Nurse with smile: Does it make difference in patients' healing?

Abstract

Smiling is a highly significant component of nurses' caring behavior. Nurses have to deal with too many people at workplace and interpersonal relation building is the key secret for quality work and also enhances job satisfaction. A genuine smile given by a nurse can do wonders as it conveys acceptance, builds trust and establishes inter-personal relationship. It also helps nurses to feel better and avoid anxiety or stress burnout in clinical situation. This paper of ours highlights the importance of nurses' smile in patients' recovery and important research literature to support smiling culture among health-care professionals.

Smile does not need any language; it is universal and acceptable across all cultures. It is something that is not learned or taught, and rather it is innate. Research evidence states that even the fetus in the womb smiles although, the exact onset and its relation to gestational age are still not clear.[1] Blind people also smile in the same way as we all smile in different situations in spite of the fact that they had not have any observational learning on how to smile. Smiling with eyes is always performed with mouth lifting up and contraction of eyes' socket which makes eyes to twinkle and that is why it is said that true smile reflects through eyes.[2] Nurse has to deal with too many people at workplace and interpersonal relation building is the key secret for quality work and also enhances job satisfaction. Positive attitude with a smile in nursing profession may results in the following:

1. Builds confidence and enhance self-esteem among nurses

2. Conveys unconditional positive regard to patient and colleagues

3. Creates good first hand impression

4. Conveys confidence and positivity

5. Instill hope and mutual feeling of trust

6. People feel comfortable around nurse who smiles

7. Receive others' cooperation for the treatment and procedures

8. Brings more satisfaction among patients.

SEARCH STRATEGY

Integrative reading and review of published and unpublished materials were done on the subject of smile and its importance in patients' recovery. A thorough literature search was conducted to explore published materials using PubMed, Embase, and Ovid databases. Articles published in English were considered for this review. The initial term (Mesh) used for search was “smiling,” “nonverbal communication,” “interpersonal relations,” “facial expression,” “affect,” and “empathy.” Synonyms for these terms were used in combination for literature search. List of references given in identified articles were also explored. Framing content for this study required lot of exhaustive review and reading.

IMPORTANCE OF NURSES' SMILE IN PATIENTS' RECOVERY

Being a Nurse, is not an easy task as it demands lots of patience and hard work to be around the sick or ill all the times in order to meet their needs and address their queries. Of course, the education and mentor plays a major role in all this, but there are many other qualities which make a nurse exceptionally great and different from many others in the race. To name some of them are never-ending perseverance, effective communication skills, trustworthy, clemency, nonjudgmental, critical thinking skills, and emotional stability.[3,4] However, above all smile (genuine smile) of a nurse while dealing with patient can make a lot of difference in overall treatment and recovery as it minimizes suffering and enhance comfort of client. Patients admitted to hospitals are vulnerable and emotionally upset most of the time due to their illness. Dealing them with a smile brings positive energy among them and fosters a change in attitude toward healing and recovery.

Genuine smile given by a nurse can do wonders as it conveys acceptance, builds trust, and establishes inter-personal relationship. The patient might feel hopeless during hospitalization and nurse's empathy with smile reflects better understanding and will be helpful in addressing emotional needs of the patients, which remains neglected most of the times.[5,6] It has been called that a smile is contagious and nobody can resists smiling back to a person.[7] Hence, in a distressing hospital environment, it can act as a stress buster for patients and family members. Different hospitals have different dress codes for nurses to make them look professional but in our opinion, nurse without a smile is not at all fully dressed as a professional. Moreover, nurses wearing a real smile on their face make them more approachable and they look more confident in addressing clients' queries and problems.[8,9] Most of the time, patients are worried and anxious and therefore pleasing and warm personality of a nurse is helpful in avoiding arguments and communication problems among them [Figure 1].

Figure 1.

Cycle of nurses' smile

HOW DOES SMILE BENEFITS TO NURSE?

Being a nurse is not a causal job of 6–8 h but it also requires an enormous amount of dedication, hard work and ability to deal with complicated human behavior. Nurse has to deal with patients in their ups and downs along with emotional turmoil which is the difficult part to deal with and all these take off all energy sometimes. That is why it is important for a nurse to have a balance in their personal and professional life. In order to take care of others' wellbeing, i.e., both physical and emotional, it is required first to have insight towards own needs and emotions. Smile is considered as an initial step toward cycle of happiness, if you are happy you smile and if you smile you will become happy and that is why nurses who wear smile look more confident and it helps them to feel better and avoid anxiety, stress burnout in clinical situation. Endorphins are released during laughter or smile and it helps to reduce stress level and minimize pain, which is why laughter therapy is used commonly for patients with chronic illnesses.[10,11,12]

Mood plays an important role in our day to day life and most of the time, what we make best out of challenging situations if our mood is appropriate. For a nurse who handles numerous problems or challenging situations like caring for a dying client, breaking the news of critical illness to family and many more, a good smile can help him/her to release pent up emotions and she/he can deal the situation with positive perspectives.[13,14] There are many other health benefits of smile resulting from good mood: Increases life expectancy,[15] lowers the risk of cardiovascular death and coronary artery diseases.[16] It has also been observed that happy and cheerful individuals are less prone to unhealthy coping responses like alcohol, smoking, etc., and live a healthy life because they have a problem solving attitude rather than complaining.[17] Smile has a power to radiate positivity and that is why smiling nurses have good social relations not only with their patients but also with colleagues, supervisors, physicians and other health team members. Nurse with a good sense of humor can avoid many conflicts at workplace and that will automatically help him/her to maintain good mental health [Figure 2].

Figure 2.

Impact of smile on nervous system and body physiology

WHY DO NURSES GIVE LESS PREFERENCE TO SMILE?

There is no need to wonder that most of the times, nurses deal with patients with flat affect and do not give genuine or appropriate smiles. The probable reason for this could be no training for importance of professional smile. Although therapeutic communication is considered as an important aspect of nursing curriculum, it ignores the unmeasurable benefits of nurses' genuine smile on patients' comfort and sense of wellbeing. In hospital scenario, if we establish culture of genuine smile, it is not only beneficial for the client but also for everyone working in that setup, it may seem like we are exaggerating the fact but it is true. It was noted that when a supervisor or senior member gives positive feedback with no smile and flat affect then it conveys discrepancy between what is said and felt which ultimately discourage working team members rather than encouraging.[18] Although nowadays, it is quite common practice to smile in all customer care service-related departments, leading to fake smiles more often which is easily recognized by costumers. Hence, one important thing to understand here is that smile is not the eligibility criteria for a good nurse but it adds more weightage to your care and gives a happy as well as successful carrier. The under mentioned may be the reason that refrain nurses from offering a genuine smile:

1. Personality traits of being shy and reserved

2. Cultural beliefs or schemas where smiling with patients are considered inappropriate

3. Preoccupied with workload and distress at work

4. Uncertainty of patients' health condition

5. Fear of developing transference and counter-transference

6. Getting emotionally attached to patient.

IMPORTANT RESEARCH FINDING TO SUPPORT THE SMILE CULTURE IN HEALTH CARE SETTING

In todays' complex world, when there is no time to think about own health and wellbeing, only a smile can make drastic change in professional as well as personal life. Health care professionals like doctors and nurses are more prone to stress and burnout as they face various situations which increases their cortisol levels.[16,19] Institute for healthcare improvement shifted its major focus on nurturing practice environment in such a way that brings joy and happiness among workers.[20] The American Association of Critical Care Nurses had actively supported nurses reported its concern and stated that if there is no joy at workplace then it impact both satisfaction of nurses at workplace and patients' recovery.[21,22]

Nursing care is the core element in patients' recovery and this was supported by a study on expectations of patients from a group of professional nurses while they were hospitalized. Study reported that experience of a nurse is more important for patients rather than their titles and rank. Nurses' smile and pleasant attitude were appreciated most by patients.[23] Most often nurses complaints that they are unable to spend much time with patients because of their busy schedules but patients' satisfaction does not always depend on the amount of time spent with client rather, it totally depends on whether patient was treated with courtesy or not.[24,25] Simple or genuine smile given by nurse is an inestimable gestures for the client and it enhances trust and positivity.

Smiling can be called as a measure to bring happiness. A study findings reported that one smiling expression have the potential to induce happiness and joy which is equal to eating 2000 chocolates.[26] Research also reported that it is difficult for our brain to differentiate between genuine smile and fake smile as both produces similar electrical signals. Hence, there is no harm to fake it until you produce a genuine smile spontaneously.[25,26] Another study reported that facial expressions of human robot can have influence on how patients respond and thus highlighted the importance of facial reactions whether it is frowning or smiling.[27]

HOW TO PROMOTE SMILING CULTURE AMONG NURSES?

Smile can be considered as an expressive component of caring behavior. Leaders in nursing must convey to upcoming nurses that providing care without expressive component make them act like a robot and one of the study explained that non-caring behavior of nurses lead to fear, stress, fatigue, and hamper quality of care provided by them.[14] It is interesting to know that patients reported pleasant feeling and satisfaction even if a little attention with personal touch and positive appearance were given by nurse. Revelation of patients' point of view in one of the study can be an eye-opener for many as most patients did not know the name of their nurse and were not at all satisfied with nursing services and mentioned that “nurses treat us like a case not as an individual.[10] Meeting patient only when bedside care or procedures need to be performed is considered as a mechanical nursing which can also be done by robots then why do we need a nurse? Body posture, eye contact and smiling are the three important components that influence patients' trust and smile given by health care professionals convey sympathy and sense of encouragement.[28] It is high time that leaders and mangers in the field understand the importance of sharing and understanding human emotions while dealing with patient. It is believed that each set of communication skill and behavior can be learned and mastered by practice. Hence, the same goes with adapting genuine smile as a practice to bring a positive change in environment and spread sense of happiness and content. We understand that offering a genuine smile to patients in hospital scenario seems difficult and therefore some strategies are explained that can be helpful in giving genuine smile to patients. Tips/strategies to serve patients with genuine smile and positivity are enlisted below:

1. Try to be familiar with the patients and relatives

2. Use non-judgmental approach while interacting

3. Do not act strange and offer sincere and genuine smile while meeting

4. Plan some smile cues as a reminder like while getting in and out of a patients' room

5. Always take a deep breath while smiling

6. Spent some quality time with your patient

7. Always keep your motivation up

8. Stay calm and relaxed

9. Never carry baggage of own emotions whenever at work

10. Avoid non-verbal expressions of being busy or overburden

11. Self-introspection for own emotional needs and address them

12. Perform yoga, meditation and prayers for relaxation.

CONCLUSION

Nursing is considered as a noble profession in which compassion and empathy is critical to treat patients. It is very much difficult to recreate first impression and that is why nurses need to be more alert and cautious whenever they make first interaction and should practice being in the moment technique to give undivided attention to client. Although smile does not cost anything but have enormous benefits to patient and nurse which cannot be ignored. Practicing the art of smiling while serving others is important to make this profession noble in real term.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.