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Perception shapes reality. In other words, the heart lies, quite convincingly, to the mind.

One needs no more evidence than a common medical school exercise on bedside manner that Claudia Riel, MN, RN, adapted for nursing students a few years ago when she taught at Delta-Montrose Area Vocational Technical Center in western Colorado.

Nursing students were given identical questions and 60 seconds each to spend with a patient. Students were told either to hover at the foot of the bed or to go to the head of the bed, pull up a chair or lean against the bed rail, put a hand on the bed and touch a patient who reached out.

Patients later were interviewed about the minute-long visits, Riel said, and invariably they reported that the nurse at the head of the bed had spent from three to five minutes with them. The student who stayed at the foot of the bed and talked to them-for the same 60 seconds, asking the same questions-had been there for perhaps 20 seconds, Riel said.

The perception of closeness and caring shaped the patient's reality-reaching out, pulling up a chair. "In that very small amount of time, the intimacy was remarkable," Riel said. "I think it's a matter of trust and credibility and the feeling that someone really cares. Time is so valuable and [patients] realize that and they feel that," just as they feel the distance and negative body language of a nurse who is poised to run out the door.

Personal attention is No.1, said Steve Kresl-hotz, RN, who holds a bachelor's degree in psychology and is a charge nurse in same-day surgery at United Medical Center in Cheyenne, Wyo.

"Just physically being there makes a big difference to people," Kresl-hotz said. To appreciate that, all RNs have to do is recall when they've been on the other side of the nurse-patient coin.

"Most of us have been to a doctor's office and they put you in the room and you sit there and twiddle your thumbs, waiting, waiting, waiting," Kresl-hotz said. "It's distressing," and stress wears on the body and retards healing.

Of course, staffing and caseloads affect the time nurses can devote to any one patient and, because both nurses and patients are people, personalities figure into any connection equation.

Kresl-hotz said he relies on conversation to put patients at ease. "You have to be pretty personal if you're doing hands-on nursing care," and some people are taken aback. "Their personal space is a lot wider than we can allow."

In such cases, Riel emphasizes sensitivity with patients. "Because we reach out to take somebody's blood pressure, we don't realize that we are actually touching them," she said. "We are achieving an intimacy with them and we sometimes don't ask permission to do that. So I always ask the students to ask permission."