Unit 8
Person-Centered Conversation
Workplace English for Nursing Assistants
Meet Gene
Watch the video about Gene. Watch what happens.
Gene — Waiting Near Nursing Station
Talk about it
- Since Gene is nonverbal, what signs would you watch for to learn how they feel?
- Name one emotional, one physical, and one spiritual way to care for Gene holistically.
- What social activities could Gene take part in, even without talking?
Core person-centered care terms
Chattybot · FlashcardsScan to drill these words out loud.
| Term | Plain meaning |
|---|---|
| Holistic care | Caring for the whole person — physical, emotional, social, and spiritual needs, not just the body. |
| Quality of life | A measure of happiness: emotional health, physical comfort, spiritual wellness, and social activity. |
| Homeostasis | The body keeping its internal state stable despite outside changes (e.g., staying 98.6°F on a cold day). |
| Esteem | Respect or admiration — for yourself (self-esteem) and for others. |
| Self-actualization | Meeting your own social, creative, emotional, and spiritual needs; reaching your full potential. |
| Nonpharmacological pain management | Relieving pain WITHOUT medicine (e.g., repositioning, warm blankets, music, massage). |
Practice 1 — Core Words
1.1 Match the term to its meaning
- 1. Quality of life
- 2. Nonpharmacological pain management
- 3. Holistic care
- 4. Esteem
- 5. Self-actualization
- 6. Homeostasis
- A. Admiration or respect
- B. The body keeping its internal state stable despite outside changes
- C. Meeting one’s own emotional, social, creative, and spiritual needs
- D. A measure of happiness: emotional health, physical comfort, spiritual wellness, and social activity
- E. Caring for a client’s emotional, physical, social, and spiritual needs
- F. Managing pain without the use of drugs
Maslow’s Hierarchy of Needs
Chattybot · FlashcardsScan to drill these words out loud.Maslow arranged human needs as a triangle. You must meet the lower needs before the higher ones — a hungry, frightened person cannot focus on creativity. Read the triangle from the bottom up.
| Level | The need | How you meet it as a caregiver |
|---|---|---|
| 1. Physiological | Food, water, breathing, sleep, elimination | Offer food and fluids often; toilet the client promptly |
| 2. Safety | A safe body, home, money, and ethics | Keep the client safe (e.g., a working wander-alert bracelet) |
| 3. Love & belonging | Friendship, family, intimacy | Build a caregiver relationship; encourage family visits |
| 4. Esteem | Respect and self-respect | Offer choices; treat the client with dignity |
| 5. Self-actualization | Creativity, learning, full potential | Encourage arts, outings, and mind-stimulating activities |
Test questions ask which level an action meets. Learn the anchors:
- Getting a job / money → Safety.
- An art tour or museum visit → Self-actualization.
- Making friends → Love & belonging.
- Being offered choices → Esteem.
Notice something about levels 3 and 4. Love and belonging and esteem are not met with equipment or procedures. They are met almost entirely with words — with how you talk to the person, and whether you talk to them at all.
- Would you like to wear the blue sweater or the grey one?
- Is it better for you to wash now or after breakfast?
- You have two choices: the dining room or your room.
- How about we do your hair first?
Practice 2 — Maslow’s Hierarchy
2.1 Put the five levels in order, bottom (1) to top (5)
- Esteem
- Physiological needs (food, water, sleep)
- Self-actualization
- Safety
- Love and belonging
2.2 Which level does each action meet?
(choices: physiological • safety • love & belonging • esteem • self-actualization)
- A client finds a new job to support their family.
- You take a client on a tour of a local art exhibit.
- You offer the client choices during their care.
- You encourage visits from family and friends.
- You offer food and fluids and help the client to the toilet.
- You call a client “Mrs. Adler” instead of “sweetie.”
The Skill of This Unit: Small Talk
“Small talk” means light, friendly conversation — the weather, a photo on the wall, a football game. It sounds like the opposite of work. In this job it is part of the work: it is how you build the relationship that meets love and belonging, and it is your main tool against loneliness and social isolation.
It depends. Not when the client is busy with visitors, in pain, or trying to sleep. But many clients — especially those with few visitors — want very much to talk to you, and the two minutes you spend may be the only real conversation they have that day.
Safe topics and taboo topics
In the United States, some topics are safe — friendly and low-risk with almost anyone. Others are taboo — too personal for a work relationship, even when you mean well. This differs between countries. In many places it is normal and warm to ask a new acquaintance what they earn, why they have no children, or how much they weigh. In a U.S. workplace, those questions can upset a client or become a complaint.
| ✔ SAFE topics | ✘ TABOO topics |
|---|---|
| The weather; the seasons | Money, salary, the cost of their care |
| Food, meals, cooking, recipes | Age, weight, or body size |
| Family photos the client shows you | Why someone has no children / is not married |
| Pets, gardens, plants | Religion — unless the client raises it |
| Sports, hobbies, music, TV shows | Politics, elections, who they voted for |
| Their old job, their hometown | Their diagnosis or another client’s |
| Holidays and traditions in general | Sex, relationships, personal habits |
| Compliments on a room or a sweater | Your own problems, money, or opinions |
- That’s a beautiful photograph — who is that?
- It’s really coming down out there. Do you like the rain?
- Is that your garden in the picture?
- What did you do before you retired?
1. If the client raises a taboo topic, they may. You may listen. A client can talk about their religion, their money worries, or the election. You listen kindly — but you do not give your own opinion, and you never argue.
2. Never talk about another client. “Mrs. Rossi down the hall has the same thing” is a privacy violation, not small talk.
- Uh-huh. / Mm-hmm.
- Go on. / I’m listening.
- Really? You’re kidding!
- That’s wonderful. / Oh, no — I’m sorry to hear that.
How You Speak Is Part of the Care
Maslow level 4 is esteem — respect. Respect is not only what you say, but how you say it. There is a very common, very well-meant habit that damages it, and it has a name: elderspeak.
Elderspeak is talking to an older adult the way you would talk to a small child. Almost everyone who does it is being kind. Most older adults hear it as being treated like a toddler.
| ✘ Elderspeak | ✔ Respectful speech |
|---|---|
| “Are we ready for our bath?” | “Are you ready for your bath, Mrs. Adler?” |
| “Good girl! You ate it all up!” | “You finished your lunch — that’s good to see.” |
| “Sweetie / honey / dearie / darling” | “Mrs. Adler” — until she says “call me Ruth” |
| A high, sing-song voice; very slow speech. | Your normal adult voice; slower only if they ask. |
Start with Mr., Mrs., or Ms. and the family name, every time, with every new client. Use a first name only after they invite you to. Ask on the first day: “What would you like me to call you?” Then write the answer in the care plan so the whole team uses it.
Some clients will say “Oh, call me Betty — and you can call me sweetheart if you like.” Then that is what they want, and it is fine. The rule is not “never say honey.” The rule is ask first.
Quality of Life: Four Areas
Chattybot · FlashcardsScan to drill these words out loud.Quality of life answers one question: “Does the client enjoy life?” If not, ask which area is missing, and help with it. There are four areas.
| Area | What to watch for / do |
|---|---|
| Emotional health | Content, smiling, coping well = healthy. Allow feelings; use therapeutic communication; report mood problems. |
| Physical comfort | Ask “Are you in pain?” Relieve it. Watch a nonverbal client for pain signs (see below). |
| Spiritual wellness | Respect the client’s religion or lack of it. Support meditation, nature, quiet time. |
| Social activity | Encourage friendships, family visits, and group activities suited to the client’s stage. |
Reading a nonverbal client’s pain
Some clients cannot tell you they hurt. Watch and listen: facial grimacing, sighing, groaning, crying, guarding a body part when moved, or a pained expression. Then work through simple causes — too hot or cold, needs the toilet, needs repositioning, hungry, thirsty, tired, product too tight. If they are still uncomfortable, tell the nurse.
Never urge your own religious beliefs on a client, and never assume their religion from the chart. Always ask what they prefer, then support the spiritual or religious activities that matter to them — or none, if that is their choice.
Practice 3 — Quality of Life
The four areas: emotional health • physical comfort • spiritual wellness • social activity
3.1 Which area of quality of life?
- Helping a client to a comfortable position and asking about pain.
- Encouraging a client to join an after-lunch card game.
- Giving a client quiet, private time to meditate.
- Allowing a client time to express their feelings.
3.2 Reading a nonverbal client
1. List three signs that a nonverbal client may be in pain or discomfort.
______________________________________________________________
2. True or False: You may call in a priest for a dying client without asking, if you are sure it will comfort them.
Practice 4 — Safe and Taboo Small Talk
4.1 Safe or taboo? Write “Safe” or “Taboo.”
- “That’s a lovely photo — is that your daughter?”
- “How much does it cost your family to keep you here?”
- “It’s freezing out there today, isn’t it?”
- “Why did you and your husband never have children?”
- “What did you do before you retired?”
- “Who are you going to vote for?”
- “Mrs. Rossi down the hall has the same condition as you.”
- “Is that your garden in the picture?”
4.2 Elderspeak or respectful? Write “E” or “R.”
- “Are we ready for our bath?”
- “Good morning, Mr. Haddad. Are you ready for your bath?”
- “Good girl, you ate it all up!”
- “What would you like me to call you?”
- “Come on, sweetie, let’s get our sweater on.”
- Say the five levels in order, bottom to top.
- A client joins the after-lunch card game. Which level?
- Write one sentence that offers a client a real choice.
- Name three safe topics and three taboo topics.
- A client starts telling you who she voted for. What do you do?
- Write one opening question about a photo on a client’s wall.
- What is elderspeak? Give two examples.
- What do you call a new client on the first day?
- Rewrite: “Are we ready for our nap, sweetie?”
- Name the four areas of quality of life.
- Give three signs a nonverbal client may be in pain.
- A client stops joining activities. Who do you tell, and what do you say?
Dialogue Practice
Read these dialogues out loud with a partner.
Mrs. Adeyinka, 88, has been at Maple House three weeks. She has had no visitors. You are making her bed; she is in the chair, watching you.
You: Good morning, Mrs. Adeyinka. Did you sleep all right?
Mrs. Adeyinka: (shrugs) Well enough.
The healthcare worker finishes the bed, then sits down in the other chair instead of leaving.
You: That’s a beautiful photograph. Who is that?
Mrs. Adeyinka: (pause) That’s my husband. Nineteen fifty-eight. He was a tailor.
You: A tailor. Really?
Mrs. Adeyinka: Forty-one years. He made that suit he’s wearing. He made my wedding dress too — everyone said no man should do that, but he did.
You: Go on. What was it like?
Mrs. Adeyinka: Ivory. Little covered buttons, all the way down the back. Twenty-six of them. I counted them on the morning.
You: Mm-hmm. Twenty-six.
Mrs. Adeyinka: (laughing) You must think I’m a silly old woman.
You: Not at all. I’d like to hear more tomorrow, if you’ll tell me.
Mr. Baptiste used to play cards after lunch every day. He has not come out of his room since Thursday. You mention it to the nurse.
You: Do you have a minute? It’s about Mr. Baptiste — nothing urgent, but something’s changed.
Supervisor: Go ahead.
You: In summary, he’s stopped going to the card game. Four days now, since Thursday.
Supervisor: Is he eating?
You: Less. He leaves about half. To sum up, no card game since Thursday, eating about half, and he’s in the chair facing the window when I come in.
Supervisor: Did anything happen Thursday?
You: His son called and cancelled the weekend visit. I heard the end of the call. It sounds like he was looking forward to it — is that right? That’s my guess, not something he said.
Supervisor: Good. I’ll assess him for depression. Keep offering the card game — don’t push, just offer.
You: Offer every day, don’t push. Got it.
Role Plays
Work with a partner.
Situation
Mr. Sandoval, 84, has been in the facility a month and rarely speaks to anyone. In his room: a photo of a fishing boat, a small wooden carving, and a folded flag in a case. You have finished his morning care and have two minutes.
Your Goals:
- Open with a question about something HE chose to display.
- Use at least THREE Verbal Cues to keep him going.
- Ask ONE follow-up question about what he tells you.
- Stay entirely on safe topics.
- End by saying you would like to hear more another time.
Situation
A cheerful new coworker calls every client “baby doll” and says “Are we going to be good for our shower?” A client has just said something sharp to him about it and he is hurt and confused. He asks you what he did wrong.
Your Goals:
- Acknowledge that his intention was kind.
- Name elderspeak and give ONE concrete example from what he said.
- Explain the “we” problem in plain words.
- Give him the exact sentence to use instead.
- Teach him the day-one question about names.
Cumulative Review
Multiple Choice
1. Providing holistic care means paying attention to the client’s
- physical and emotional needs
- social and spiritual needs
- both physical/emotional AND social/spiritual needs
2. Joanne is gardening in 90-degree heat and begins to sweat. This is an example of
- homeostasis
- self-actualization
- elimination
3. Meeting one’s social, creative, emotional, and spiritual potential is called
- self-image
- self-actualization
- esteem
4. Luther lost their job and cannot support their family. Finding new work meets Maslow’s level of
- esteem
- safety
- love and belonging
5. Taking a client on a tour of a local art exhibit helps meet the need for
- esteem
- love and belonging
- self-actualization
6. Which is a nonpharmacological way to relieve a client’s pain?
- giving a pain pill
- repositioning and a warm blanket
- calling the doctor
7. A nonverbal client who is grimacing and guarding their arm is most likely
- hungry
- in pain or discomfort
- asleep
Part 2 — Fix the elderspeak
Rewrite each sentence respectfully.
- “Are we ready for our nap, sweetie?” →
______________________________________________________________
- “Good girl! We finished all our dinner!” →
______________________________________________________________
- “Let’s get our teeth brushed now, dear.” →
______________________________________________________________
Part 3 — Open a conversation
For each thing you notice in a client’s room, write one safe opening question.
- A framed photo of a young man in a navy uniform.
______________________________________________________________
- A large, well-watered plant on the windowsill.
______________________________________________________________
- A baseball cap with a team logo on the bedside table.
______________________________________________________________
Back to Gene
Read the case and answer in complete sentences. Use the sentence starters if you wish.
You work in a long-term care facility. Gene has dementia and does not talk to staff or other clients. Gene sits near the nurses’ station, waiting for their partner to visit. You notice Gene looks upset. When you ask if something is wrong, Gene just shakes their head and looks away.
1. Give one way you could help Gene meet each of Maslow’s five levels.
______________________________________________________________
2. Since Gene is nonverbal, what signs would you watch for to learn how they feel?
______________________________________________________________
3. Name one emotional, one physical, and one spiritual way to care for Gene holistically.
______________________________________________________________
4. What social activities could Gene take part in, even without talking?
______________________________________________________________
5. How could you help meet the needs of Gene’s partner when they visit?
______________________________________________________________
Instructor Answer Key
Unit 8 — Person-Centered Conversation
This unit explores how communication supports dignity, belonging, and quality of life. Learners apply Maslow’s hierarchy of needs to caregiving and examine loneliness, holistic care, small talk, appropriate workplace topics, personal choices, and the harmful effects of elderspeak. A case study about Gene asks learners to interpret nonverbal behavior and consider physical, emotional, social, and spiritual needs. Through illustrated readings, flashcards, knowledge checks, dialogues, and role-plays, learners practice starting respectful conversations, offering manageable choices, observing nonverbal cues, reporting what they notice, and correcting child-directed speech without embarrassing a coworker.
Practice 1–4 and Review
Practice 1.1: 1-D, 2-F, 3-E, 4-A, 5-C, 6-B.
Practice 2.1 (order): Physiological = 1, Safety = 2, Love and belonging = 3, Esteem = 4, Self-actualization = 5. Practice 2.2: 1. safety 2. self-actualization 3. esteem 4. love & belonging 5. physiological 6. esteem.
Practice 3.1: 1. physical comfort 2. social activity 3. spiritual wellness 4. emotional health. Practice 3.2: 1. any three of — grimacing, sighing, groaning, crying, guarding a body part, pained expression. 2. False (never assume; always ask first).
Practice 4.1 (safe/taboo): 1. Safe 2. Taboo 3. Safe 4. Taboo 5. Safe 6. Taboo 7. Taboo (also a privacy violation) 8. Safe. Practice 4.2 (elderspeak/respectful): 1. E 2. R 3. E 4. R 5. E.
Multiple Choice: 1-c, 2-a, 3-b, 4-b, 5-c, 6-b, 7-b.
Back to Gene Case Study (sample): (1) Physiological: offer food/fluids and toileting; Safety: ensure a safe area and wander-alert; Love/belonging: sit with Gene, welcome the partner’s visits; Esteem: offer choices, use their proper name, treat with dignity; Self-actualization: art, music, or a craft. (2) Facial expression, sighing/groaning, crying, guarding a body part, looking away, restlessness. (3) Emotional: allow feelings and use calm, therapeutic communication; Physical: check for pain/comfort and reposition; Spiritual: quiet time, music, or nature as Gene prefers — ask, do not assume. (4) Music, crafts, watching or feeding activities, gardening, being present in group settings. (5) Build a relationship with the partner, give them private time with Gene, and suggest support (e.g., a senior center or facility volunteering).
Put three objects on a table (a photo, a plant, a cap). Set a timer for two minutes. The learner must sit down, open a conversation about one object, and keep the partner talking for the whole two minutes using cues and follow-up questions only — no talking about themselves.
Two minutes feels very long the first time. That discomfort is the point: most learners fill silence by talking about themselves, and the client stops being the subject of the conversation.