Every day we are faced with challenges and opportunities for growth and change both at a personal and professional level. As advanced practices nurses (APNs) we can capitalize on these opportunities provided we are willing to step out of our comfort zone. For most individuals, professional speaking is not within their comfort zone. If we examine the strategies that lead to success at the podium, we notice that the skills that make us effective program leaders, educators of staff/patient/families, and members of highly functional teams are the same skills necessary to be an effective presenter. Public speaking can increase self-confidence, heighten awareness, and enhance personal power. By learning how to communicate more effectively and to actively listen, personal and professional relationships can be improved. The ability to express ideas clearly, concisely, and with confidence is the best collateral for future career success. However, most graduate education programs are limited in their provision of sufficient knowledge or practical experience in developing and giving professional presentation. Therefore, gaining skill in giving presentations in the APN role requires knowledge of successful strategies, as well as practice. As with all skills, repeated performance helps one to perfect their presentation abilities.
Knowing the basic elements of giving successful presentations can help the APN in preparing and delivering a presentation. The ideal presentation has the audience participating, leaving fully satisfied with new ideas supported by facts that help them to feel inspired to change or think in a different way. How is this outcome reached 100% of the time? The outcome is easily obtained by consistently incorporating the key components to every successful presentation. These components include preparing the message and mastering the delivery skills.1-7
Preparing the Message: the Key to Success
Several strategies can be used to create a presentation that will excite, educate, enthuse, or inspire. Preparation is key.7 An ill-prepared presenter sends a dramatic message to an audience saying, "I don't think you are very important; if you were I would have been better prepared." Up to 10 hours of preparation time may be needed for every 1 hour of presentation time.3 Preparation entails choosing the right topic; knowing your target audience; defining the purpose; crafting the message in a clear, concise, and logical format; and creating visual aids to support the message.
Selecting a Topic and Knowing the Audience
An APN may be requested to speak on a topic or may independently submit an abstract for consideration for a presentation. When requested to speak or self-select a topic, consider narrowing your choice to areas that you have knowledge or experience and find exciting. Preparing an exceptional presentation takes significant time and energy. If the topic doesn't generate passion within, it is likely not to elicit a favorable response from your audience.8 The presentation's title should convey the purpose or key content. A topic chosen must also fit the intended audience.
Understanding the audience is essential to delivering a meaningful message. What is their background? Why are they here? Is their participation mandatory or self-selected? What will be the size and how much time is available to deliver the message? The answer to theses questions helps to create and tailor a more effective message. It will also help in the selection of appropriate humor, graphics, and analogies. Knowing the size of the audience will determine whether a formal or informal delivery style would work best, the number of handouts required, and the level of preparation and practice necessary. One of the most important assessments of an audience is finding the common ground to make the connection and begin to build rapport. This will speak to the reality of the message and the sincerity of its delivery.
Defining the Purpose and Organizing the Information
The next step in the preparation phase is to determine the purpose of the presentation. Motivating the audience to action is why we speak and should always be a presentation's overriding purpose. There are several additional reasons for giving a speech: to inform, solve a problem, persuade, and/or sell an idea. Defining the purpose before beginning review of the literature will help shape the search and prevent wasted work. When designing the content, remember that the audience will be asking, "What's in this for me and what content applies to me?" Listeners are more likely to pay attention to a presenter who understands and affirms their point of view.
A presenter can use different methods for organizing materials (Table 1). Creating an outline with an introduction, a body with several key messages, and a conclusion is called the topic method. If using the story line method, information is organized by telling a story from beginning to end. One example of this type of presentation is a hospital's experience preparing for Magnet status. Problem-solving format can be an effective organizing strategy. Presentations on quality improvement initiatives frequently use this method by defining the problem and sharing the solution. Organizing a presentation using an analogy can be very creative. Consider delivering a presentation on oxygen transport using the analogy of a train, its equipment, and the conductor. The analogy method assists the learner in understanding complex information by connecting it with something familiar.9 Using a series of letters (pneumonic) as an organizational structure may help the learner with greater retention. A presentation on head of the bed, mobility, and oral care to reduce ventilator-associated pneumonia could be arranged around the letters HMO. (Debra Trau, personal communication, April 2004). The strategy should match the audience to deliver maximum impact and greatest retention.
Information for the content of the presentation is gathered from a variety of sources including the Internet, journal articles, research, professional associations, newspapers, and personal communications. Timeliness and quality of the information help enhance the final product and build credibility.3 Before starting the review, create themes or an outline with subheadings based on the organizational strategy chosen. Important information and references can be transferred onto note cards and labeled with the theme or subheading. As you prepare to construct the speech, the note cards can be grouped and placed in the order of the outline.10
How much information is enough to gather for a presentation? One recommendation is to gather seven times more information about the topic as you will use and only use approximately one-third.11 Several strategies can be used to help construct a speech. The information cards can be used to build slides with notes or the speech can be written. When writing a speech every 1,000 words are equivalent to 10 minutes of speaking time.5 It is important to write the speech using a conversational tone. When done successfully the audience will feel as if the presentation was written uniquely for them. In addition, writing out a speech may help the APN use the template as a precursor for a publishable article.
Presentation Components
All presentations must include a powerful introduction and conclusion with three to five key messages delivered within the body of the talk regardless of the organizational strategy. The body is 80% of the content, leaving 20% to the introduction and conclusion.12 An introduction must capture the audience's attention and convey the purpose of the talk. It sets the expectations and establishes interest and credibility. The first 90 seconds of a presentation are critical and must engage the learner. It serves as a warm up and registers a feeling to the audience that you are glad they are there. Express your excitement. Start crisply; the audience will sense the adrenaline running high. They will see it, feel it, and want to be a part of it. A mind can quickly tune in or out. Use a quote, a story, music, or an anecdote that relates to the presentation. For example, a creative way to open a talk on positioning strategies to improve oxygenation in critically ill patients might be to start with a 35-second clip of a song such as "Turn, Turn, Turn," queued to correspond to slides/graphics of various positioning strategies both serious and humorous. Another example is a presentation on the impact of cocaine on the myocardium. A creative opening might include the song "Cocaine" to exemplify how we have glorified drugs within music; the message can then be offset visually using slide posters from the Partnership for a Drug-Free America Campaign (Denise Adams, personal communication, April 2004). With your initial impression, create curiosity; raise awareness and a sense of coherency.
The body of a presentation is a fairly classic structure. The old adage of tell them what your going to tell them, tell them, and then tell them what you told them applies to any presentation. The central core of the presentation delivers the three to five key messages in a clear and concise manner. Key messages are supported with the addition of helpful tools or hooks. Hooks are short, catchy phrases or concepts that remain in the mind of the audience long after you leave.2 They strengthen the message, make it memorable, and help grab the audience's attention. Examples of hooks include: humor, analogies, personal examples, statistics, quotes, questions, headlines, audience-based anecdotes, songs, and emotions.
Presentation Strategies/Hooks
The key messages of scientific presentations are frequently supported by very detailed, intricate information, making learning difficult. The uses of analogies are especially helpful to convey critical concepts. An analogy takes the subject matter and links it to a common every-day concept. For example, one strategy to describe the role and function of cellular mediators in acute respiratory distress syndrome (ARDS) might be to compare them to a scrubbing bubble. The job of a scrubbing bubble is to remove the dirt and grime from the sink or bathtub. The natural role of cellular mediators in the lung is to remove the dirt and foreign bacteria. In ARDS the scrubbing bubbles get mean. They are no longer just cleaning the dirt from the bathtub; they are beginning to eat away at the enamel. In essence the mediators are no longer serving in a protective fashion but are causing direct injury to the lung tissue. This type of analogy takes a very complex subject and makes it completely understandable.
Real-life experiences are another strategy or hook that help to deliver the key message in a memorable way. Sharing with an audience as a bedside practitioner how you first started to believe that some patients required greater-than every-2-hour positioning in order to improve their gas exchange is one example. The story unfolds to explain the presenter's experience in caring for critically ill patients on the night shift. After having read a research study where animals demonstrated a better effect on gas exchange when turned every 30 minutes, the presenter described how this concept was applied with critically ill ARDS patients. The initial discovery of the benefit of frequent positioning led to a 20-year research interest on the impact of positioning strategies in critically ill patients. Real-life experiences help to place the audience into the contextual environment and to continue to build rapport while emphasizing a key point. The audience recognizes the validity of emotion being shared. When using self-disclosures or self-confessions, be brief, clear, and always relevant.2
Humor is a very powerful hook when used appropriately. It can be a strong ally in getting the message across. Most successful humor is conveyed using the fewest possible words and is personalized. The types of humor that are off limits include: slapstick, gratuitous insults, put-downs, sarcasm, and humor that contradicts your personality or philosophy. Have you ever been to a presentation where a joke slide is used that is completely unrelated to the talk? Chose humor that fits the context precisely.2 For example, during part of a presentation that is discussing creative feeding strategies for ventilator patients a graphic is shown that depicts a ninja turtle frog with a pizza hanging from a pole. In a humorous way this picture represents a creative kind of enteral nutrition. Another method to engage the learner is asking questions throughout a presentation. It is an effective way to switch the brain from a passive listening mode to an active mode. The audience is not required to respond verbally unless requested, but the question itself creates the desired change from passive to active learning. The body of the presentation must sustain the interest. Use of these tools or hooks will keep the delivery of the message clear while entertaining and engaging the audience in the learning process.
The final piece of the presentation is the conclusion. In this segment a presenter must tie introductory comments and key content messages with a closure that focuses on a call to action or an inspiration. In a presentation on the development of a unit-based bereavement program for families who have lost a love one in the intensive care, a call for action was made. If anyone in the audience was interested in starting a program, the speaker made the material available for free; however, the gift included a contingency. If you requested the material, a verbal contractual promise was made that you would "pay it forward" (return the kindness) three times. A story line in a recent movie of the same name showed how a good deed was done for three people, with the only request being that they "pay it forward" to three additional people. In the movie this resulted in touching many more lives. This conclusion was a very strong emotional hook and resulted in the desired action. In actual use of this technique, to date 75 packets have been mailed out within the United States and overseas. (Glenda Graft, personal communication, March 2004).
Visual Aids
Visual aids are the final component of preparation and are essential to a dynamic presen-tation. Visual aids include slides, overheads, handouts, and also the speaker. They assist the presenter in sequencing material, clarifying information, stimulating interest, enhancing memory, and reducing an idea or theme to its essential components. Visual aids should support the verbal and not distract from the presentation. The ideal visual aids act as supplements to a presentation, not as substitutes.13 A speaker can improve an audience's perception of his or her presentation with well-designed visuals. Most (75%) learners are visual, 13% are auditory, and 12% are kinesthetic learners.14 Each visual should have a distinct function; if not, it should not be used. Learners remember 10% what is read, 20% of what is heard, 30% of what is seen, and 50% of what is seen and heard.14 Therefore, your visual aids need to add to the presentation's content, not distract from it.
With the ability to self-generate visuals, the presenter must be aware of several pitfalls in the use of PowerPoint or other software programs that create visual aids. Overuse of color, multiple templates, fonts, pictures, sounds, and custom animation results in the learner focusing on what will appear on the next slide versus the content of the message.15 If the presenter is spending more time interacting with the computer than connecting with the audience the visual aid will be ineffective. There are several rules to follow when creating visual aids (Table 2). Background color must have a high level of contrast to the text color to maximize readability. Colors should be used to create a mood, focus attention, or stir the senses. To ensure a sense of cohesiveness, a consistent color should be used throughout. If a computer template is used, the design must not interfere with the ability to visualize the text. Clarity of text against a design background on a 17-inch computer screen may not be discernable when projected on a large screen in a conference hall. Text should be limited to the 5-7-7 rule; five words in the title, seven words in a line, and seven lines of text per slide.16 When writing text for a slide, incomplete sentences or phrases should be used to convey the main points and one concept per slide. Limit the number of fonts for the presentation to two. The use of many fonts creates a significant distraction. The best fonts to use for maximum visibility are Serif (Times New Roman, Bookman Old Style, Century Schoolbook, and Garamond) and Sans Serif (Arial, Arial Black, Lucida Sans, and Comic Sans Serif). The font size for the title should be 40 or 44 point, with basic text size being no smaller than 24 point. Uppercase letters are difficult to read; therefore, sentence case is best. When using a graphic, it should be placed on the left side of the slide if it serves as a learning cue and on the right side if it is supplemental to the text. Most individuals read from left to right; therefore, placement of the graphic is done to achieve the appropriate effect. The title should also be positioned on the left or centered.17,18 The use of animation where the object moves across the screen is distracting. If using animation or screen transition it is better to use the wipe, fade, or dissolve effects than to use the fly or spiral effects because the former do not move across the screen and distract the learner.19 Multimedia type features should only be used to add a video or music if it enhances the message.15
Handouts are an essential part of the visual aid package. Opinions vary as to whether PowerPoint handouts should be given at the beginning or end of a presentation. If given at the beginning, there is the risk that the learner will read ahead and ultimately lose interest in the talk. If given at the end, learners may become preoccupied in capturing all the key concepts while taking notes, ultimately distracting from their ability to concentrate on the key messages. Consider placing at least 80% of the material presented in the handout. The handout should always include the title of the presentation, your name and credentials, role, institution/business, contact information, outline/PowerPoint slides, and a reference list. If making a PowerPoint handout, print the handout using three to six slides per page in black and white. If slides have areas of text that have been filled in with dark coloring as background, remember to lighten before printing or the text will be unreadable. The purpose of a handout is to help the audience retain more information. Before the handout is sent for copying, proofread for content, clarity, spelling, and grammar.
The final and most effective visual aid for any presentation is the presenter. Slides are the appetizer, but the presenter is the main course.8,20 How you present yourself will send a clear message to the audience about your passion, confidence, and sincerity. Personal grooming and appearance provide an instantaneous projection on the surface of how you feel inside. It is another form of nonverbal communication. When considering what to wear, a common-sense approach should be used. As the presenter you should be the best-dressed person in the audience. Keep the accessories simple so as not to distract. Presenters should have between nine and 14 accessories.21,22 Accessories can be categorized as different color hose from your shoes, or jacket from skirt or pants, a necklace, each ring or ear ring, a scarf, etc. The main item of clothing is the one that has the most material near your face. Start by ensuring that color best matches your skin tone. There are two major color palettes: cool and warm tones. The way to self-test which palette looks best with your skin is easy. Under excellent lighting hold a bright white cloth and a cream or beige cloth next to the face. Watch what happens to the skin tone and eyes. Which color makes the eyes "come alive"? Which color makes you look vibrant and healthy? If it is white, you belong to the cool color palette that includes black, white, blue-based reds, royal blue, emerald green, shocking pink, and silver. If the cream-based cloth looks better, you belong to the warm color palette that includes dark brown, olive, cream, teal blue, coral, orange red, camel, and gold.21 Another way to identify the appropriate color palette is to examine the color of the veins in your hand. Veins that are more blue/red in color belong to the cool color palette; veins that appear more yellow/green belong to the warm color palette. A winning style image is created when the right color is combined with the interplay of line, proportion, and balance in the wardrobe selection. Remember, you are your best visual aid.
Delivery Skills: Power at the Podium
Mastering delivery of a presentation requires conquering the fear of public speaking and creating a solid connection with the audience. Fear is the number-one emotion that prevents APNs from communicating effectively in any forum, whether to one person or 100. Nervousness prevents us from behaving normally. Nerves make us to talk too fast, usually in a higher-pitched voice with jerky body motions or gestures. Each presenter must be able to recognize how his or her nervousness might present itself. Frequent symptoms include "butterflies" in the stomach, dry mouth, sweating, increased heart rate, rocking motion, fiddling with objects or clothing, and general body tension. Nervous energy can be used effectively when channeled to provide a heightened level of awareness, energy, and a greater sense of connection with your environment.3 There is a point at which the fear and nervousness hinders the ability to convey the message. This crossroad is dangerous. This is the point where the audience no longer sees the presenter's nervousness as an endearing life sign but as a black cloud. The audience begins to worry and becomes nervous. Never announce nervousness. The audience will feel obligated to worry about the presenter and the admission won't inspire great confidence.
So how do we make the fear work for us? Several strategies can be used to conquer the nervousness and use the energy to your benefit. These include preparation, practice, a night-before routine, and a pre-speech warm up.
The first, and likely the most important, activity to reduce nervousness is preparation. Lack of preparation is the single-greatest contributor to fear and nervousness. Being prepared reduces anxiety, improves style, and increases one's confidence level.8 Preparation encompasses both the construction of the content and a sufficient number of practices to ensure adequate knowledge and comfort with the material. How much practice is enough? A presenter should practice at least three times for every new speech. The first practice focuses on presenting the content and obtaining a general sense of time and flow with notes and note cards. Familiarizing yourself with the material versus memorizing the content is key. The second practice should concentrate on voice emphasis, gestures, and eye contact. Consider presenting in front of a full-length mirror to examine your body language, eye contact, and gestures. The third practice provides the opportunity to rehearse with the visual aids while adding the finishing touches of humor, analogies, and personal stories. Consider improving the delivery by having a critique performed by peers or a videotape of the speech in order to conduct an in-depth analysis. This method can help identify awkward phrases, blind spots, and repetitive words like "um," "you know," and "actually" that are frequently used to fill silence periods when nervous. Remember, preparation and practice can reduce fear by 75%.22
The night-before routine includes avoiding alcohol or heavy meals and indigestible foods.2 A usual routine might consist of a light dinner, one last review of the material, and getting a sufficient night's sleep. That routine carries over to the morning by starting with exercise to infuse energy. Arrive early to the room to check on the functioning of audiovisual aids. Use this time to ask a few questions to a few members of the audience. Find out what they would like to gain by attending. This builds rapport and projects warmth and friendliness.17
The official warm-up occurs 5 to 10 minutes before the presentation. It is called the ABC routine: affirming, breathing, and composing oneself.23 The affirmations include self-talk about how one looks and feels. The key is to fill the mind with positive thoughts that will reinforce success. If the self-talk is negative, such as, "I just know that I am going to forget my speech," "I don't feel as if I am ready," "I don't know my material as well as I should," the outcome will be as the self-talked predicted. Talking positively to yourself screens distraction and allows pure concentration that will raise the level of performance. The talk may include a statement like, "I know this material extremely well; I have studied it, rehearsed it, thought about it, and know it."
The B in the ABCs refers to breathing: The use of deep-breathing techniques to ease nervousness is a great warm-up activity. Breathe deep from the abdomen versus the chest. Abdominal breathing helps relieve tension and improves voice projection.
The final prep activity is "C" or composing yourself. Composure focuses on additional strategies to relieve muscle tension. Take a brisk walk before the presentation begins. The walk will loosen up the whole body loosened and burn off excess nervousness. Consider creating a warm-up routine like athletes do before a performance. The job is demanding on the vocal cords, nervous system, body coordination, and circulation. If the speaker is not warmed up, he or she is liable to be tense, awkward, and slow to think. Walking in the hallway before a presentation and greeting audience members helps. Both practices help burn off excess energy; the latter also begins building rapport with the audience while warming up the voice. Consider going to the bathroom 5 to 10 minutes prior to the start time. Just prior to stepping onto the stage, use the technique of anchoring. An anchor is a gesture alone, or a combined gesture and word that helps to recall previous feelings/emotions around a particular event. The anchor is created and reinforced after successful presentations. It locks in the feelings, emotions, and physiology of the moment. The anchor is used just before the next presentation to recapture the feeling of success and confidence.24 The very last thing to do before stepping up to the podium is to smile. It is very difficult for the brain to register fear when smiling.
Success on Stage
The first step to achieving success on the stage is to warm up the crowd. This is done mostly through physical movement, and a good introduction with the addition of effective eye contact. Eye contact helps to establish a degree of intimacy with an audience. It is a powerful tool. Start with a friendly face or a supporter, then move around and make eye contact with others; let them feel your energy. If you encounter an unfriendly face and become unnerved, return your focus to a supporter, get refueled, and try again. Make eye contact with the entire audience including those members in the back rows. Shifting eye contact greater than every 5 seconds can reduce its role as a powerful nonverbal message.2 Eye contact is a type of punctuation and conveys 55% of the nonverbal message. Eye contact also serves as an effective feedback tool. It tells you whether the audience understands the message, agrees or disagrees, or is bored. The assessment will allow a speaker to adjust content as needed to meet the audience's needs. Eye contact may be affected by standing in a pool of light, reading notes, looking at the audiovisuals versus the crowd, or if audience lighting is too dark or they are seated too far away.
Another technique to maintain the audience's attention is movement. Physical movement increases your exposure to the audience and is a part of your body language. Body language is an essential component to any message, as it is five times more powerful than the verbal message.17,23 If the two languages are inconsistent, the audience will believe the body message every time. To improve body language, consider increasing your physical space by a slightly broader stance and wider gestures. Keep your posture erect with chin up. This conveys a sense of energy and confidence. Plant the feet firmly to prevent rocking from side to side. When moving on stage, make it deliberate. The movement should coincide with an important verbal point or a transition. Eliminate distracting items and try not to hold anything beyond a laser pointer. The final component of body language is the appropriate use of gestures. The most successful gestures are those that are the most natural. These include resting the arms comfortably whether on a podium or at the side, opening arms and palms if it matches the verbal message, enumerating with the hands, tenting the fingers, and sweeping the arm from one side to the other to show movement or progress. Larger audiences require the speaker to make exaggerated movements or gestures to convey the same visual effect that a normal gesture would have with a smaller audience.3 Gestures that convey a negative body language message include rigid posture; arms crossed at the chest; a tight grip on the podium or projector with white knuckles showing; playing with hair, clothing, or face; clasping hands behind you; mismatching gestures and words; shrugging; or moving extraneously in any way.
Your voice is one of the most powerful personal presentation tools. The sound and quality of the voice is 35% of the impact where visual is 55% and verbal message or word choice is 7%.11,23 The voice enhances the visual and brings feeling to the entire presentation. The presenter's personality and character can be conveyed in various voice dynamics. Vary the voice in speed, volume, and pitch to match the content of the message and place emphasis on key components.5 Voice speed adds energy; volume adds emotional intensity; and range/pitch adds color and human qualities. The situation and topic will influence volume and range and the nature of the material will help to determine the speed. The use of a pause can create focus and attention to an important concept. It gives the audience time to think and can signal a transition. A speaker is the most persuasive when using the voice to create a more conversational tone with the audience versus a feeling of being addressed.2 The unique use of eye contact, body language, voice speed, volume, pitch, and wardrobe of a speaker becomes his or her style. The speaker's style when properly used makes it easier to engage, persuade, inspire, and hold the audience's interest.8 A Speaker's Checklist might be a useful strategy for incorporating the many components to designing and delivering an effective presentation (Table 3).
A few additional factors will help to create a stronger impact for any presentation. Consider the issue of timing and the amount of content to present. Various factors can interfere with the ability to present the content in the scheduled amount of time. Know what can and cannot be extracted from the presentation if time is running short. Consider designating a section that can be extracted completely instead of trying to trim words or phases from various sections of the talk.3
Effectively Managing the Question-and-Answer Period
The question-and-answer period is a critical component of any presentation because it is the last impression for an audience. Often it is considered the most unsettling part of a presentation. We fear that questions will be asked that we are unable to answer or that an audience member will challenge a part of the content that we will be unable to defend. A speaker must recognize that audience participation or questions are a complement. Questions are an expression of genuine interest. There are no hostile questions, only defensive answers. Several strategies can help to facilitate a successful question-and-answer period (Table 4). As part of preparation, a speaker should anticipate and answer likely questions. If the list exceeds 20 questions, it probably means content needs to be added to the presentation's body. If a hostile question is asked, provide a brief response and communicate that you will continue the discussion later, then move to the next question. Use the question-and-answer period to bring the audience back to the key messages delivered within the presentation.
Conclusion
Whether we ever stand in front of an audience of 100 or just one individual, the key components of preparation, practice, delivery style, and stage presence are key in our ability to persuade, inspire, engage, or share ideas and thoughts. Consider taking that step out of your comfort zone. Effective use of the tools and techniques included in this article will make the process more comfortable and allow you to control your fear. Presenting can be fun, engaging, and reenergizing. APNs have a commitment as a part of their higher education and advancing the profession of nursing to share the knowledge generated to improve patient care and outcomes. Overcome the fear and find the passion in presenting.
References