this to the charge nurse
C. Report this to the patient’s/resident’s doctor
D. Make a copy of the chart for the patient/resident
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 21 of 40
6. When patients/residents express their feelings and concerns, the Nurse Assistant will best respond by:
A. Adding his or her opinions
B. Giving the patient/resident suggestions for feeling better
C. Sharing personal problems and concerns
D. Listening to the patient’s/resident’s concerns
7. A patient’s/resident’s family asks to meet their mother’s new roommate who is sitting in the day room. The nursing assistant
will most correctly:
A. Inform the patient’s/resident’s family that this is against hospital policy
B. Take the family and patient/resident to the day room and introduce them to the new roommate
C. Ask the family to wait until the new roommate has been in the facility at least a week
D. Report this request to the charge nurse to handle as time permits
8. A Nurse Assistant works on the first floor of a skilled nursing facility. The Nurse Assistant’s uncle is a patient/resident on the
second floor. Which statement is true about this relationship?
A. The Nurse Assistant can access her uncle’s medical record
B. The Nurse Assistant can visit her uncle during lunch time
C. The Nurse Assistant can attend patient/resident care conferences with her uncle
D. The Nurse Assistant can assist with her uncle’s care plan
9. Which form of communication may reveal the most about a patient’s/resident’s true feelings?
A. Listening skills
B. Written communication
C. Verbal communication
D. Body language
10. What is the most appropriate way to answer a patient’s/resident’s telephone?
A. “Good morning. Mrs. Gray’s room”
B. “Good morning. Third floor”
C. “Hello. Who is calling?”
D. “Good morning. Mrs. Gray’s room, this is Mary Jones, Nurse Assistant speaking”
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 22 of 40
11. What information must be included when giving an end of shift report?
A. The full name and address of the patient/resident.
B. Facts and specific information that were observed and care given by the Nurse Assistant.
C. Number of visitors
D. Personal feelings about the patient/resident
12. Listening skills are enhanced by:
A. Engaging a patient/resident in an activity
B. Being animated while listening
C. Conversing in a public location
D. Empathy
13. A patient/resident tells the Nurse Assistant that he misses participating in religious activities. The most helpful action by the
Nurse Assistant at this time is to:
A. Tell the patient/resident that it is against policy for the Nurse Assistant to discuss religion with patients/residents
B. Memorize each patient’s/resident’s religious preference
C. Insist that the patient/resident attend the religious services offered by the agency
D. Talk with the patient/resident about religion to encourage discussion
14. A confused patient/resident was recently moved to a private room at the family’s request. The Nurse Assistant understands that:
A. The patient/resident may experience an increased appetite
B. Patients/residents with dementia cannot tolerate isolation
C. Any change in routine can produce anxiety in a patient/resident
D. The patient/resident probably did not want to change rooms
15. Information that can be seen, heard, or smelled is called:
A. Assessment
B. Observation
C. Objective data
D. Subjective data
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 23 of 40
16. When should changes in a patient’s/resident’s condition be reported?
A. Right away
B. As soon as possible
C. During the patient/resident care conferences
D. During the end-of-shift report
17. When charting, it is essential to record:
A. Safety measures performed
B. What co-workers observed
C. What co-workers did
D. Comments of the family and guests
18. A patient/resident was moved out of her home and into a long-term care facility. She is angry about being moved. How will the
Nurse Assistant be most helpful for this patient/resident?
A. Ignore her behavior
B. Sit with her and let her express her feelings
C. Tell her that she will get used to the facility
D. Ask another patient/resident to talk with the new patient/resident
19. Which action is best to do before transferring a telephone call?
A. Explain that the call is going to be transferred and where
B. Set the phone down and find out where to transfer the call
C. Take a message
D. Find out the reason for the call
20. Stress is best defined as
A. A vague feeling of apprehension
B. A response to any demand made on an individual
C. The main cause of illness
D. Blaming another for one’s problems
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 24 of 40
21. The Nurse Assistant is assigned to the care of a newly admitted patient/resident who does not speak English. What is the best
approach for the Nurse Assistant when beginning care?
A. Use pictures and gestures to communicate with the patient/resident
B. Ask the charge nurse to get an interpreter
C. Delay care until the family can come in to interpret
D. Find a television station in the language the patient/resident understands
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 25 of 40
Sample Test Answers: Module 3
1. C
2. C
3. B
4. C
5. B
6. D
7. B
8. B
9. D
10. D
11. B
12. D
13. D
14. C
15. C
16. A
17. A
18. B
19. A
20. B
21. B
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum
- Revised December 2018
Page 26 of 40
Module 3: Communication/Interpersonal Skills
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum
- Revised December 2018
Page 27 of 40
Module 3: Communication/Interpersonal Skills
Handout 3.2: Examples of Human Needs
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 28 of 40
Examples of Human Needs as Related to Maslow
Winning games
Original paintings
The pride of
rehabilitation
Self- Actualization
Self Esteem
Laughing at my old jokes
Keeping your promise to me
Accomplishing agenda behavior
Asking my opinion
Never making fun of me
Listening to me
Love
Caring when I hurt
Admiring my grandchildren
Holding my hand or hugging me
You’re thinking about what I may want or need
Safety and Security
Washing your hands before you touch me
Shutting off the air conditioning when my arthritis hurts
Using a gait belt when you help me walk
Finding the bone in my creamed chicken before giving me my tray
Physical needs
Keeping me clean and caring for my skin
Stopping to give me a drink of water
Finding me an extra blanket at night
Feeding me everything served even though I am slow
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 29 of 40
Module 3: Communication Skills
Handout 3.4a- How to Fold a Napkin- Written Instructions
How to Fold a Napkin- Written Instructions
“Fleur de Lis” Shape
1. Fold napkin in half diagonally to form a triangle.
2. Bring right and left points to the center to form a diamond.
3. Fold bottom points up to about one inch from top and fold it back on itself.
4. Turn napkin over bringing corners together, tucking one into the other.
5. Turn the napkin back over.
6. Peel down the right and left side from the top center to make petals.
7. Open base to stand upright.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 30 of 40
Module 3: Communication Skills
Handout 3.4b- How to Fold a Napkin- Drawings
How to Fold a Napkin—Fleur de Lis
Fold napkin in half diagonally to form a triangle.
Bring right and left points to the center point to form a diamond.
Fold bottom points up to about one inch from top and fold it back on itself.
Turn napkin over bringing corners together, one into the other.
Turn napkin back over. Peel down the right and left side from the top center to make petals. Open base to
stand.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 31 of 40
Module 3: Communications Skills
Handout 3.8a: Myths about Conflict
Myth #1: “Conflict is Negative”
Myths About Conflict
Conflict is natural, neither positive nor negative, it just is. It is the outcome of conflict that can be good or bad. In nature, friction
between elements (wind, sand, and water) acts as its primary motivator for change, creating beaches and canyons, mountains, and
pearls. It is not the situation that causes upset and bad feelings, but how people handle it. A disagreement between friends can lead
to an end of the friendship or a chance to gain a better understanding of how the other person views things.
Myth #2: “Conflict is a Contest”
Conflict is not a contest. Conflict just is. People choose whether to make it a contest, a game in which there are winners and losers.
There doesn’t always have to be a winner and a loser. That’s great for a game, which people decide to play that way, but to be a
loser at work or in a family or community doesn’t feel great for anyone. The ideal is to create solutions in which everyone’s needs
are met and they are all winners. Resolving conflict is rarely about who is right. It is about acknowledgement and appreciation of
differences.
Myth #3: “The Presence of Conflict is a Sign of Poor Management”
An effective leader anticipates conflict when possible, deals with conflict when it arises and enjoys its absence when possible.
Conflict, in itself will not affect the way other people feel about someone else. If however, they choose to ignore the conflict and
allow it to continue, their employees will see them as a less-than-effective leader. On the other hand, if they address the conflict and
motivate the staff, they will win their support and respect. They may avoid future conflicts as well.
Myth #4: “Conflict, if Left Alone, Will Take Care of Itself”
This is a half-truth. People can avoid conflict – it is a valid coping strategy, but not the only strategy. The intensity of the conflict
varies. Left unchecked, conflict can escalate as easily as dissipate.
Myth #5: “Conflict Must Be Resolved”
This myth stifles creativity, causing the leader to become solution-oriented. Some conflict is best managed by endurance, while
other events require multiple solutions. Quick movement toward resolution can limit success.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 32 of 40
Module 3: Communication Skills
Handout 3.8b: Conflict Self-Assessment Activity
Conflict Self- Assessment Activity
Directions: Answer each of the following questions. This self-assessment will not be handed in nor graded.
1. What is your definition of conflict?
2. What is your definition of conflict resolution?
3. Give an example of a previous conflict in your life and your method of resolving the conflict.
4. What are the ways you usually resolve conflicts?
5. Give an example of a conflict and/or conflict resolution that you have observed in a clinical setting.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 33 of 40
Module 3: Communication Skills
Handout 3.8c- Five Conflict- Handling Modes
The Five Conflict-Handling Modes
A. Competing:
1. Assertive and uncooperative.
2. Power-oriented.
3. Useful for:
a. Standing up for rights.
b. Defending an important position.
c. Trying to win.
B. Accommodating:
1. Unassertive and cooperative.
2. Involves self-sacrifice.
3. Useful for:
a. Charitable causes/generosity.
b. Obeying orders.
c. Yielding to another point of view.
C. Avoiding:
1. Unassertive and uncooperative.
2. Does not address the conflict.
3. Useful for:
a. Diplomatic sidestepping.
b. Avoiding until a better time.
c. Withdrawing from a threatening situation.
D. Collaborating:
1. Assertive and cooperative.
2. Seeks to satisfy both sides.
3. Useful for:
a. Gaining additional insights.
b. Avoiding negative competition for resources.
c. Solving interpersonal problems.
E. Compromising:
1. Somewhat assertive and somewhat cooperative.
2. Solutions are mutually satisfying; acceptable to all.
3. Middle ground mode.
4. Useful for:
a. Splitting the difference.
b. Making concessions.
c. Finding a quick middle-ground position.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 34 of 40
Module 3: Communication Skills
Handout 3.8d: 4 “E’s” of Constructive Feedback
4 “E’s” of Giving Constructive Feedback
Definitions:
1. Feedback: Information given to and received by an individual about his or her performance.
2. Behavior: What an individual does or says.
3. Objective: Specific description of a behavior or action rather than judgment, evaluation or interpretation.
4. Constructive Feedback:
A. Provides information to improve performance
B. Is a vehicle to promote constructive relationships
C. Promotes an environment of openness and mutual respect
D. Provides a way to monitor how things are going
E. Creates a way for issues to come to the forefront before they become major problems
F. Keeps lines of communication open and assists staff in owning problems and creating solutions
4 “E’s”:
Engage: Set the stage to convey your positive intent in the spirit of mutual respect and learning.
Preparation:
o Think about the positive outcome you want to achieve. Even if you are giving feedback “on the spot,” frame
it in terms of what behavior, issue, and situation you want to improve. Don’t give feedback unless there is a
constructive outcome you wish to achieve. Have that outcome in mind when you give feedback
Link feedback to common goals:
o How will the feedback improve processes, meet deadlines, enhance the work environment
State what you want to discuss
o “I have a concern about…”
o “People need to talk about…”
o “I have some thought on…”
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 35 of 40
Module 3: Communication Skills
Handout 3.8d: 4 “E’s” of Constructive Feedback
Empathize: Determine the best time and place to convey the message focusing on facts and feelings, while utilizing active listening.
Environment and Timing
o Think about distraction, other people that may be around, or whether or not the person is upset
o Address feeling that may emerge to enable you to move on to the point of the discussion
o If “on the spot” feedback is necessary, move to a private area
Educate: Describe observation and impact of behavior: Focus on the situation, issue or behavior, not the person.
Descriptive observation
o State the facts and avoid judgment, evaluation, or interpretation
o Be specific and to the point
o Convey respect and support
o Stay focused on the issue at hand; avoid past or unrelated situations
o Don’t let issues go unaddressed or you run the risk of unleashing stored up concerns
Impact of behavior
o Describing the impact of the behavior helps to keep the discussion objective and will help minimize
defensive responses
o Link behavior to business goals or challenges:
▪
Improved patient/resident care
▪
Customer satisfaction
▪
Better access to patient/resident information
▪
Improved work environment
o Point out one or two of the most significant consequences
Remain objective
o Avoid getting caught up in your own emotions
o If this may be a “hot button” issue for you, practice ahead of time or role-play with a colleague
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 36 of 40
Module 3: Communication Skills
Handout 3.8d: 4 “E’s” of Constructive Feedback
Enlist: Set the stage for the person to respond: Focus discussion on solutions. Promote open discussion.
Elicit the person’s response.
o Use feedback as a tool to ascertain what the person thinks
o Use questions to probe, such as:
▪
“What are your thoughts about…?”
▪
“How do you think people can improve this situation?”
▪
“What do you suggest can be done?”
o Listen and summarize what you heard. This will let you validate what you heard and demonstrate that you
are interested in what the person has to say
o Proceed based on the person’s response
Guide toward a solution
o Move the discussion toward a solution based on standard practice and/or your expectations. Avoid telling
the person exactly what to do
o Guide and assist the person in developing possible solutions to promote ownership of the problem
o Assist the person in selection and implementation of behaviors supporting resolution
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 37 of 40
Module 3: Communication Skills
Handout 3.10: Defense Mechanisms
DEFENSE MECHANISMS
Introduction:
In order to better understand patient/resident behavior, as well as our own and our co-workers, it is necessary to know something
about mental mechanisms, what they are and how and when they are used.
Assignment:
1. What are the basic needs of every individual? List them below:
2. What happens when these needs are not met? Sometimes they can’t be satisfied because of:
A. Cultural and social restrictions. Give an example:
B. Environmental limitations. Give an example:
C. Personal, social, religious beliefs. Give an example:
D. Personal, physical or intellectual limitations. Give an example:
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 38 of 40
Module 3: Communication Skills
Handout 3.10: Defense Mechanisms
3. When people’s needs cannot be met – they feel insecure, their self-image (the way they see themselves) is threatened, they
may experience frustration and develop anxiety and tensions. This is often true of patients/residents in the hospital.
Hospitalization often makes a patient/resident feel:
A. Helpless and insecure
B. Isolated
C. That self-identify is threatened or lost
What are some of the symptoms of anxiety? List them below.
4. What do people do when their needs cannot be met and they are frustrated and anxious? If their actions are:
A. Successful – they will:
1. Recognize the problem troubling them
2. Think through possible solutions
3. Do something about the situation – change their environment, themselves or both
B. Unsuccessful – this may lead to all sorts of problems, mental illness, psychosomatic disorders, etc.
C. People may resort to using mental mechanisms to assist in coping with frustrations and anxieties.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 39 of 40
Module 3: Communication Skills
Handout 3.10: Defense Mechanisms
5. Mental mechanisms are patterns of behavior that consciously or unconsciously help people handle their anxieties and feel
better and more comfortable with themselves. These are actions which keep people from facing reality. They help the
symptoms but not the real problem. They protect a person’s self-image. They are useful if used in moderation and can help
people in trouble. When used habitually, they can become like big thick walls which protect people from reality. It is hard to
get through to people who have developed such strong defenses. They may never learn to face and solve problems
maturely. Mentally ill people sometimes carry this to the extreme. People may use several of these mechanisms and tend to
use those which have been successful in the past, so that this sort of response may become habitual.
A. Regression- Reverting to childish behavior. There aren’t as many responsibilities to face and this type of
behavior gets attention. For example, a child may return to thumb sucking when a new baby is born, or a sick
patient/resident may make childish demands and become increasingly dependent on the nurse for personal
care. At the other extreme there is the mentally ill patient/resident who curls up on the floor in the fetal
position, soils himself, and is dependent on the nurse for feeding, bathing, toileting, and daily hygiene.
B. Rationalization - Is an unconscious mechanism sometimes confused with reasoning. It is important for
people to think well of themselves. Rationalizing can make this possible. It is face-saving. It is developing
good, socially acceptable reasons to explain behavior and feelings so that the self-esteem and the approval of
others are retained. Continual dependence on this mechanism develops the type of personality who never
assumes responsibility for personal behavior, rather goes through life making excuses for personal failures.
For example, an individual who is unable to do acceptable schoolwork drops out of school and claims it is
because he can no longer go along with “the dumb stupid type of education that is being offered”. Another
example is a patient/resident who states he cannot give up smoking because he would gain weight and that
would be more dangerous to his health than cigarettes. Remember this is not a conscious deception.
C. Projection – Is an unconscious mental mechanism which is close to rationalization. A person attributes or
imputes to other people his own intolerable and unacceptable feelings, wishes or thoughts. For instance, a
nurse may dislike a particular patient/resident very much. As a good nurse she may feel she shouldn’t dislike a
patient/resident and it hurts her own self-image as a good nurse, so she may say that the patient/resident does
not like her. A student, who cheats and wishes that he could stop, may accuse other people of cheating. In
the mentally ill patient/resident this may lead to blaming others and paranoia.
California Community Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018
Page 40 of 40
Module 3: Communication Skills
Handout 3.10: Defense Mechanisms
D. Displacement – Is the redirecting of thoughts, feelings and impulses directed at one person or object but
t a k e n out upon another person or object “unconsciously”. For example, a hospital administrator criticizes a
head nurse when something has gone wrong. The head nurse feels hurt, his self-image as a good head nurse
is threatened, and he feels insecure. He returns to the floor and criticizes the team leader. The team leader in
turn criticizes the nursing assistant and the Nurse Assistant becomes crabby and irritable with a
patient/resident.
E. Denial – Is one of the simplest and most primitive of a person’s ego defenses. Material, facts, feelings, and
experiences that are intolerable are disowned by the unconscious denial of their existence. For example,
parents may have all sorts of evidence that their children are misbehaving, but do not believe it. “Our children
wouldn’t do that.”
F. Conversion – Substituting acceptable physical symptoms for unacceptable emotions and feelings. For
example, a student has a test and is nervous and afraid of failing, develops nausea and vomiting.
G. Repression – Probably the most widely used defense mechanism. It is an unconscious, involuntary, and
automatic pushing away of a person’s intolerable ideas and unacceptable impulses into the subconscious
where they are not normally subject to recall. One example is forgetting a dentist appointment. Feelings
associated with the repressed material may still be present. For example, a man who was rejected by his
mother as a child has difficulty in relationships with women, even though he has long forgotten the initial
rejection.
H. Sublimation – Consciously unacceptable drives (urges) are channeled into personally and socially accepted
behaviors. Those who work off sexual drives in athletic competition, or an angry housewife who scrubs the
kitchen to work off her temper are two examples.
I. Substitution (or compensation). An unconscious process by which an unacceptable emotion or unattainable
goal or object is replaced by a more acceptable or attainable one. Example: a childless woman becomes a
nursery school teacher.
J. Identification – the process, unconscious, by which an individual patterns himself on another, perhaps by
transferring to himself the thoughts, behaviors, and body language of the other person. For example, a person
may believe he is Napoleon, or that she is Queen Mary.
