| |

Received: 14 June 2018    Revised: 4 October 2018    Accepted: 16 October 2018

DOI: 10.1111/jocn.14708

REVIEW

Self-­awareness in nursing: A scoping review

Subia P. Rasheed1 | Ahtisham Younas2,3  | Amara Sundus4,5

1
Shifa College of Nursing, Islamabad,
Pakistan Abstract
2
Memorial School of Nursing, Memorial Aims and objectives: To outline and examine the literature about self-­awareness in
University of Newfoundland, St. John’s,
nursing and to identify areas for future research and practice.
Newfoundland and Labrador, Canada
3 Background: Self-­awareness is important for the personal and professional develop-
School of Social Work, Memorial University
of Newfoundland, St. John’s, Newfoundland ment of nurses, for developing an effective nurse–patient relationship and for im-
and Labrador, Canada
proving nursing abilities. Despite its importance in nursing and therapeutic
4
Al-Shifa Eye Trust Hospital, Rawalpindi,
Pakistan nurse–patient relationship and its evolving nature, the knowledge base for self-­
5
Healthcare Management at RIPAH awareness in nursing remains under-examined.
University, Islamabad, Pakistan Design: A scoping review using PRISMA guidelines.
Correspondence Methods: A five-­step approach: (a) identification of research question; (b) identifica-
Ahtisham Younas, School of Social Work, tion of relevant studies using a three-­step search: keywords search within PubMed
Memorial University of Newfoundland, St.
John’s, NL, Canada. and CINAHL, literature search within PubMed, CINAHL, ERIC, PsycINFO, Science
Email: ay6133@mun.ca Direct and Google Scholar, and literature search of references lists; (c) study selec-
tion; (d) data extraction and charting; (e) data collation, summarisation and reporting,
was used.
Findings: Of 1,531 identified sources, 76 full-­text sources were read and 29 English
language sources, published from January 1980 until January 2018, which included
nurses or nursing students, were reviewed. Two themes: perspectives on self-­
awareness and strategies for enhancing self-­awareness emerged. Under these
themes, conceptualisation of self-­awareness; its antecedents and value; and theory-­
based, educational and personal strategies for its enhancement were described.
There is sufficient literature regarding self-­awareness conceptualisation and theory-­
based strategies for its enhancement, but inconclusive evidence regarding value of
self-­awareness, and educational and personal strategies for its improvement.
Conclusion: There is limited research on self-­awareness. Most of the literature com-
prises of theoretical discussions and opinions which adequately provide a conceptual
understanding of self-­awareness. However, more empirical and applied research is
needed to apply the available theoretical knowledge in practice.
Relevance to clinical practice: This review delineated theoretical, educational and
personal strategies for nurses to improve their self-­awareness and indicated that en-
gagement in self-­awareness at relational and contextual levels is essential for devel-
oping nurse–patient relationship.

KEYWORDS
interpersonal relationship, nurse–patient relationship, nursing, reflection, self-awareness

762  |  wileyonlinelibrary.com/journal/jocn

© 2018 John Wiley & Sons Ltd J Clin Nurs. 2019;28:762–774.
RASHEED et al. |
      763

1 | I NTRO D U C TI O N
What does this paper contribute to the wider global
The nursing literature highlights the importance of therapeutic nurse– clinical community?
patient relationship for improving physical, emotional, social and
• The importance and value of self-awareness in nursing
mental well-­being of patients and for enhancing the quality of nurs-
are frequently described in the literature over the last
ing care (Feo, Rasmussen, Wiechula, Conroy, & Kitson, 2017; Peplau,
35 years, but it has received limited empirical attention
1952; Strandås & Bondas, 2018). Effective therapeutic nurse–patient
in the last 15–20 years.
relationship is also essential for improving nursing care. However, in
• There is an extensive conceptual and theoretical body of
order to develop an effective therapeutic nurse–patient relationship,
nursing knowledge regarding self-awareness, and nu-
self-­awareness has been described as a central component of nurse–
merous benefits of self-awareness are described.
patient relations and one of the essential traits of nurses (Dziopa &
However, this knowledge has not been operationalised
Ahern, 2009; Rasheed, 2015). A lack of self-­awareness on the part
for use in clinical practice and research. There is a dire
of nurses could impede the development of a positive therapeutic
need of applied empirical research to evaluate and test
nurse–patient relationship (Varcarolis, 2018). Self-­awareness is an
the available theoretical knowledge on self-awareness.
evolving process of self-­discovery, which means self-­awareness is dy-
• The scoping review provided a new operational defini-
namic and ever-­changing and it never achieves saturation (Eckroth-­
tion of self-awareness, that is, it is an ongoing, deliber-
Bucher, 2010). Because of its evolving nature, self-­awareness enables
ate, intrapersonal, relational, extrapersonal and
nurses to develop an interpersonal relationship and engage in thera-
contextual process.
peutic communication with patients, and continuously improve their
relationship and communication (Rasheed, 2015).
Becoming self-­aware does not only help nurses in developing a
therapeutic and interpersonal relationship, but also enable them to im- their personal strengths (Eckroth-­Bucher, 2010) in order to achieve a
prove their critical thinking and clinical decision-­making skills (Han & sense of well-­being. Becoming more self-­aware prevents nurses from
Kim, 2016; Jack & Smith, 2007). It also helps nurses to determine their projecting their personal biases and values onto their patients and
roles and responsibilities in a given situation and discern appropriate others (Eckroth-­Bucher, 2001). Self-­awareness does not only include
nursing actions. Therefore, several nursing associations have identi- examining one’s traits and emotions, but it also includes examining
fied self-­awareness as an important nursing competency (American environmental and contextual factors that may influence nurse–pa-
Psychiatric Nurses Association, 2014; Nursing and Midwifery Council, tient interactions and the interplay of these interactions between
2015; Registered Nurses Association of Ontario, 2002) which should and among the nurses and the patients. Through examination of such
be developed over time to enhance nurse–patient interactions. factors and the interplay among these factors, nurses can develop
Self-­awareness is a widely used concept in psychology and has their competencies and discern their nursing actions (Rasheed, 2015).
been considered to have both cognitive and neuroanatomical basis Therefore, self-­awareness is especially needed for healthcare provid-
(Morin, 2011a, 2011b). The process of becoming self-­awareness ers to manage their cognitive, affective and behavioural self which
starts from infancy and continues until adulthood. During this time, helps in improving their caring behaviours (Rungapadiachy, 1999).
self-­awareness is developed through exposure and responses to phys- Despite the importance of self-­awareness for nurses and nurse–pa-
ical and emotional stimuli, social interactions, verbal and nonverbal tient relationships and its evolving nature, the body of nursing knowl-
communications, personal appraisals and reflections, recall of past edge regarding self-­awareness remains under examined.
events and ongoing cognitive processes. The use of guided imagery,
reflection, personal and social feedback are essential elements of this
1.2 | Aims
development process. Throughout this process, individuals become
self-­focused and self-­regulated and develop abilities to make infer- The primary aim of this paper is to outline and examine the literature
ences about others’ emotions and mental states (Morin, 2011a) which about self-­awareness in nursing and to identify areas for future re-
help them in better understanding themselves and others. search and nursing practice. The secondary aim was to expand the
In nursing, self-­awareness has been acknowledged as an import- knowledge base about self-­awareness for a prospective mixed meth-
ant tool for the personal and professional development of nurses ods study on self-­awareness theory and scale development.
(Rasheed, 2015). It has also been identified as an important attribute
of nurses that helps them improve their sensitivity towards others
2 | M E TH O DS
and their caring abilities (Jack & Smith, 2007). Self-­awareness enables
nurses to recognise their emotional states, thoughts, feelings, biases,
2.1 | Design
strengths and limitations in general as well as in any given nursing
situation. Based on this personal recognition, nurses can understand The scoping review was conducted following the PRISMA guide-
strengths, deficits and needs of their patients and help them recognise lines and the steps (see Supporting Information) outlined in Levac,
 |
764       RASHEED et al.

Colquhoun, and O’Brien (2010) and Khalil et al. (2016). We employed that were written for any nursing field such as mental health nurses,
a five-­step approach: (a) identification of the research question; (b) intensive care, primary health care, community nurses, paediatric
identification of relevant studies using a three-­step literature search: nurses and emergency nurses were included.
literature search within PubMed and CINAHL to identify keywords
and phrases, literature search in other selected databases and litera-
2.3.2 | Literature sources
ture search of the references lists; (c) study selection; (d) data extrac-
tion and charting; (e) data collation, summarisation and reporting. The articles published in the English language in peer-­reviewed jour-
The research question was: What is known about self-­awareness in nals, articles that explicitly connected the discussion to nurses’ or
nursing? The scope of inquiry was to identify the current trends and nursing students’ self-­awareness and online sources which contained
areas for future research with an intended outcome to advance re- substantial information (i.e., a clear definition of self-­awareness
search and practice directives for nursing. and/or clear implications for the nursing profession) regarding self-­
awareness of nurses were included. The dissertations, non-­English
language sources, books, book chapters, editorials and letters were
2.2 | Search strategy
excluded because such sources would not help determine the state
A preliminary search was performed in CINAHL and PubMed to of knowledge on the topic and some sources are written for multidis-
identify the indexed terms. We identified three indexed terms: self-­ ciplinary audience. The inclusion criteria were not limited to empiri-
knowledge, self-­awareness and self-­knowing. Upon using the terms cal studies because of the multifaceted nature of self-­awareness that
self-­knowledge and self-­knowing, relevant articles could not be found. can be better explored through an examination of a much broader
Therefore, we decided to use the broad term self-­awareness. Then, knowledge base.
the literature search was performed within six databases: PubMed,
CINAHL, Eric, PsycINFO, Science Direct and Google Scholar using
2.3.3 | Additional search
two main search terms: (a) self-­awareness of/and nurses and (b) self-­
awareness in/and nursing (initial hits = 1,386, 608) from January 1980 Additional search was performed within three grey literature data-
until January 2018. Most of the hits matched the keywords “nursing,” bases, namely Open Grey, Trip and OAlster to identify any grey lit-
“self,” “nurses” and were irrelevant to self-­awareness of nurses. The erature. In total, 8,289 hits were retrieved in all of these databases.
search terms were modified by using Boolean operators “or” and Most of the sources focused on cultural awareness, cultural com-
“and”; then, the titles of the sources were reviewed. The book re- petence, awareness about different nursing assessment techniques,
sults and duplicates were removed. This initial search was performed management of various diseases, electronic medical management
by two authors independently. We also excluded any sources from and healthcare systems, self-­perceived competence and aware-
the disciplines of psychology and social sciences because the body ness of ethical issues. Others were focused on self-­care and self-­
of knowledge of these disciplines is theoretically and conceptually education efficacy of patients. Therefore, this search resulted in the
different from nursing and we intended to focus exclusively on the identification of one additional literature source. Also, the reference
nursing discipline. This screening resulted in 1,531 citations in all the lists of the selected sources were explored to identify any additional
databases. The irrelevant results were removed, and a sample of 241 sources, resulting in no additional source. The detailed search strat-
potentially relevant articles were further screened by skimming the egy has been presented (Figure 1).
titles and abstracts. After removing the editorials, letters and papers
that focused on scale development in the discipline of psychology, 76
2.4 | Data extraction
full-­text articles were read. This resulted in an exclusion of nine arti-
cles that were published in Chinese, Korean, Portuguese, Japanese, The data extraction was conducted by each author using a data ex-
Persian and German. Further screening based on the inclusion criteria traction sheet that was developed after critical discussion. This sheet
resulted in the selection of 28 sources. Each author independently included information about authors, country of origin, aims and objec-
completed the final screening. We used purposive sampling for the tives, type of research and literature source, target population, use of
final selection of the articles based on the following inclusion criteria. a conceptual framework, development of a framework, research out-
come and major themes. For extracting data from the discussion pa-
pers, the emphasis was placed on extracting apparent themes from the
2.3 | Inclusion criteria
papers and then interpreting those themes using personal judgements.

2.3.1 | Target population and context

3 | R E S U LT S
We included the literature sources that were written for nurses and
included practising nurses and nursing students as the target popu-
3.1 | Study characteristics
lation. This was assessed by reviewing the credentials of the authors
(i.e., presence of the title “RN” of the literature sources and the Of 29 sources, most of the sources were discussion papers (n = 14)
population for whom the paper was written. The literature sources followed by research studies (n = 10), programme evaluations (n = 3)
RASHEED et al. |
      765

Search Terms
"Self" AND Initial hits: PubMed
"awareness" OR (703), CINAHL
Intial search: PubMed and "awareness"AND
CINAHL (363), ERIC (1,149),
"nursing" OR PsysInfo (144),
Keywords: "self- "nursing"OR Science Direct
awareness in nursing" and "nursing" OR (104,252), and
"self-awareness of nurses" "nursing" self- Google Scholar
awarenessAND (1,280,000)
"nurses"OR
"nurses"

29 sources
included in the
review: 14 1,531 potential
disscussion 241 screened by sources identified
76 full-text
papers, 10 reading the titles after removing
articles screened.
research articles, and abstracts. duplicates and
Editorials, letters,
3 teaching and Non-English books results, and
book chapters,
learning projects language and limiting literature
and dissertations
and program brief reports search to nurses
removed.
evaluations, and 2 excluded. and nursing
opinion pieces. students

F I G U R E   1   Flow chart of literature

search

and opinion pieces (n = 2). Most of the sources originated from the becoming self-­disciplined, freely expressing one’s feelings and expe-
USA (n = 11), UK (n = 10), Turkey (n = 3) and Norway (n = 2) followed riencing emotions in relation to other people. Eckroth-­Bucher (2001,
by one each from Ireland, Egypt, Finland and New Zealand. Most of 2010) conceptualised self-­awareness as an introspective cerebral
the sources were from the years 2002 to 2012 (n = 13), 1991 to 2001 exercise (i.e., inspection of one’s emotional states, thoughts and feel-
(n = 6) and 2014 to 2017 (n = 7). Ten research studies comprised of ings), as an ongoing process (i.e., continuous analysis and compari-
cross-­sectional (n = 2), nonrandomised control trial (n = 1), pre-­post son of one’s old emotional states, thoughts, biases and preconceived
experimental study without a control group (n = 2), mixed methods ideas with newly developed ideas and beliefs), as an understanding
(n = 1), descriptive qualitative (n = 1), phenomenology (n = 1), case of one’s convictions and values (i.e., a profound inspection of one’s
study (n = 1) and concept analysis (n = 1). The detailed findings of meaningful traits, beliefs, life patterns and experiences) and as a
the reviewed studies are presented in Table 1. guidepost (i.e., an analysis of one’s actions consistent with personal
values and beliefs so as to guide future actions).
On the basis of the analysis of conceptualisations, the fol-
3.2 | Theme I: perspectives on self-­awareness
lowing definition was derived that encompasses all the existing
Twenty sources described perspectives on self-­awareness (Table 1). definitions and could be more practical and operational. Self-­
All of these sources were discussion papers and opinion pieces ex- awareness is: (a) an ongoing (Campbell, 1980; Croston & Jack,
cept one concept analysis and a case study. Three categories were 2016; Drew, 1997; Eckroth-­B ucher, 2001, 2010; Gessler & Ferron,
developed under this theme: (a) conceptualisation of self-­awareness, 2012; Jack & Miller, 2008; Jack & Smith, 2007; Rasheed, 2015;
(b) antecedents of self-­awareness and (c) value of self-­awareness. Roberts, 1998); (b) intrapersonal; (c) relational; (d) extrapersonal;
and (e) contextual process of becoming aware of one’s physical
and physiological traits, emotional states and feelings, and mean-
3.2.1 | Conceptualisation of self-­awareness
ingful life patterns, actions, beliefs and preconceived ideas. It
Self-­awareness was conceptualised in several different ways. For ex- helps an individual to direct one’s situational and future actions
ample, Campbell (1980) conceptualised it as an ongoing process that in the light of recognised patterns and actions and to develop a
entails four components: physical (i.e., being aware of one’s body habit to engage in continuous self-­d iscovery. It is also important
image and bodily sensations), psychological (i.e., being aware of to delineate that the level of self-­awareness required to become
one’s feelings and external stresses), philosophical (i.e., being aware aware of one’s physical and physiological traits is superficial com-
of one’s meaningful life patterns, experiences and actions) and en- pared to that required to examine one’s meaningful life patterns,
vironmental (i.e., being aware of environmental factors influencing actions, beliefs and preconceived ideas about any given situation
self-­awareness). All of the 20 sources conceptualised self-­awareness (i.e., deep) (Eckroth-­B ucher, 2010; Rasheed, 2015). Therefore, the
as an ongoing process. For example, Burnard (1986) conceptual- relational and contextual nature of self-­awareness is critical for
ised self-­awareness under four domains such as becoming aware of developing deeper awareness of self, beliefs and meaningful life
one’s thoughts and feelings, identifying one’s traits that can lead to patterns.
TA B L E   1   Findings of the reviewed sources
|

Research Target Conceptual/theoretical Framework

766      

Authors Origin Purpose Type of source design population framework proposed Major themes

Campbell USA To describe the relationship of Discussion NA Nurses No The self-­model Conceptualisation,
(1980) self-­awareness in nursing antecedents, value and
strategies for enhancing
self-­awareness
Krikorian USA To evaluate a personal behaviour Research Pre-­post Nursing No No Educational strategy for
and analysis tool to enhance self-­ experimental students enhancing
Paulanka awareness of nursing students action self-­awareness
(1982) research
Burnard UK To propose a model for enhancing Discussion NA Nurses No Integrated Conceptualisation,
(1986) self-­awareness self-­awareness antecedents, value and
model theory-­based strategy
for enhancing
self-­awareness
Burnard UK To define self-­awareness and its Discussion NA Intensive care No No Conceptualisation of
(1988) benefits for intensive care nurses nurses self-­awareness, value of
self-­awareness and
strategies for enhancing
self-­awareness
Rawlinson UK To describe self-­awareness and its Discussion NA Nurses No No Conceptualisation and
(1990) dimensions value of self-­awareness
Drew (1997) USA To explore meaningful experiences Research Phenomenology Nursing Carper’s patterns of No Conceptualisation,
of nurses with their patients students knowing antecedents, value in
terms of relationship
with patients and
strategies for enhancing
self-­awareness
Roberts UK To describe self-­awareness, its Discussion NA Accident and No No Value of self-­awareness
(1998) development and benefits in emergency
accident and emergency settings nurses
Rowe (1999) UK To describe the role of self-­ Discussion NA Nurses Transactional analysis, No Conceptualisation,
awareness in improving nurse–pa- Johari window, antecedents, value in
tient interactions six-­c ategory interven- terms of relationship
tion analysis with patients and
strategies for enhancing
self-­awareness
Cook (1999) UK To critically examine the conceptu- Discussion NA Nurse No No Issues in conceptualisa-
alisation of self-­awareness in educators and tion and teaching
nursing and the role of experiential students strategies of
teaching strategies in enhancing self-­awareness
self-­awareness
RASHEED et al.

(Continues)
TA B L E   1   (Continued)

Research Target Conceptual/theoretical Framework

Authors Origin Purpose Type of source design population framework proposed Major themes
RASHEED et al.

Eckroth-­ USA To examine the philosophical basis Discussion NA Nurses No No Conceptualisation of

Bucher of self-­awareness in nursing self-­awareness, value in
(2001) terms of relationship
with patients and
strategies for enhancing
self-­awareness
Severinsson Norway To describe a model for nursing Discussion NA Nurse No Clinical Value of self-­awareness
(2001) supervision that entailing educators supervision and strategies for
self-­awareness as a main model enhancing
component self-­awareness
Kwaitek UK To describe a partnership course for Program NA Social care Gibbs reflection cycle No Antecedents of
et al. (2005) therapeutic use of self in learning evaluation nursing staff and John’s reflective self-­awareness and
disability services model educational strategy for
enhancing
self-­awareness
Vandemark USA To delineate the role of self-­ Discussion NA Advanced Peplau’s theory of No Antecedents of
(2006) awareness in improving nurse–pa- practice interpersonal relations self-­awareness,
tient relationship in psychiatric nurses and Newman’s theory theory-­based strategy
nursing of health as expanding for enhancing self-­
consciousness awareness and potential
training areas for
self-­awareness
South (2007) USA To describe the development and Teaching and NA Nursing Johari window, Peplau’s No Value of self-­awareness
use of an educational strategy for learning students theory of interpersonal and educational strategy
self-­awareness project relations for enhancing
self-­awareness
Jack and UK To describe self-­awareness as a tool Discussion NA Nurses Yes, six-­c ategory No Theory-­based strategy
Smith for professional and personal intervention analysis, for enhancing self-­
(2007) development Johari Window awareness and personal
strategies such as
reflective practice and
port folios
Jack and UK To describe self-­awareness and its Discussion NA Nurses Johari window Now, Transition Theory-­based strategy
Miller practice in professional nursing and Re-­group for enhancing
(2008) framework self-­awareness
Engin and Turkey To examine the outcome of Research Quasi-­ Nurses No No Value of self-­awareness
Cam (2009) self-­awareness education on experimental and strategies for
self-­efficacy and sociotropy/ without a enhancing
autonomy of nurses control group self-­awareness
|
      767

(Continues)
TA B L E   1   (Continued)
|

Research Target Conceptual/theoretical Framework

768      

Authors Origin Purpose Type of source design population framework proposed Major themes

Williams USA To study the use of reflective Research Descriptive Nursing No No Educational strategy for
et al. (2009) journaling for enhancing qualitative students enhancing
self-­awareness self-­awareness
Eckroth-­ USA To clarify the concept of Research Concept Nurses No No Conceptualisation,
Bucher self-­awareness analysis antecedents and value
(2010) of self-­awareness
Oflaz et al. Turkey To assess the use of psychodrama Program NA Nurses No No Educational strategy for
(2011) for enhancing self-­awareness evaluation enhancing
self-­awareness
Scheick USA To determine the effect of Research Quasi-­ Nursing No The STEADFAST Strategies for enhancing
(2011) self-­awareness guide on students’ experimental students self-­aware self-­awareness, actual
self-­control and mindfulness with qualita- mindfulness practice of self-­
tive evaluation development awareness in real life
and pre-­post model practice, value of
control and self-­awareness
experimental
group
Ünal (2012) Turkey To determine the effect of Research Experimental Nursing No No Value of self-­awareness
self-­awareness education on pre-­post students and strategies for
assertiveness and self-­esteem design enhancing
self-­awareness
Gessler and USA To describe the role of self-­ Opinion piece NA Nurses No No Consequences of lack of
Ferron awareness in developing healthy self-­awareness, value of
(2012) workplace self-­awareness,
antecedents of
self-­awareness and
strategies for enhancing
self-­awareness
Rahim et al. Egypt To assess students’ self-­awareness Research Descriptive Nursing Johari window No Value of self-­awareness
(2014) after an education session cross-­sectional students and educational strategy
for enhancing
self-­awareness
Ramvi (2015) Norway To understand personal and Research Case Study Retired nurse No No Antecedents of
professional experiences of a self-­awareness and
nurse and its impact on her value of self-­awareness
self-­understanding and profes-
sional practice

(Continues)
RASHEED et al.
 RASHEED et al. |
      769

Self-­awareness is intrapersonal (Burnard, 1986; Campbell, 1980;

Educational strategies for

theory-­based strategies
Drew, 1997; Eckroth-­Bucher, 2001, 2010; Jack & Miller, 2008; Jack

Value of self-­awareness

Value of self-­awareness
antecedents, value in
terms of relationship
& Smith, 2007; Rasheed, 2015; Rawlinson, 1990; Rowe, 1999) be-

and strategies for

Conceptualisation,

with patients and

cause it focuses on exploring the nurses’ personal self and examining

self-­awareness

self-­awareness

self-­awareness
for enhancing
Major themes

personal thoughts. It is relational (Burnard, 1986; Campbell, 1980;

enhancing

enhancing
Drew, 1997; Eckroth-­Bucher, 2001, 2010; Jack & Miller, 2008; Jack
& Smith, 2007; Kwaitek, McKenzie, & Loads, 2005; Rawlinson, 1990)
because it allows oneself to analyse oneself in relation to other peo-
ple and connect personal thoughts and feelings with that of others.
It is extrapersonal (Burnard, 1986; Campbell, 1980; Drew, 1997;
Framework

Eckroth-­Bucher, 2001, 2010; Jack & Smith, 2007; Ramvi, 2015;

proposed

Rowe, 1999; Vandemark, 2006) because it continuously expands

No

No

No

No
beyond personal self and focuses on the analysis of the environ-
ment, where environment could be internal (i.e., mental, intellectual
Johari window and Now,

Rogers patients-­centred
Conceptual/theoretical

state, spirituality and so forth) and external (i.e., culture, relations,

Re-­group framework

clinical settings). Self-­awareness as an extrapersonal process also

Transition and
Johari window

means that expanding beyond personal self which enables individ-

framework

uals to identify sources of anxiety and gain control of those sources

theory

in future interactions with others (Jack & Smith, 2007). It requires

No

consciously examining one’s meaningful lived experience as a nurse

(Rasheed, 2015). Finally, it is contextual (Burnard, 1986; Campbell,
1980; Croston & Jack, 2016; Eckroth-­Bucher, 2010; Jack & Miller,
Nurses and
population

2008; Rasheed, 2015; Rowe, 1999; Vandemark, 2006) because it

students

students
nursing

Nursing
Nurses

Nurses
Target

focuses on intrapersonal, interpersonal and extrapersonal analysis

within a given context or situation. It is about recognising the in-
fluence of all kinds of social, environmental, cultural and political
Cross-­sectional

factors on self-­awareness. Eckroth-­Bucher (2010) argued that self-­

awareness is a multidimensional concept. This notion is incongruent
Research
design

with the majority of conceptualisations in the reviewed sources. The

NA

NA

NA

four-­dimensional concept of self-­awareness, that is, intrapersonal,

relational, extrapersonal and contextual, is consistent with different
Type of source

domains of self-­awareness presented by Campbell (1980), Burnard

Opinion piece
Discussion

Discussion

(1986) and Eckroth-­Bucher (2010).

Research

3.2.2 | Antecedents of self-­awareness
self-­awareness, listening, empathy
To examine the relationship among

Of the 20 sources that described perspectives of self-­awareness, ten

To develop self-­awareness using

self-­awareness in HIV nursing

self-­awareness in therapeutic

sources reported different antecedents (foundational characteris-

To describe the importance of
nurse–patient relationship
To describe the benefits of

tics) of self-­awareness. The most reported antecedent was making a

and patient-­centred care

conscious choice to become more self-­aware. This conscious choice

reflective practice

could arise after a person recognises inconsistencies in personal

thoughts and behaviours (Burnard, 1986; Campbell, 1980; Eckroth-­
Bucher, 2010; Gessler & Ferron, 2012; Rasheed, 2015). For example,
practice
Purpose

Eckroth-­Bucher (2010) states that a person is less likely to take ini-

tiative to become more self-­aware until a conscious effort is made to
recognise inconsistent thoughts and actions. Rasheed (2015) argues
Zealand
TA B L E   1   (Continued)

that self-­awareness starts with a conscious choice of engaging in in-

Finland
Origin

New

USA

trapersonal self-­discovery. Three of the studies noted that a stimu-

UK

lus is required to engage in a conscious process of self-­awareness

Greenwood

(Eckroth-­Bucher, 2010; Rasheed, 2015; Rowe, 1999). An impetus

Jack (2016)
Croston and

Haley et al.
Fyers and

could be feedback from others, personal reflection (Eckroth-­Bucher,

Rasheed
Authors

(2015)

(2017)
(2016)

2010; Rasheed, 2015), and it could arise from inside as an intuitive

feeling (Rowe, 1999) or an inner dialogue (Gessler & Ferron, 2012).
 |
770       RASHEED et al.

For instance, Kwaitek et al. (2005) noted that acknowledging one’s discerning one’s actions and managing difficult situations (Rasheed,
personal values could serve as an antecedent to engage in self-­ 2015).
awareness. Recognition of one’s personal values could involve iden- In the context of nursing education, self-­awareness can help
tifying one’s historical, cultural and social understanding of oneself nursing students to develop meaningful relationships with their
and one’s family values (Eckroth-­Bucher, 2010; Ramvi, 2015), and patients and other nurses and enable them to express themselves
identifying one’s meaningful life patterns (Ramvi, 2015; Vandemark, during their clinical practice and postclinical discussions. It can
2006). Reflection and introspection, although noted as the strate- also help students in their personal and professional development
gies to develop self-­awareness, are also considered antecedents of as a nurse (Drew, 1997; Rasheed, 2015). In the simplest terms,
self-­awareness (Gessler & Ferron, 2012; Severinsson, 2001; Table 2). the sources highlighted that self-­awareness enables nurses and
nursing students to pay attention to personal reactions and elu-
sive responses in relation to patients and other people involved
3.2.3 | Value of self-­awareness
in any given situation. Becoming self-­aware enables nurses to be
All of the sources highlighted the value of self-­awareness for nurses fully present for the patients (Table 2). However, a lack of self-­
and for nursing practice. Self-­awareness helps nurses in recognising awareness could negatively affect one’s personal and professional
their stress and in preventing burnout (Burnard, 1988), developing development. This assumption was supported by one study. Ramvi
therapeutic relationship with self and others (Burnard, 1988; Rahim, (2015) described a case study of a nurse with 50 years of pro-
Shalaby, & Hassan-­El-­Abd, 2014; Rasheed, 2015; Rawlinson, 1990; fessional experience in different settings, particularly oncology
Rowe, 1999), becoming more disciplined and understanding towards settings. This nurse grew up in a community in Norway where pro-
other people (Burnard, 1988), becoming empathetic (Haley et al., fessional status and wealth were highly valued; therefore, nursing
2017; Kwaitek et al., 2005), improving one’s communication skills was perceived to be a low-­s tatus profession. These social, histor-
(Croston & Jack, 2016; Rowe, 1999), increasing one’s self-­esteem ical and cultural notions led the nurse to believe that nursing is
(Rasheed, 2015; Rowe, 1999; Ünal, 2012), becoming more resilient, “something that ‘anyone’ can do, and that care and conversation
engaging in healthy behaviours, improving the quality of workplace with the patients is not a proper ‘competence’, since it does not
environments (Gessler & Ferron, 2012), increasing self-­efficacy and require any specific knowledge and is nothing to be proud of” (p.
sociotropy/autonomy (i.e., being involved in decision-­making for the 6). This self-­understanding prevented her from professional devel-
improvement of positive self-­image through investment in interper- opment as she did not value her profession. The account of this
sonal relations; Engin & Cam, 2009) and reacting to other people, nurse indicates that throughout her nursing career the nurse ex-
perienced inferiority complex, carried her personal burdens and
negative values into her workplace, and put on a mask to hide her
TA B L E   2   Antecedents and value of self-­awareness for nurses negative values while caring for the patients.

Antecedents (foundational characteris-

tics) of self-­awareness Value of self-­awareness
3.3 | Theme II: strategies for developing
1. Making a deliberate choice to engage 1. Recognising stress self-­awareness
in self-awareness and preventing
2. Stimuli (personal reflection, burnout All of the sources presented different strategies for increasing self-­
introspection and feedback) serve as 2. Developing awareness. Based on the analysis, we divided the strategies into
impetuses for engaging in the process therapeutic
three categories: theory-­based strategies, educational strategies
of self-awareness relationship with self
3. Acknowledging personal values and others and personal strategies.
4. Recognising one’s historical, cultural 3. Becoming more
and social understandings of self and disciplined and
family values understanding 3.3.1 | Theory-­based strategies
5. Identifying meaningful life patterns towards others
4. Improving communi- Under theory-­based strategies, some sources guided their discussion
cation skills based on specific theories and suggested those theories or frame-
5. Becoming resilient works for improving self-­awareness (Croston & Jack, 2016; Jack &
and empathetic
Smith, 2007; Rasheed, 2015; Vandemark, 2006), while others de-
6. Improving the quality
of workplace veloped new frameworks to improve one’s self-­awareness (Burnard,
environments 1986; Jack & Miller, 2008; Scheick, 2011). The commonly used and
7. Increasing self- proposed theories and frameworks were the Johari Window, the six-­
esteem, self-efficacy
category intervention analysis, Peplau’s theory of interpersonal rela-
and sociotropy/
autonomy tions and Newman’s theory of expanding consciousness.
8. Discerning actions The Johari Window, originally developed by Luft and Ingham
for managing difficult (1955), is a model comprising four quadrants: open, blind, hidden
nursing situations
and unknown. Becoming more self-­aware is related to changes in
RASHEED et al. |
      771

the size of these quadrants. The increased size of the open area and mindfulness (learning something new about self) and therapeutic use
decreased size of the unknown area indicate greater self-­awareness. of self (consciously helping a patient based on the awareness gained
This can be achieved by revealing one’s hidden self to others and in the situation). The use of these frameworks helps nurses in de-
learning more about one’s blind self (Croston & Jack, 2016; Jack & veloping interpersonal, intrapersonal and contextual self-­awareness
Smith, 2007; Rasheed, 2015). The six-­category intervention analysis and discerning the best possible actions to provide care.
framework, originally proposed by Heron (1990), helps one to exam-
ine personal perceptions of communication with others. It comprises
3.3.2 | Educational strategies
two styles: authoritative and facilitative, which entail six categories
describing how people intervene when helping others. The author- Several educational strategies were evaluated for their usefulness
itative interventions are prescribing (offering advice), informative in enhancing self-­awareness such as reflective strategies (Fyers &
(providing information) and confronting (challenging others’ be- Greenwood, 2016; Williams, Gerardi, Gill, Soucy, & Taliaferro, 2009),
haviours and actions). The facilitative interventions are cathartic Johari Window-­based teaching strategies (Krikorian & Paulanka,
(helping others to fully express themselves), catalytic (attempting 1982; Rahim et al., 2014; South, 2007) and psychodrama (Oflaz,
to engage others in self-­discovery and reflection in order to learn Meriç, Yuksel, & Ozcan, 2011). For example, Krikorian and Paulanka
how to promote problem-­solving) and supportive (instilling self-­ (1982) used an “Analysis Personal Behaviour in Groups” tool that
confidence in others; Jack & Smith, 2007). Peplau’s and Newman’s asked nursing students to rate themselves in terms of their listen-
theories are not necessarily for developing self-­awareness, but they ing abilities, trust, willingness to express feelings and be influence
can help persons in recognising the importance of self-­awareness of others, awareness of others’ feelings, reactions to groups dynam-
and expanding awareness in order to develop therapeutic relation- ics, reactions to others in a group and understanding of one’s ac-
ships (Vandemark, 2006). tions. The students rated themselves and discussed those ratings
Three sources proposed new frameworks for engaging in self-­ with other students. Although the use of this tool did not affect the
awareness. For example, Burnard (1986) presented the integrated self-­awareness of students, students reported that participation in
self-­awareness model that comprises four types of methods for in- this activity helped them learn more about themselves. Rahim et al.
creasing one’s self-­awareness: (a) classical/apollonian methods that (2014) provided an educational session to 216 students on self-­
help nurses to develop logical thinking and thoughtfulness in order awareness using the Johari Window. The students’ self-­awareness
to identify personal behaviours. Such methods require support and was assessed using a newly developed tool called self-­awareness
education from others; (b) romantic/apollonian methods that are data. Before the lecture, 6.5% (n = 14) of students were knowledge-
self-­directed and increase nurses’ concentration abilities leading to able about self-­awareness and 93.5% (n = 202) of students were not
self-­discipline; (c) classical/dionysian methods that enable nurses to knowledgeable. After the lecture, 69.9% (n = 151) of students indi-
focus on their emotions and recognise the emotional experiences; cated developing more knowledge about self-­awareness and 30.1%
and (d) romantic/dionysian methods that enable nurses to engage (n = 65) of students indicated otherwise. This finding indicates that
in “free expression of feelings and let go” (p. 221) and explore new teaching students about self-­awareness increases their knowledge,
areas by pushing against one’s limits (Burnard, 1986). Jack and Miller but does not provide any indication of the self-­awareness levels of
(2008) proposed an experiential “Now, Transition and Regroup” students. South (2007) evaluated the use of the Johari Window and
framework. It enables nurses to “unframe” their thinking, make Mandalas (symbols adapted from Buddhism that are used to illus-
changes and then “reframe” their thinking. In the now stage, a nurse trate truthfulness and wholeness of an individual). The students par-
asks a series of questions to himself or herself: “why is myself at ticipated in a 1-­hr and 40-­min class and drew their mandalas in the
this moment, what do I know about myself, what is it I would like light of the Johari Window. Through participation in this activity, the
to be more aware of, and what has triggered the desire to change” students were able to initiate learning about themselves. However,
(p. 33). In the transition stage, a nurse identifies personal strengths they acknowledged that becoming self-­aware is an ongoing and time-­
and limitations in a given situation, identifies learning needs and consuming process. Oflaz et al. (2011) evaluated psychodrama as a
looks for the opportunities to learn about the needs. Based on the teaching strategy to improve self-­awareness of nurses. Psychodrama
analysis undertaken in the first two stages, in the regroup stage, a was defined as a way of practising nursing that enabled nurses to
nurse evaluates the proposed changes and develops a plan for future engage in a critical analysis of their actions on a daily basis and to
self-­awareness. Recently, Scheick (2011) proposed the STEADFAST identify areas for improvement. Three nursing groups (12–15 in each
self-­awareness mindfulness model. The STEADFAST is an acronym group) participated and each psychodrama session comprised four
for self-­assess (consciously assessing the personal self in a given sit- parts, namely warm up (recalling a past memory), enactment (talk-
uation), therapeutic role (completely taking on the role of a nurse), ing about that memory through role reversal), sharing (sharing with
empathy (personally experiencing a patient’s experience), detached others and connecting the memory to everyday practice) and clos-
reflection (consciously detaching oneself from the stimulus for some ing (reflecting and identifying areas for improvement). Engaging in
time to think about one’s actions), facilitated debriefing (seeking help psychodrama helped nurses to better understand their personal be-
from others to understand one’s actions in a given situation), alert liefs and values and the values of their patients. This understanding
empathy (staying true to self and connecting with others), self-­aware helped them in developing a relational connection with the patients.
 |
772       RASHEED et al.

understanding experiences and life patterns, and informing future

3.3.3 | Personal strategies
practice. In relation to the contextual nature of self-­awareness,
Across all of the studies, the most commonly reported personal these antecedents can help nurses to inform their practice by under-
strategies were reflection, reflective journaling (Williams et al., standing their past experiences of caring for patients and discerning
2009) and reflective practice (Jack & Smith, 2007); using portfolios actions in a given situation. The value of self-­awareness for nurses
(Jack & Smith, 2007; Rasheed, 2015); seeking feedback from oth- has been well described in the literature, but it remains largely un-
ers (Rasheed, 2015); and noticing (Burnard, 1988). For example, supported by research. There is a further need to evaluate these
Williams et al. (2009) evaluated the use of structured reflective benefits through correlational research and experimental studies. In
journaling for increasing self-­awareness of 16 nursing students un- addition, the value of nurses’ self-­awareness for patient health out-
dertaking a mental health nursing course. A content analysis was comes needs to be explored because none of the literature described
used to analyse the reflective journals. It was reported that students the benefits from the patients’ perspective. It is recommended that
became more aware of their preconceived notions about mental ill- this exploration should be researched through exploration of pa-
ness, their competencies to care for people with mental illness and tients’ views about nurses’ self-­awareness.
their limitations. Burnard (1988) stated that self-­awareness can be With regard to the strategies outlined to improve self-­awareness,
increased by using a simple technique called noticing. This technique several theory-­based strategies and experiential frameworks have
involves paying attention to one’s feelings, thoughts and actions, de- been proposed. These frameworks appeared useful and practical,
veloping a greater understanding of those feelings, seeking feedback but there is a scarcity of the literature about actual application of
and appraisal from others, and then comparing personal beliefs with these frameworks and their usefulness from nurses’ perspectives.
others. Therefore, given the complex and intricate nature of healthcare en-
vironments, the tailoring of these frameworks to nursing settings is
suggested before further testing. It is also important to subject these
4 |  D I S CU S S I O N frameworks to critical scrutiny before use. This suggestion is consis-
tent with Cook’s (1999) argument that despite the presence of several
This scoping review synthesised the literature on self-­awareness in frameworks for promoting self-­awareness, there is limited rigorous
nursing from the last 35 years and presented various conceptualisa- testing and critique of these frameworks. Similarly, educational and
tions of self-­awareness, its antecedents and its value. This review also personal strategies have been proposed for improving nurses’ self-­
examined different theory-­based, educational and personal strat- awareness, but there is a need for further research before these
egies for improving self-­awareness. It is apparent from the review strategies could be recommended for use. A few of these strategies
that more research work is needed to be done on self-­awareness, es- were based on the Johari Window, while others did not use any the-
pecially in Eastern countries because most of the reviewed sources ory to guide the development of interventions. Therefore, future
originated from the USA, UK and Turkey. It is interesting to note research should focus on developing theory-­based and evidence-­
that only one study was found from the Middle East and no stud- informed interventions and evaluating different theory-­based ed-
ies were found from Asia. Further research is also needed in both ucational strategies to foster self-­awareness in nursing students,
Western and Eastern countries because most of the available litera- thereby preparing students to practise self-­awareness upon entering
ture included discussion papers which were based on the subjective the clinical settings. However, the challenge lies in developing the
opinions of the scholars and are not well substantiated with research content and exercises for use in educational and personal strategies
findings. Therefore, more quantitative, qualitative and mixed meth- for self-­awareness because the reviewed sources did not clearly de-
ods studies on self-­awareness are recommended. scribe the content of the used strategies. Nevertheless, the most
With regard to the perspectives on self-­awareness, there is common aspects of all these strategies seem to be self-­apparent
ample theoretical literature (Eckroth-­Bucher, 2010; Rasheed, 2015) and include reflection, reflective practice, experiential learning and
that provides an adequate body of nursing knowledge for develop- seeking feedback from others are known to be useful for developing
ing a conceptual and operational understanding of self-­awareness. self-­awareness. We suggest the use of developing strategies that use
Based on this theoretical literature, we developed an operational the above-­listed aspects for developing content for educating self-­
definition of self-­awareness that further clarifies its conceptual un- awareness to practising nurses and nursing students.
derstanding and can be used for future research studies. The most The primary aim of this review was to examine the literature on
important findings drawn from the reviewed literature are that de- self-­awareness in nursing and identify areas for research and practice.
veloping one’s self-­awareness is a deliberate and a relational pro- One of the central findings of the review is limited empirical research-­
cess and involves engaging in self-­awareness in every given situation based sources, especially research on how self-­awareness is mani-
(Burnard, 1986; Campbell, 1980; Croston & Jack, 2016; Eckroth-­ fested in clinical practice. Based on this finding, several research and
Bucher, 2010; Jack & Miller, 2008). This means that the contextual practice areas have been suggested. The secondary aim of this review
nature of self-­awareness cannot be disregarded. The antecedents was to build a knowledge base for a future mixed-­methods study and
of self-­awareness are well laid out in the literature indicating that theory development. With regard to this aim, we have identified a
development of self-­awareness requires making conscious efforts, sound conceptual and theoretical body of nursing knowledge, but
RASHEED et al. |
      773

there is a need to ground this knowledge in specific contexts. This 6 | R E LE VA N C E TO C LI N I C A L PR AC TI C E

is also indicative of the finding of this review that self-­awareness is
interpersonal, intrapersonal, extrapersonal and contextual in nature. This scoping review has delineated different aspects of self-­
awareness exclusively in nursing practice. It has identified the rela-
tional and contextual nature of self-­awareness in nursing practice. It
4.1 | Limitations
has also identified the value of self-­awareness for personal and pro-
Several limitations of this review should be acknowledged. First, fessional development of nurses and for developing an interpersonal
due to the use of the scoping methodology, we did not perform nurse–patient relationship. It has highlighted that self-­awareness
quality appraisal of the reviewed sources which could have resulted is a process of continuous expansion of one’s thoughts, feelings
in an inclusion of studies with comprised research quality and in- and beliefs in relation to patients. The review also presented dif-
complete synthesis. Therefore, consistent with the purpose of a ferent theoretical, educational and personal strategies that can be
scoping review, we expanded the literature search from January used by nurses in practice and education in order to improve their
1980 until March 2018, so that more literature sources could be self-­awareness.
identified, and findings could truly reflect the state of knowledge.
Second, 96.5% (n = 28) of the reviewed studies originated from
C O N FL I C T O F I N T E R E S T
Western countries which limits the findings to the Western world.
This limitation could have been because of the exclusion of non-­ The authors declared no conflict of interest.
English language studies. Third, the exclusion of dissertations could
have resulted in the loss of potential areas of research. However,
dissertations were excluded to assure the feasibility of the review. ORCID

Finally, most of the reviewed sources were discussion papers based Ahtisham Younas  http://orcid.org/0000-0003-0157-5319
on opinions of the researchers. Therefore, it is recommended that
the findings should be used with caution and applied in research
and practice after careful scrutinisation. We did not contact the
study authors to identify any potential unpublished research stud- REFERENCES
ies which could further affect the drawn conclusions.
American Psychiatric Nurses Association (2014). Psychiatric-mental
health nurse essential competencies for assessment and management
of individuals at risk for suicide. Retrieved from https://www.apna.
5 | CO N C LU S I O N org/files/public/Resources/Suicide%20Competencies%20for%20
Psychiatric-Mental%20Health%20Nurses(1).pdf
Burnard, P. (1986). Integrated self-­awareness training: A holis-
The importance and value of self-­awareness in nursing are fre- tic model. Nurse Education Today, 6(5), 219–222. https://doi.
quently described in the literature over the last 35 years, but it org/10.1016/0260-6917(86)90118-8
has received limited empirical attention in the last 15–20 years. Burnard, P. (1988). Self-­awareness and intensive care nursing. Intensive Care
Nursing, 4(2), 67–70. https://doi.org/10.1016/0266-612X(88)90040-5
There is an extensive conceptual and theoretical knowledge base
Campbell, J. (1980). The relationship of nursing and self-­
of self-­awareness, and numerous benefits of self-­awareness have awareness. Advances in Nursing Science, 2(4), 15–26. https://doi.
been indicated and demonstrated. However, this knowledge has org/10.1097/00012272-198007000-00004
not been operationalised for use in clinical practice and research. Cook, S. H. (1999). The self in self-­awareness. Journal of Advanced Nursing,
29(6), 1292–1299. https://doi.org/10.1046/j.1365-2648.1999.01014.x
Therefore, there is a dire need of robust quantitative, qualita-
Croston, M., & Jack, K. (2016). Self-­awareness and HIV nursing. HIV Nursing,
tive and mixed methods research to evaluate and test the avail- 16, 47–51. Retrieved from https://e-space.mmu.ac.uk/617062/
able theoretical knowledge on self-­awareness. The review also Drew, N. (1997). Expanding self-­awareness through exploration of mean-
highlights that a challenge lies in the utilisation of the existing ingful experience. Journal of Holistic Nursing, 15(4), 406–424. https://
doi.org/10.1177/089801019701500407
theoretical base for developing clinical instruments for assessing
Dziopa, F., & Ahern, K. J. (2009). What makes a quality therapeutic re-
and improving self-­awareness of nurses, designing clinical inter-
lationship in psychiatric/mental health nursing: A review of the re-
ventions for evaluating the effects of nurses’ self-­awareness for search literature. The Internet Journal of Advanced Nursing Practice,
nurses and patients, refining educational strategies for helping 10(1), 7. Retrieved from http://ispub.com/IJANP/10/1/7218
nursing students become more self-­aware and improving the ex- Eckroth-Bucher, M. (2001). Philosophical basis and practice of self-­
awareness in psychiatric nursing. Journal of Psychosocial Nursing and
pansion of self-­awareness in nurses as well as patients. Most im-
Mental Health Services, 39(2), 32–39.
portantly, the existing knowledge base should be utilised for more Eckroth-Bucher, M. (2010). Self-­awareness: A review and analysis of a
applied research in nursing, exploring its benefits for patients and basic nursing concept. Advances in Nursing Science, 33(4), 297–309.
nurses and its impact on the nursing practice. There is also limited https://doi.org/10.1097/ans.0b013e3181fb2e4c
Engin, E., & Cam, O. (2009). Effect of self-­awareness education on the
research on the effectiveness of educational and personal strate-
self-­efficacy and sociotropy–autonomy characteristics of nurses in
gies for increasing self-­awareness during nursing education, which a psychiatry clinic. Archives of Psychiatric Nursing, 23(2), 148–156.
needs to be investigated. https://doi.org/10.1016/j.apnu.2008.05.003
 |
774       RASHEED et al.

Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Ramvi, E. (2015). I am only a nurse: A biographical narrative
Developing effective and caring nurse-­patient relationships. Nursing study of a nurse’s self-­u nderstanding and its implication for
Standard, 31(28), 54–62. https://doi.org/10.7748/ns.2017.e10735 practice. BMC Nursing, 14(1), 23. https://doi.org/10.1186/
Fyers, K., & Greenwood, S. (2016). Cultural safety: Developing self-­ s12912-015-0073-y
awareness through reflective practice. Nursing Review, 16(2), 28–29. Rasheed, S. P. (2015). Self-­awareness as a therapeutic tool for nurse/
Retrieved from http://nursingreview.co.nz/cultural-safety-develop- client relationship. International Journal of Caring Sciences, 8(1),
ing-self-awareness-through-reflective-practice/ 211–216. Retrieved from http://www.internationaljournalofcaring-
Gessler, R., & Ferron, L. (2012). Making the workplace health- sciences.org/docs/24-abstract.pdf
ier, one self-­aware nurse at a time. American Nurse Today, Rawlinson, J. W. (1990). Self-­awareness: Conceptual influences, contribu-
7(7). Retrieved from https://www.americannursetoday.com/ tion to nursing, and approaches to attainment. Nurse Education Today,
making-the-workplace-healthier-one-self-aware-nurse-at-a-time/ 10(2), 111–117. https://doi.org/10.1016/0260-6917(90)90205-5
Haley, B., Heo, S., Wright, P., Barone, C., Rettiganti, M. R., & Anders, Registered Nurses Association of Ontario (2002). Establishing therapeu-
M. (2017). Relationships among active listening, self-­awareness, tic relationships. Retrieved from http://rnao.ca/sites/rnao ca/files/
empathy, and patient-­centered care in associate and baccalaureate Establishing_Therapeutic_Relationships.pdf
degree nursing students. Nursing Plus Open, 3, 11–16. https://doi. Roberts, J. (1998). Self-­awareness in counselling. Accident and
org/10.1016/j.npls.2017.05.001 Emergency Nursing, 6(4), 226–229. https://doi.org/10.1016/
Han, S., & Kim, S. (2016). An integrative literature review on self-­awareness S0965-2302(98)90085-6
education/training programs in the nursing area. Perspectives in Nursing Rowe, J. (1999). Self-­awareness: Improving nurse-­client interac-
Science, 13(2), 59–69. https://doi.org/10.16952/pns.2016.13.2.59 tions. Nursing Standard, 14(8), 37–40. https://doi.org/10.7748/
Heron, J. (1990). Helping the client: A creative practical approach. London: ns1999.11.14.8.37.c2709
Sage. Rungapadiachy, D. M. (1999). Interpersonal communication and psychology
Jack, K., & Miller, E. (2008). Exploring self-­awareness in mental health for health care professionals. Edinburgh, UK: Elsevier.
practice. Mental Health Practice, 12, 31–35. https://doi.org/10.7748/ Scheick, D. M. (2011). Developing self-­aware mindfulness to manage
mhp2008.11.12.3.31.c6803 countertransference in the nurse-­client relationship: An evaluation
Jack, K., & Smith, A. (2007). Promoting self-­awareness in nurses to im- and developmental study. Journal of Professional Nursing, 27(2), 114–
prove nursing practice. Nursing Standard, 21(32), 47–52. https://doi. 123. https://doi.org/10.1016/j.profnurs.2010.10.005
org/10.7748/ns2007.04.21.32.47.c4497 Severinsson, E. I. (2001). Confirmation, meaning and self-­awareness as
Khalil, H., Peters, M., Godfrey, C. M., McInerney, P., Soares, C. B., & core concepts of the nursing supervision model. Nursing Ethics, 8(1),
Parker, D. (2016). An evidence-­based approach to scoping reviews. 36–44. https://doi.org/10.1177/096973300100800105
Worldviews on Evidence-­Based Nursing, 13(2), 118–123. https://doi. South, B. (2007). Combining mandala and the Johari Window: An exer-
org/10.1111/wvn.12144 cise in self-­awareness. Teaching and Learning in Nursing, 2(1), 8–11.
Krikorian, D. A., & Paulanka, B. J. (1982). Self-­awareness – The key to https://doi.org/10.1016/j.teln.2006.10.001
a successful nurse-­patient relationship? Journal of Psychosocial Strandås, M., & Bondas, T. (2018). The nurse-­patient relationship
Nursing and Mental Health Services, 20, 19–21. https://doi. as a story of health enhancement in community care: A meta-­
org/10.3928/0279-3695-19820601-06 ethnography. Journal of Advanced Nursing, 74, 11–22. https://doi.
Kwaitek, E., McKenzie, K., & Loads, D. (2005). Self-­awareness and re- org/10.1111/jan.13389
flection: Exploring the ‘therapeutic use of self’. Learning Disability Ünal, S. (2012). Evaluating the effect of self-­awareness and commu-
Practice, 8(3), 27–31. https://doi.org/10.7748/ldp.8.3.27.s22 nication techniques on nurses’ assertiveness and self-­esteem.
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Contemporary Nurse, 43(1), 90–98. https://doi.org/10.5172/
Advancing the methodology. Implementation Science, 5(1), 69. https:// conu.2012.43.1.90
doi.org/10.1186/1748-5908-5-69 Vandemark, L. M. (2006). Awareness of self and expanding con-
Luft, J. & Ingham, H. (1955). The Johari window, a graphic model of inter- sciousness: Using nursing theories to prepare nurse-­therapists.
personal awareness. Proceedings of the western training laboratory in Issues in Mental Health Nursing, 27(6), 605–615. https://doi.
group development. Los Angeles, CA: University of California. org/10.1080/01612840600642885
Morin, A. (2011a). Self-­awareness part 1: Definition, measures, effects, Varcarolis, E. M. (2018). Therapeutic relationships. In M. J. Halter (Ed.),
functions, and antecedents. Social and Personality Psychology Compass, Varcarolis’ foundations of psychiatric-mental health nursing: A clinical
5(10), 807–823. https://doi.org/10.1111/j.1751-9004.2011.00387.x approach (8th ed., pp. 125–136). St. Louis, MO: Elsevier.
Morin, A. (2011b). Self-­awareness part 2: Neuroanatomy and importance Williams, G. B., Gerardi, M. B., Gill, S. L., Soucy, M. D., & Taliaferro, D. H.
of inner speech. Social and Personality Psychology Compass, 5(12), (2009). Reflective journaling: Innovative strategy for self-­awareness
1004–1017. https://doi.org/10.1111/j.1751-9004.2011.00410.x for graduate nursing students. International Journal for Human Caring,
Nursing and Midwifery Council (2015). Standards for competence for 13(3), 36–43. https://doi.org/10.20467/1091-5710.13.3.36
registered nurses. Retrieved from https://www.nmc.org.uk/globalas-
sets/sitedocuments/standards/nmc-standards-for-competence-for-
registered-nurses.pdf S U P P O R T I N G I N FO R M AT I O N
Oflaz, F., Meriç, M., Yuksel, C., & Ozcan, C. T. (2011). Psychodrama: An
Additional supporting information may be found online in the
innovative way of improving self-­awareness of nurses. Journal of
Psychiatric and Mental Health Nursing, 18(7), 569–575. https://doi. Supporting Information section at the end of the article. 
org/10.1111/j.1365-2850.2011.01704.x
Peplau, H. E. (1952). Interpersonal relations in nursing. New York, NY:
Putnam. How to cite this article: Rasheed SP, Younas A, Sundus A.
Rahim, A., Shalaby, M. H., & Hassan-El-Abd, A. M. A. (2014). Assessment
Self-­awareness in nursing: A scoping review. J Clin Nurs.
of nursing students’ self-­awareness dealing with psychiatric patient.
International Journal of Advanced Research, 2(2), 705–713. Retrieved 2019;28:762–774. https://doi.org/10.1111/jocn.14708
from http://www.journalijar.com/article/1089/assessment-of-nurs-
ing-students-self-awareness-dealing-with-psychiatric-patient-/