- Body language (e.g., use of hands or arms).
- Facial expressions.
- Eye contact (depends on culture).
- Lip movements.
- Gestures.
- Posture.
- Physical appearance (including clothes and grooming).
- Space (distance between two people).
- Touch (differentiate for skilled care and support).
- Silence (can be therapeutic or awkward).
- Qualities of voice (intonation, rate, rhythm, and pitch).
- Active listening.
- Avoid interruptions.
- Concentrate on the speaker.
- Maintain eye contact if culturally appropriate to do so.
- Lean toward and face the speaker.
- Maintain open posture, not crossed arms.
- Make a conscious effort to hear and understand the other person; avoid premature interpretations and judgments.
- Avoid extensive note taking.
Touch is a form of nonverbal communication that is a learned behavior filled with meaning. Touch is generally not necessary in obtaining a health history but is necessary in performing a physical assessment. This poses a difficult problem for the nurse. In general, it is best to avoid the use of touch, particularly invasive procedures, until a nurse-patient relationship is well established and the nurse is knowledgeable about the beliefs related to touch in the particular culture. When touch becomes necessary, it is best used by members of the same gender and culture. If touch seems appropriate while taking a nursing history (e.g., if a patient should begin crying), gentle touch of the nurse’s hand on the patient’s upper arm or shoulder could be used.