Presenting problems

When it comes to public speaking, most people – including nurses – are
filled with dread. But with the right training giving a presentation needn’t be
a fear-inducing experience, by Linda Caren

I hate heights. I once had to be carried off the Coca-Cola Roller Coaster at
the Glasgow Garden Festival in 1990, having lost all dignity and the power of
my legs. As for public speaking, just the thought of it produces the kind of
rapid weight loss Dr Atkins could only dream about. Both activities can get me
hyperventilating for Scotland. So why get involved in either? It’s the
challenge. In my case, it’s that self-doubting inner voice that says, "So…
you think you’re a big girl? Let’s see if you’re really up to this one."

I hear this voice a lot now I’m the wrong side of 40, so when I recently
received a telephone call from a friend asking me if I’d like to speak at an OH
study day in Ayrshire, I heard the gauntlet strike the floor. So, instead of
replying honestly "No, in fact I’d rather stick pins in my eyes", I

Now, I do think Mark Twain said it best, "There are two types of
speakers: those who are nervous and those that are liars".

Fear of speaking in public is listed as the number one fear of all fears,1 death
being number seven.

I asked Carol Bannister, the RCN’s occupational health spokeswoman what she
thought might put nurses off presenting at conference level.

"Time constraints mainly. Most nurses are already too busy in their
working lives to devote the amount of time required to preparing a paper for
presentation. That, and the fact that a lot of nurses simply don’t feel that
what they do is innovative enough for people to want to listen to, and they are
very experienced, very highly educated people… nervousness is a factor of
course, especially for novice speakers. I remember seeing one delegate
literally tremble from head to toe prior to presenting at her first national
conference. She regularly speaks very successfully at international level now. Fear
is something that will subside with practice."

How do we get that practice?

The RCN offers study days and workshops designed to help nurses prepare
themselves and their papers for presentation. These events are free, but
generally very poorly attended. OH education courses do provide the opportunity
for practitioners to present to fellow students, but that might be a one-off
performance and may not provide the crucial, one-to-one, detailed feedback
needed to polish a performance to a professional standard.

There are frequent opportunities to raise the OH profile in the workplace. I
spoke to 20 OHNs working across Scotland’s central belt.

Sixty per cent regularly trained or presented to groups of employees,
including management.

The range was impressive. From toolbox talks to small groups on sharps
injuries and blood-borne viruses, travel health, skin-care programmes,
prevention of occupational asthma, manual handling programmes, hearing
conservation and first aid training/scenarios, to corporate induction
programmes, maximising attendance at work presentations, and in some cases,
presenting the service to a potential customer.

Great opportunities to practice, but only 25 per cent of the nurses I spoke
to reported this as being an enjoyable experience. The lack of feedback made it
difficult for the nurses to assess whether or not the presentation or training
had been understood, or had made any positive difference to the working
practice within the company.

Considering that many of us – particularly those working for local
authorities or within the NHS – have very large numbers of employees to reach
and have to manage with limited resources, it doesn’t make sense to miss any
opportunity to address groups in large numbers, while making sure our efforts
are effective.

In order to share ideas, knowledge and opinion as widely as we can, speaking
or writing in the public arena 2 is very necessary and we will be more
effective if we can convey a passion for what we do.

Why learn to present?

How nurses present themselves (both physically and verbally) can affect the
success of their overall message.

We know from Mehrabian’s3 research that the impact and perceived sincerity
of any communication is primarily body language, at 55 per cent. The sound of
the communication or voice quality accounts for 38 per cent, the words
themselves only 7 per cent.

In communication, where there is disharmony between the words and the body
language, the listener pays attention to the non-verbal part of the

So if how you look and how you sound accounts for 93 per cent of your
communication, it might be reasonable to assume that most of us would benefit
from some professional help to try to ensure our presentation skills complement
the message we intend to convey.

Presentation training

Within AHS, (see box on p18) our training and development
consultant/business coach, Margaret Rose was tasked to address this issue.
Members of our multi-disciplinary team, OH advisers, OH physicians,
occupational hygienists and our ergonomist have attended her three-day training
programme, alongside delegates who were also our customers. This gave us the
opportunity to strengthen relations with our clients and market the role of OH
within the workplace.

On successful completion we were awarded the nationally-recognised Chartered
Institute of Environmental Health’s (CIEH) professional trainer’s certificate.

The course included sessions on:

– Accelerated learning, learning styles and group dynamics

– Structuring, writing and reviewing objectives

– Planning and structuring the three phases of an interactive training
session using buzz-maps/thought showers

– Question technique

– Visual and kinaesthetic learning aids5

– The skill of giving and receiving structured feedback to develop learning

Most importantly, the critical part of the coursework was to deliver two
training sessions to the other members – no previously prepared pieces of work
were permitted – the first lasting 30 minutes, the second assessment lasting 45
minutes. The sessions were both videoed to allow the class to see how potential
barriers such as irritating mannerisms, unnecessary hand gestures, and
physical/verbal tics (see Figure 1) can distract an audience from getting the
point of the presentation.

Although uncomfortable at first, the camera was almost immediately forgotten
and proved an invaluable tool by allowing us to see how an audience might
perceive us.

Margaret Rose’s formula for success is:

"200 per cent preparation to achieve a 90 per cent delivery. You can’t
prepare enough and on reflection, there’s room for improvement every

Our first attempt proved that old habits die hard, and remaining in our
comfort zones we produced

– Slide shows – as opposed to training sessions

– Word-for-word reading of notes delivered in a monotone (a read intro is a
dead intro)

– Boring, cramped, overhead slides in small type, complete with spelling

– Abandoning of notes part way through and ‘winging’ the rest of it

– Failing to anticipate the needs of the audience – completely

– Asking closed questions

Most people feel nervous before speaking to a group of people, but
nervousness in itself isn’t a bad thing as it allows the adrenaline to flow and
contributes to a better performance. The aim is to get the balance right so as
to appear as a good speaker even if you are quaking inside.

The secret lies in good preparation of yourself

After delivering the second training presentation and feedback sessions, we
could see how steep our learning curve had been in achieving the required
standards. The resulting training sessions from my colleagues were really
enjoyable, enlightening and informative.

As for my presentation at the nursing study day, I was still horribly
nervous, but without the rapid weight loss this time. I remain indebted to all
my friends and colleagues who conspired to turn me into an ‘expert’ for the
occasion, to the veteran speakers at the event who were unbelievably generous
in their support of me, and also the Ayrshire Occupational Health Nurses Group
who organised a fantastic day and gave me the opportunity to further practice
and develop my presentation skills.


Professional presentation skills training will provide you with the tools to
package OH recommendations in the most appropriate way to your management team.
Not only will effective communication enhance your professional status but it
will also ensure the appropriate delivery of OH care.

Linda Caren MA, BScCN (OH), RGN, RM has been an OH adviser for Associated
Health Specialists for five years. Her customers include local authorities, the
explosives industry, electronics and food packaging.


1. Wallechinky D (1993) The Book of Lists Little Brown & Co
ISBN 0316920797

2. Hadfield-Law L (2001) Presentation skills for nurses: How to
prepare more effectively. British Journal of Nursing October 11-24; 10

3. Mehrabian A (1972) Non verbal communication, Chicago: Aldine

4. O’Connor J, Seymour J (1994). Presentation skills training
with NLP p86 Thorsons London

5. Rose C , Nicholl MJ (1998). Acquiring the Information pp 91
-96 Accelerated Learning for the 21st Century, Dell, New York

Top 10 annoying habits (% annoyed)

while others are talking                                                       88
Swearing                                                                                              84
Mumbling or talking too softly                                                              80
Talking too loudly                                                                                73
Monotonous, boring voice                                                                   73
Using filler words (um, you know…)     
A nasal whine                                                                                      67
Talking too fast                                                                                    66
Using poor grammar or mispronouncing words                                      63
A high pitched voice                                                                            61

Associated Health Specialists

Associated Health Specialists (AHS)
is a multi-disciplinary occupational health consultancy offering services that
cover the whole of Scotland and the North of England.

Main industry sectors include shipbuilding, local authority,
electronics and semi-conductors, light and heavy engineering, waste management,
pharmaceuticals, financial services, NHS trusts, explosive industries and
catering. The majority of customers are medium – large mainly blue chip

The multidisciplinary team comprises:

– Occupational medicine

– Occupational hygiene

– Training and development

– Human factors/ergonomics

A training and development consultant works with AHS employees
and external customers to cover training requirements as part of an overall
package of services, training on a group basis or individual (one-to-one)

Where clients have in-house training resources, AHS can provide
additional training support to ensure in-house trainers have appropriate skills
to train and to ensure conformity between personnel and departments.

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