Fundamentals of Nursing and Midwifery 2e

241 Chapter 13 Thoughtful practice: Self-awareness and reflection

Self-awareness

Context of thoughtful nursing and midwifery practice

Reflective practice

Reflection

Critical thinking

Figure 13-1 The components of reflective practice

To be self-aware, the three interrelated aspects of cogni- tion (thinking), affect (feeling) and behaviour (acting) must be considered (Rungapadiachy, 1999). For instance, feelings can affect the actions of a clinician who has unresolved issues related to death and dying. These issues may make it difficult for the clinician to engage in a therapeutic relation- ship with a dying person or the person’s family. Self-awareness includes the personal attributes of moti- vation and moral agency that are essential for reflective practice and being aware of the influence our emotions have on our thoughts and behaviour. Clinicians need to develop this deeper level of self-awareness, understanding motiva- tion and moral agency in order to engage in therapeutic relationships. M otivation is the desire to do the best you can, which determines how you, as a healthcare professional, contribute to the relationships that develop between you and others in the workplace (Toode, Routasalo & Suominen, 2011). It is through becoming aware of the self that the individual becomes more adept at creating the relationships needed for person-centred care. In using the self to create a therapeutic relationship, the nurse or midwife is enacting a sense of agency, and when this agency has an ethical dimension, it becomes moral agency . In Chapter 9, the concept of agency is discussed. Stein-Parbury (2009) points out that, in any intervention, nurses and midwives need to make sure that the tool they are using is in good order. This is as true for the nurse or midwife using the self as the tool as it is for any physical piece of equipment. In addition, becoming self-aware is an important precursor to the self-growth that occurs through professional development.

Motivation and moral agency depend on being aware of our own beliefs and values, and understanding the impact these have on our actions. This understanding is an impor- tant aspect of how we develop as healthcare professionals. It is concerned with who we are as individuals and with what we bring of ourselves to the context of practice. If we are to develop and grow through our experiences, it is important for each of us to become more self-aware. Chapter 6 discusses this ability to know self, in terms of cultural beliefs and prejudices, and how this affects the way we see and treat others in a culturally safe way. By becom- ing more self-aware of how your preconceptions can sometimes influence your judgements, you can grow as a professional carer. For example, a student may hold the belief that all older adults are incapacitated by illness, and so may treat all older people in the same way. Through experience, after meeting many older adults who are not incapacitated by illness, the student realises that this pre- conception was wrong, and then starts to question whether this is the only preconception held that is influencing how they perceive and treat patients. This student is becoming more self-aware, and when this is carried through into prac- tice, professional growth occurs. As discussed above, self-awareness is an essential attrib- ute for clinicians who are required to work effectively with other people. Through self-awareness, you can also develop the final two attributes in Box 1-5—leadership and bravery —through your ability to respond appropriately to your own needs, recognise the needs of others, and lead and motivate others in the team. This ability was termed ‘emotional intel- ligence’ by the psychologist and author Daniel Goleman (Akerjordet & Severinsson, 2007).