IT WAS MY first day as a new grad with patients of my own. Working in a Level I trauma center ICU sounded like such fun when I was in nursing school, but on that day, I felt intimidated. Orientation on the unit was an extensive and informative blur. I still had questions and plenty of concerns, but I asked myself, "Is anyone ever really ready?" Luckily, that was enough to get me out of the huddle room and down the hallway to my assigned patients. I knew other nurses who would be excited to have the chance to exercise their critical thinking skills caring for high-acuity patients, but I was too nervous to be excited that day.
My first patient had a family member with her in her room. Although endotracheally intubated, she wasn't sedated, so she was actively interacting with her sister and me. Despite assurances that she was doing okay and that she and her family were in good hands, my patient mouthed something to her sister. The sister then asked me on her behalf, "You're nervous, why?"
What had I done to relay my inner nervousness? I told myself I had to regain their confidence. I said with a smile, "I'm not nervous. It's just that we have to ask some silly questions to make sure you're okay, and it might make me seem nervous."
I could tell that I hadn't convinced my patient when I looked into her eyes. I realized at that moment that our patients observe our body language and facial expressions for information about their condition as carefully as we read theirs for signs of pain or discomfort. So what messages could I possibly have been sending, and how?
I decided that I'd probably been slouching-something I did habitually but unconsciously at the time. Not a very confidence-inspiring posture. After I left the patient's room and began to think more about the interaction, I realized I needed a change. I began to look for ways to improve the image I was projecting to my patients.
The power of body language
First, I happened upon a video presentation about posture.1 The speaker's research showed that maintaining a "power stance" for 2 minutes lowered cortisol levels, increased testosterone levels, and made her test subjects perform better on stressful tests. Imagine Wonder Woman with her feet apart, her hands on her hips, looking boldly into the eyes of her opponent-that kind of stance.
This jogged a memory of an episode of Dog Whisperer with Cesar Millan I'd watched years ago.2 In this particular episode, Cesar (a professional dog trainer) was working with a dog that couldn't walk on the sidewalk in a busy community without cowering. It was both debilitating for the dog and heartbreaking to watch. Cesar's simple yet innovative solution was to tie another leash to the dog's tail and raise it into a confident show dog position. With some work, the once fearful animal was transformed and walked without hesitation down the street. Improvements in posture, it seemed, really could help me master my nerves, lower my stress levels, and convey a confident attitude to my patients.
It was time to put it into practice. With some mirror work, I was able to internalize a confident body posture. Assuming a natural-looking position proved to be difficult to master and required constant maintenance initially, but grew easier with time. Maintaining awareness of my posture and improving my body language got me through many difficult care situations, reducing anxiety and stress for my patients and their families, too.
Learn the language
I'm challenging you to give it a try. Assess your body language during your next encounter with a patient. Does your body language signal a lack of confidence, dissatisfaction, frustration, or inattention? Patients and their family members will pick up on it.
Seasoned nurses and preceptors: Please challenge your new grads to be mindful of their body language. Nothing is more dismaying to a patient than watching a nervous young nurse prepare to insert an I.V. catheter. As new nurses master their body language, they'll learn to conquer their nerves-and their patients' confidence in them will grow.
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