Genuineness

1. Differentiate between genuine and nongenuine behavior

2. Discuss the importance of being genuine with clients and colleagues

3. Participate in exercises to build skills in demonstrating genuineness

Rather a heart without words than words without heart.

Benefits of genuineness in interpersonal relationships

If we say a person is genuine, what does it mean? Why is it important to be “your natural self” in human relationships? According to the Gallup Organization’s 2010 annual poll, nurses ranked number one on professional honesty and ethical standards. Our clients care and notice that we are honest and genuine in interpersonal relationships. A woman diagnosed with cancer shared one thing she thinks nurses need to know that is a demonstration of genuine concern. She asked that when you enter a client’s room, you stop and see the person first. “Here’s what would be so healing that won’t take but a moment” (Guilmartin, 2010, p. 18). “Could you soften your gaze as you look at me? As you approach my bed could you consider whether I need a gentle touch or a positive thought to remind me that I am more than one additional task in a tough day?” Guilmartin (2010) relates this story when she discusses the power of a pause. Here a pause is a few moments, perhaps, one deep breath, that can reframe how you see your work and its meaning and communicate your genuineness. Carl Rogers (1980), a pioneer in the study of communication, used the two synonyms realness and congruence for genuineness, which he claims is the basis for the best communication. A fundamental feature of genuineness, in Rogers’s view, is the presentation of our true thoughts and feelings, both verbally and nonverbally, to another person. It is not only the words you say or how you say them, but also your facial expression and body posture that signify genuineness. Being genuine means that you send the other person the real picture of you, not a distorted one that differs from how you really think or feel. Genuineness is a spontaneous expression conveying an individual’s experience (Haber et al, 1997). It is the opposite of self-alienation, in which a person suppresses spontaneous reactions to life (Stuart, 2009). You can be open to new possibilities in meeting clients’ needs when you are truly present and trust the authenticity of your intention to care for and serve (Bruce and Davies, 2005).

In the classic children’s story The Velveteen Rabbit (Bianco, 1922/1996), toys talk about what it means to be real.

When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become real . . . by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.

To be real is to be yourself

In the helping relationship with clients and in mutually supportive relationships with colleagues in the workplace, being genuine does not mean impulsively dumping your reactions on others. To “hit” clients and colleagues with feelings and then “run” is aggressive. In a therapeutic relationship, genuinely presenting your thoughts and feelings to others can be done assertively and constructively.

As nurses, we make an important judgment call in deciding to genuinely share our inner thoughts and feelings with others. The literature advises nurses to be genuine “when it is appropriate to do so.” Appropriateness is linked to whether our revelations will benefit our clients (or colleagues) and/or our relationships. Read carefully the counsel of Peck (1997) on dedication to the truth:

So the expression of opinions, feelings, ideas and even knowledge must be suppressed from time to time in . . . the course of human affairs. What rules, then, can one follow if one is dedicated to the truth? First, never speak a falsehood. Second, bear in mind that the act of withholding the truth is always potentially a lie, and that in each instance in which the truth is withheld a significant moral decision is required. Third, the decision to withhold the truth should never be based on personal needs, such as a need for power, a need to be liked, or a need to protect one’s map from challenge. Fourth, and conversely, the decision to withhold the truth must always be based entirely upon the needs of the person or people from whom the truth is being withheld. Fifth, the assessment of another’s needs is an act of responsibility which is so complex that it can only be executed wisely when one operates with genuine love for the other. Sixth, the primary factor in the assessment of another’s needs is the assessment of that person’s capacity to utilize the truth for his or her own spiritual growth. Finally, in assessing the capacity of another to utilize the truth for personal spiritual growth, it should be borne in mind that our tendency is generally to underestimate rather than overestimate this capacity.

We take a risk when we are genuine because sometimes genuineness involves expressing negative thoughts and confronting others with our reactions. When we are genuine, whether expressing negative or positive reactions, the message we give to our clients and colleagues is “You are strong and worthy of my engaging fully with you.” When we are genuine, we give careful attention to listening to the other person. We extend ourselves and take the extra step to do the hard work of listening, and oppose the “inertia of laziness or the resistance of fear” (Peck, 1997). We enter into a relationship with a client with a fresh perspective, aware that information we have read or heard about a client could influence our ability to be genuine and see him or her as unique. Focusing on making your own observations of the client’s behavior will help you avoid stereotyping or stigmatizing a client (Sundeen et al, 1998).

Nurses who are genuine seem to their clients to mean exactly what the words they are saying connote, and their accompanying affective behavior matches their words (Arnold and Boggs, 2011). When our verbal message does not correspond to our facial expression, posture, tone of voice, and body language, clients and colleagues decode the disparate information as two distinct and dissimilar messages. It is not hard to imagine that this incongruence of conflicting or mixed messages puts our credibility in question. Furthermore, a meaningful relationship is unlikely to ensue when our clients or colleagues doubt our trustworthiness.

As nurses we have expectations about the behaviors that accompany our assumed roles. Some of the behaviors expected of nurse-advocates are providing competent nursing care based on current standards, serving on committees to ensure quality care, and coordinating all services used by clients in an attempt to restore, maintain, or promote health. The roles we assume have cultural, gender, and situational performance expectations. These roles are comforting because they provide guidelines for performance. Being genuine means remembering that roles are filled by individuals with unique personalities, styles, and ideas (Nuwayhid, 1984). Realness means being free from the bonds of the role and not hiding behind the façade of the role. Being a person and a nurse at the same time involves spontaneity; we cannot weigh every word we say or talk in scripts that seem planned or rigid. Congruence includes an openness to sharing without always waiting to be asked, to express directly what is going on inside us without distorting our messages.

Genuineness is a “what you see is what you get” phenomenon. People experiencing your genuineness can trust you because they know you are not sending false signals or hiding something from them. This building of trust is the most important reason for being genuine (Box 9-1). When we believe that we can count on others, we can start to relax in the relationship. We stop worrying about what others might really be thinking and feeling. The energy freed from worrying can be put into the relationship, both deepening it and moving it in the direction for which it was established. Being genuine as a nurse is one major step in gaining credibility with clients and colleagues.

Box 9-1 Benefits of Nurse Genuineness for Clients and Colleagues

Nurse genuineness

• Speaks deep from within without apology

• Expresses thoughts, feelings, and experiences in the here and now

• Shows spontaneity

• Conveys openness

Benefits for clients and colleagues

• Feel free to express their true thoughts and emotions

• Develop a feeling of trust for the nurse

• Are provided with information they can use in the relationship here and now

• Can unwind in a relaxed atmosphere

• Enjoy a climate of realness

Incongruence

When a mismatch exists between nurses’ experiences of their thoughts and feelings and their awareness, this incongruence is called denial of awareness or defensiveness (Rogers, 1995). You may notice, for example, that your colleague looks angry. She is stamping her foot, pointing her finger, becoming red in the face, and raising her voice in an accusatory way. When you suggest that she is angry, however, she brushes it off and denies her obvious feelings.

When a mismatch exists between nurses’ thoughts and feelings and their communication of this internal experience, it is usually considered falseness or deceit (Rogers, 1995). For example, if you disapprove of the new policy to merge your unit with another unit in the hospital but you hide your anger and tell your boss you think the merger is a good idea because you want to make a good impression on her, this is deceit.

If we pretend that our thoughts and feelings are different from what they really are, then we will say things that we do not believe. If we act on thoughts and feelings that we do not have, we give people the wrong impression about us, leading them astray. In contrast, expressing our genuine thoughts and feelings about issues makes what we stand for absolutely clear to our clients and colleagues. The research findings of Rogers (1957) and Shapiro and colleagues (1969) establish that genuineness on the part of the therapist has positive therapeutic outcomes.

Even if we can control our verbal communication when we are trying to deceive another about our true thoughts and feelings, our nonverbal cues can give us away (Knapp, 1995). Nonverbal behavior can reveal the information we are hiding or indicate that we are attempting to deceive without indicating specific information about the nature of the deception (Knapp, 1995). We are skilled at manipulating our facial expressions and our postures to coincide with our verbal message, but the way we move our feet, legs, or hands can betray incongruence with our verbal messages—showing that we are not genuine. Some of the foot and leg movements that might alert others to our incongruence are aggressive foot kicks, flirtatious leg displays, autoerotic or soothing leg squeezing, abortive restless flight movements, tense leg positions, frequent shifts of leg posture, and restless or repetitive leg and foot motions. Revealing hand movements might include digging our hands into our cheeks, tearing at our fingernails, or protectively holding our knees while smiling and looking pleasant. Knapp reports studies revealing that one of the reasons we may not expend much effort inhibiting or dissimulating feet and hand behavior is that, over the years, we have learned to disregard internal feedback, and we do not learn to control areas of our bodies from which we receive little external feedback (Knapp, 1995). Another way we might reveal our incongruence is by neglecting to include the nonverbal action that customarily would accompany the verbal message. Our omission is a signal to clients and colleagues that something is wrong (Box 9-2).

Box 9-2 Negative Effects of Nurse Incongruence for Clients and Colleagues

Nurse incongruence