The meaning of silence varies among cultural groups. Silences may be thoughtful, or they may be empty when a person has nothing to say. A silence in a conversation may also show stubbornness, or worry. Silence may be viewed by some cultural groups as extremely uncomfortable; therefore attempts may be made to fill every gap with conversation. Persons in other cultural groups value silence and view it as necessary for understanding a person's needs.

Many native Americans value silence and feel it is a basic part of communication among people, just as some traditional Chinese and Thais do. Therefore, when a person from one of these cultures is speaking and suddenly stops, what may be implied is that the person wants the listener to consider what has been said before continuing. In these cultures, silence is a call for reflection.

Other cultures may use silence in other ways, particularly when dealing with conflicts among people or in relationships of people with different amounts of power. For example, Russian, French, and Spanish persons. may use silence to show agreement between parties about the topic under discussion. However, Mexicans may use silence when instructions are given by a person in authority rather than be rude to that person by arguing with him or her. In still another use, persons in Asian cultures may view silence as a sign of respect, particularly to an elder or a person in authority.

Nurses and other care-givers need to be aware of the possible meanings of silence when they come across the personal anxiety their patients may be experiencing. Nurses should recognize their own personal and cultural construction of silence so that a patient's silence is not interrupted too early 'or allowed to go on unnecessarily. A nurse who understands the healing value of silence can use this understanding to assist in the care of patients from their own and from other cultures.