Unit 11

The Language of Encouragement

Workplace English for Nursing Assistants

Meet Trudy

Watch the video about Trudy. Watch what happens.

Talk about it

1. What benefits would Trudy gain by walking to the dining room for meals?
2. Trudy's care plan says "assist of one." May you use two healthcare workers to walk them safely? Why?
3. What assistive device might steady Trudy, and on which side would you stand?
4. Trudy is angry about the gait belt. What are THREE sentences you would say: agree, suggest softly, offer a choice.

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Movement helps clients stay strong, healthy, and independent. Healthcare workers support clients with walking, daily activities, and range-of-motion exercises. They must follow the care plan, use the correct equipment, and ask for more help when needed. They also encourage clients with respectful language, without ordering or forcing them.

Movement & exercise terms

Term	Plain meaning
ADLs (Activities of Daily Living)	Everyday self-care: walking/transferring, bathing, dressing, using the toilet.
IADLs (Instrumental ADLs)	Daily tasks that use tools/appliances: cooking on a stove, laundry, cleaning with a mop.
Active range of motion (AROM)	The client moves the joint themselves; you give verbal reminders.
Passive range of motion (PROM)	YOU move the client's joint through its motions; the client helps little or not at all.

Range-of-motion (ROM) exercises move each joint through its natural positions. They keep muscles toned and prevent contractures (a joint that stiffens and loses function). Never push a joint past the point of resistance; if it hurts, stop and tell the nurse. The movements come in opposite pairs:

Range-of-motion movements in opposite pairs

Movement	Meaning	Opposite
Flexion	Decrease the joint angle (bend)	Extension (straighten)
Abduction	Move AWAY from the body's midline	Adduction (toward midline)
Dorsiflexion	Toes point UP	Plantarflexion (toes point down)

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Ambulating Clients Safely

Assistive devices

• Walker: set just below the hips. The client pushes off the bed/chair to stand — never pulls up on the walker (it can tip).

• Crutches: for a temporary injury, and only for a client with good balance who can bear weight on the good leg. Weight goes on the hands, not the armpits.

Practice 1

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The Hard Part: They Don't Want To

Everything above assumes the client agrees to walk. Very often they do not. Walking is tiring. It hurts. It is frightening after a fall. It takes twenty minutes to do what used to take one.

A client has the right to refuse. You cannot make anyone walk, and you should not try. What you can do is make it easier to say yes.

Rule 1: Agree first

The instinct is to argue: "But walking is good for you." That is true and it does not work — it tells the client their feeling is wrong.

Start by agreeing with something true.

Rule 2: Make the advice soft

English has strong advice and soft advice. They mean the same thing and land completely differently.

Strong, less strong, and soft advice

Strength	Phrases
Strong / direct	"I suggest that you…" "My advice is that you…" "I strongly recommend…"
Less strong	"You should…" "It might be a good idea to…" "If I were you, I'd…"
Weak / softer	"You could…" "Why don't we…" "You might try…" "Some people find…"

Rule 3: Offer a choice, not a command

A choice gives the client control and is much harder to refuse than a yes/no question — because both answers are yes.

Practice 2 — Encouraging Without Ordering

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Dialogue Practice

Read these dialogues out loud with a partner.

Mrs. Ferreira, 79, is a one-assist. Her care plan says one walk each shift. She is in her chair with a magazine and does not want to move.

You: Good morning. It's about time for your walk — shall we?

Mrs. Ferreira: Not today. My legs are killing me.

You: You're right — it does hurt. You worked hard yesterday.

Mrs. Ferreira: (surprised) ... Well. Yes, I did.

You: Why don't we just go as far as the door and see how you feel? If it's no good, we come straight back.

Mrs. Ferreira: The door. That's all?

You: That's all. And — now, or after your programme finishes?

Mrs. Ferreira: (sighing) After the programme. Twenty minutes.

You: Twenty minutes. I'll come back then — shoes ready.

Twenty minutes later they reach the door. The healthcare worker asks again.

You: How's it feeling?

Mrs. Ferreira: Not too bad, actually.

You: Then how about the window, and we call it a day?

Mrs. Ferreira: Go on then.

Mrs. Okonkwo has not walked for three days. Each time you offer, she is very pleasant about it.

You: Shall we do a little walk before lunch? You could just try standing for a minute first.

Mrs. Okonkwo: Oh — I'll think about it, dear.

You: Of course. How about I come back at half past and we see?

Mrs. Okonkwo: Maybe later. Thank you though.

Two polite refusals. In English, "I'll think about it" and "maybe later" are a no, not a delay. The healthcare worker asks once more, smaller — then stops.

You: That's all right. Is there something making it harder this week? You were doing so well.

Mrs. Okonkwo: (pause) I don't like the dining room. Everyone watches me shuffle.

You: Ah. I agree — that's a horrible feeling. I hadn't thought of that.

Mrs. Okonkwo: It's silly.

You: It isn't silly at all. What if we walked the back corridor instead? Nobody down there but the linen cart.

Mrs. Okonkwo: ... That I might do.

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Role Plays

Work with a partner.

Situation

Mr. Lindqvist, 83, is a stand-by assist whose plan says one walk each shift. He is comfortable in his chair after lunch and says he is too tired. Nothing is medically wrong today.

Your Goals:

1. Agree with something true BEFORE you suggest anything.
2. Use a SOFT advice form — not "you should" or "I recommend."
3. Shrink the ask to something small and specific.
4. Offer a choice where both answers are yes.
5. Add a reason using "so that" or "to."
6. Ask again once he is up — but accept his answer.

Situation

Mr. Yamada has skipped his walk four days in a row. He is unfailingly courteous and has said "I'll think about it," "maybe later," and "that's kind of you" each time. Something else is going on.

Your Goals:

1. Recognize the polite refusal as a NO — do not treat it as "not yet."
2. Ask ONE more time in a smaller form, then stop asking.
3. Ask kindly WHY it has become harder.
4. Agree with whatever real reason he gives.
5. Offer an option that solves the actual problem.
6. Say that you will report the pattern to the nurse — and why that helps him.

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Cumulative Review

Fill in the Blank

Use a word from the word bank. Each is used once.

cardiovascular · safety · healthcare worker · ambulation · moving

1. The goal of exercise, like walking, is to keep the heart strong.
2. is very important when ambulating clients, to prevent injury.
3. In PROM, the physically moves the client's joints.
4. Part of the student's job is to help clients with and .

Multiple Choice

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Back to Trudy

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For the instructor — not part of the student pages

Instructor Answer Key

Unit 11 — The Language of Encouragement

This unit combines safe mobility skills with respectful ways to encourage participation. Learners study activities of daily living, active and passive range of motion, contracture prevention, ambulation, gait belts, canes, walkers, crutches, and when additional help is needed. A case study about Trudy connects stroke recovery and weakness to safe walking and client choice. Through illustrated readings, flashcards, knowledge checks, dialogues, and role-plays, learners practice acknowledging a client’s feelings, making a large request smaller, offering soft suggestions and genuine choices, encouraging movement without ordering or forcing, and reporting changes in strength or ability.

Practice 1.1: 1. True 2. True 3. False 4. True 5. True. Practice 1.2: 1. strong 2. affected 3. walker 4. hands.

Practice 2.1 (strength): 1. S 2. Soft 3. LS 4. Soft 5. S 6. Soft. Practice 2.2 (yes/no): 1. YES 2. NO 3. NO 4. YES 5. NO 6. YES. R1 Fill in: 1. cardiovascular 2. safety 3. healthcare worker 4. moving, ambulation.

Back to Trudy Multiple Choice: 1-c, 2-b, 3-a, 4-c, 5-b, 6-a.

R3 Case Study (sample): (1) Better balance and muscle tone, prevents contractures and pressure injuries, aids digestion and circulation, supports self-esteem. (2) Yes — more help than the care plan lists is always allowed; less is never allowed. Report the repeated weakness to the nurse for reassessment. (3) Proper nonskid footwear, gait belt on, assistive device in front and working, brakes locked, tell Trudy the plan and count to three. (4) A cane or quad cane in the strong (left) hand; stand on the affected (right) side. (5) Range-of-motion exercises to the weak/affected side (active or passive), plus ADLs that move the joints. (6) Answers vary — score all three parts: agreement with the feeling, a soft small suggestion, and a genuine choice. The gait belt itself is NOT negotiable.

Suggested drill — the three-sentence drill

Read one client refusal aloud, such as: “My legs hurt,” “I’m too tired,” “I did it yesterday,” or “It’s undignified.”

The learner must respond in exactly three sentences:

1. Acknowledge the client’s feeling or concern.
2. Make one small, gentle suggestion.
3. Offer the client a genuine choice.

Stop after the third sentence. The limit is important because additional explanation can easily become arguing or pressure.