An Integrative Literature Review on Self-awareness Education/Training Programs in the Nursing Area

Soolgi Han; Sungjae Kim

doi:10.16952/pns.2016.13.2.59

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Han and Kim: An Integrative Literature Review on Self-awareness Education/Training Programs in the Nursing Area

Original Article

Perspectives in Nursing Science 2016;13(2):59-69.

Published online: 19 October 2016

DOI: https://doi.org/10.16952/pns.2016.13.2.59

An Integrative Literature Review on Self-awareness Education/Training Programs in the Nursing Area

Soolgi Han¹, Sungjae Kim^2,

¹RN, Department of Nursing, Korea University Anam Hospital, Seoul

²Professor, College of Nursing ․ The Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Kim, Sungjae College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8803, Fax: +82-2-765-4103, E-mail: sungjae@snu.ac.kr

Received 18 August 2016 Revised 31 August 2016 Accepted 31 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This paper is a review of interventions designed to promote self-awareness in the nursing area. The specific purpose was to analyze the general characteristics of self-awareness intervention studies, intervention contents, and the effects of the studies in order to present basic information for developing self-awareness interventions in the nursing area. Methods: Using “nurse/nursing” and “self-awareness” as key words, the researchers searched six electronic databases. The method proposed by Whittemore and Knafl was used. Results: Seventeen studies met the inclusion criteria. The most common research design was quasi-experimental. Nine quasi-experimental studies (52.9%), 7 qualitative studies (41.2%), and 1 mixed methodology study (5.9%) were analyzed. Most studies used group intervention and student nurses as participants. The interventions were revealed to be effective in enhancing participants’ self-awareness. The reflection method was used in most intervention approaches. Conclusion: To provide therapeutic nursing care, having self-awareness is important. Future research with well-designed clinical trials applying self-awareness intervention needs to be conducted to enhance self-awareness in the nursing area.

Keywords: Awareness, Intervention, Nurses

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Fig. 1

Result of search strategy.

Table 1.

Chronological Summary of Reviewed Papers (N=17)

Author (year)	Design / Subject	Intervention	Outcome Measure	Findings
Hasanpour-Dehkordi & Solati (2016)	Quasi-experimental study / Nurse students	Context based learning method, collaborating training, and traditional training	․ Student's behavior of respect and responsibility ․ Communication skills and critical thinking ․ Self-awareness and self-evaluation ․ Student's attitude consisting of students role ․ Lecturers’ role and students’ learning level ․ The efficiency of the unit	․ Context based learning and collaborative approaches were useful in terms of increased respect, self-awareness, self-evaluation, communication skills and responsibility as well as motivation and learning score in comparison to traditional method
Lestander et al. (2016)	Qualitative study / Nurse students	High fidelity simulation	․ What has touched ․ Thoughts/feelings that raised by event ․ Knowledge after intervention ․ The use of intervention as nurse and effect on patient safety	․ Feeling stressed, inadequate, and unskilled ․ Never compromising patient safety ․ Planning the work and prioritizing ․ Understand and implement nursing knowledge ․ Appreciating colleagues, good communication, and time for thoughtfulness ․ Gaining increased self-awareness ․ Beginning to understand the profession
Wanda et al. (2016)	Qualitative study / Nurse students	Flash card	․ Use the cards as a way of sharing experiences of reflective practice and reflection and the meaning	․ Expanding view of nursing practice ․ Safe place ․ A light in the dark ․ Self-awareness booster ․ Learning through experience
Pai (2015)	Quasi-experimental study / Nurse students	Self-reflection and Insight program	․ Holistic Nursing Competence Scale ․ Self-Reflection and Insight Scale ․ Perceived Stress Scale ․ Clinical Teaching Quality Scale	․ Effectively increases nursing student's self-reflection, clinical competence, and decreases practice stress ․ Nursing core competencies are enhanced which improve self-awareness and decrease stress
Westin et al. (2015)	Qualitative study / Nurse students	Didactic Strategies	․ Learning experiences ․ What was important for their learning ․ Experiences of different didactic strategies that has support their learning	․ Focusing on the patient perspective and paying attention to others ․ Learning from discussion and reflections ․ Training for the professional role and becoming more courage ․ Gaining insights and increasing self-awareness
Demir et al. (2014)	Quasi-experimental study / Nurse students	Mentoring program	․ Student Information Form ․ Mentoring Assessment Form ․ Locus of Control Scale ․ Ways of Coping Inventory	․ Support the mentees for problem solving, adapt to university environment, self-awareness, self-confidence, and establishing of positive relations with their mentors.
				․ Increase internal locus of control parallel with social support behavior and active coping with stress
Vitello-Cicciu et al. (2014)	Qualitative study / Nurse	Leadership development program	․ Was the content leader new? ․ Did content offer a better understanding? ․ How to manage emotions more effectively. ․ The important things you learned. ․ The behavioral changes as leader ․ Enhance ability to express or hear divergent viewpoints ․ How it help to set priorities and goals. ․ An experience using the content	․ Self-awareness though self-reflection ․ Use self-regulation to manage one's emotion ․ Emotionally aware of others ․ Value the MBTI ․ Seek diverse feedback ․ Engage in active listening ․ Have crucial conversation
Ganzer & Zauderer (2013)	Qualitative study / Nurse students	Structured preclinical workshop	․ Perceptions about the psychiatric mental health clinical practicum	․ Positive insights on the efficacy of preparedness and open communication ․ Gain self-awareness, confidence, active
Unal, S. (2012)	Quasi-experimental study / Nurse students	Self-awareness and communication techniques course	․ Rathus Assertiveness Schedule ․ Coopersmith Self-Esteem Inventory ․ Student information form	․ Increased assertiveness, self-esteem ․ Practice enhances self-awareness, communication skills, assertiveness and self-esteem
Ahmed & Elmasri (2011)	Quasi-experimental study / Nurse	Self-awareness education program	․ Nurses characteristics data form ․ Self-efficacy Scale ․ Sociotropy Autonomy Scale	․ Increase self-efficacy and autonomy ․ Highly significant correlation between total of self-efficacy and total of sociotropy autonomy
Oflaz et al. (2011)	Qualitative study / Nurse	Structured psychodrama session	․ Recall a certain memory and select object ․ Talk about the personal story and personify the feeling through role reversal, the past and connection to their daily life, and reflections	․ Helpful to improve the self-awareness and prove to be a useful educational tool. ․ Helpful in understanding nurses themselves and in exploring the perspective of others in practice.
Scheick (2011)	Mixed methodology / Nurse students	STEDFAST	․ Element S: Self-concept examination	․ Learned self-awareness skills likely caused changes in self-awareness, aliveness, and self-control
Healy & Sharry (2010)	Quasi-experimental study / Nurse students	Assessing and promoting health	․ Obtained students opinions and comments of the workshop	․ Useful to nursing students in developing self-awareness of their lifestyle practices in relation to health.
Engin & Cam (2009)	Quasi-experimental study / Nurse	Self-awareness education program	․ Nurses characteristics data form ․ Self-efficacy Scale ․ Sociotropy Autoomy Scale	․ Increase self-efficacy, sociotropy-autonomy personal characteristics, and self-awareness of one's own feelings and thoughts.
Park et al. (2009)	Quasi-experimental study / Nurse students	Nursing communication curriculum	․ Communication quotient ․ Life position inventory	․ Effective in improving communication ability. ․ Increased general communication ability. ․ Being positive among self-communication increased
Williams et al. (2009)	Qualitative study / Nurse students	Reflective journaling	․ Ongoing dialogue about the process of the course ․ Reflection on relation to the clinical area and development of relationship with others	․ Becoming aware and feeling the pain ․ Worldview, personal view, and patient view of persons with mental illness ․ Personal growth
Kim (2006)	Quasi-experimental study / Nurse students	Self-awareness program	․ Self-concept ․ Self-perception ․ Self-esteem	․ Enhance self-concept and self-esteem ․ Increase positive self-perception

Table 2.

General Analysis of Reviewed Papers (N=17)

Variables	Content		n(%)
Published years	2016~2015		5 (29.4)
	2014~2013		3 (17.6)
	2012~2011		4 (23.5)
	2010~2009		4 (23.5)
	2008~2006		1 (5.9)
Research design	Quasi-experimental study		9 (52.9)
	Qualitative study		7 (41.2)
	Mixed methodology		1 (5.9)
Research subjects	Nurse		4 (23.5)
Research subjects	Student nurse		13 (76.5)
Approach	Reflection method		6 (35.3)
	Self-awareness program		2 (11.8)
	Psychodrama/action method		2 (11.8)
	Assessing and promoting health		1 (5.9)
	Context based learning method, collaborating training, and traditional training		1 (5.9)
	Communication program		1 (5.9)
	Leadership development program		1 (5.9)
	Mentoring program		1 (5.9)
	Self-awareness and communication technique course		1 (5.9)
	STEDFAST Self-aware mindfulness development model		1 (5.9)
Outcome Measure	Intra-personal factor	Self-related concepts (self-awareness, self-evaluation, self-esteem, self-efficacy, self-confidence and self-concept)	8 (18.6)
		Feelings/emotions	4 (9.3)
		Reflection	3 (7.0)
		Sociotropy-autonomy	2 (4.7)
		Assertiveness	1 (2.3)
		Critical thinking	1 (2.3)
		Holistic nursing competence	1 (2.3)
		Learning level	1 (2.3)
		Locus of control	1 (2.3)
		Responsibility	1 (2.3)
		Stress	1 (2.3)
		Others	7 (16.3)
	Inter-personal factor	Behavior	2 (4.7)
		Communication	2 (4.7)
		Coping	1 (2.3)
		Respect	1 (2.3)
		Others	6 (14.0)

Table 3.

Analysis of Intervention (N=17)

Author (year)	Approach	Intervention period		Contents
Hasanpour-Dehkordi & Solati (2016)	Context based learning method, collaborating training, and traditional training	Not mentioned	․ Context based learning method: testing situation, self-directed study, integration of new information, deep thinking	․ Collaborating Training: forming, storming, norming, performing, and adjourning	․ Traditional Training: teacher-oriented training per conventional routine
Lestander et al. (2016)	High fidelity simulation (HFS)	1 semester	․ HFS day: 3 HFS, practical nursing performance (45 min), debriefing (45 min)	․ HFS day: individual written reflection ․ First day post HFS: verbal group reflection	․ One week post HFS: Individual written reflection
Wanda et al. (2016)	Flash card	6 weeks, 2 hrs/week	․ 2 hours, 6 weeks	․ 5 Ds: doubt, description, di decision ssection, discover, and
Pai (2015)	Self-reflection and Insight program	21 credit, 1,120-hour course	․ Clinical practice program: self-reflective clinical care workshop.	․ Guidelines for 8 core nursing competencies	․ Self-reflective learning exercise
Westin et al. (2015)	Didactic strategies	2 semesters	․ Writing a report
Demir et al. (2014)	Mentoring program	14 weeks	․ Physiological needs: accommodation, nutrition, and scholarship ․ Safety needs: information about the school, awareness of student rights. Use of health services & center. Clinical practice ․ Self-esteem: self-confidence	․ Cognitive needs: information about lecturers, lessons and motivation Effective study methods Organize the mentee's work schedule. Stress regarding lessons. Use of the library, computer and internet ․ Social needs: Social activity and friendship. Problems experienced in relationship	․ Self-actualization: coping with stress, solving mentee's problems, Awareness of mentee's personality traits ․ Profession: Mentee's views and anxiety regarding the profession. Introduction regarding nursing profession, job possibilities
Vitello-Cicciu et al. (2014)	Leadership development program	4 sessions	․ AONE nurse manger leadership partnership learning domain framework
Ganzer & Zauderer (2013)	Structured preclinical workshop	1 workshop	․ The workshop included opportunities for role-playing in interactive scenarios using high-fidelity simulation as well as media presentations and movie clips
Unal, S. (2012)	Self-awareness and communication techniques course	14 weeks, 3 hrs/week	․ Week 1: Getting to know each other. Introduction & pre-test. Self-awareness and communication, types of emotion. Homework ․ Week 2: homework presentation, social skills & individual work and homework ․ Week 3: homework presentation, nonverbal behavior, and homework ․ Week 4: homework presentation, feelings and thoughts I, and group work & homework ․ Week 5: homework	․ presentation, feelings and thoughts II, individual work, and homework ․ Week 6: homework presentation, film, and homework ․ Week 7: first mid-term, homework presentation, listening, perception and interpretation, and homework ․ Week 8: homework presentation, listening, perception and interpretation, and homework ․ Week 9: homework presentation, assertiveness, false beliefs affecting assertive behavior. Homework	․ Week 10: homework presentation, rights and beliefs in assertiveness, making a request, being able to say no, film, and homework ․ Week 11: homework presentation, nurse-patient communication, communication in special conditions, and homework ․ Week 12: homework presentation, practice of communication skills ․ Week 13: seminars ․ Week 14: seminars & Final test
Ahmed & Elmasri (2011)	Self awareness education program	15 weeks, 10 session, 30~45 min/session	․ Introduction to awareness Anxiety ․ Trust	․ Dependence ․ Flexibility ․ Loneliness ․ Helplessness	․ Loss ․ Anger ․ Guilt ․ Power
Oflaz et al. (2011)	Structured psychodrama session	3 session, 90~100 min/session	․ Warm-up: recalling a certain memory and selecting an object	․ Enactment: talk about the personal story and personifying the feeling through role reversal	․ Sharing: talk about the past and connection to their daily life ․ Closing: talk about the session and reflections
Scheick (2011)	STEDFAST	1 semester	․ S: Self-Assess ․ T: Therapeutic Role ․ E: Empathy	․ D: Detached Reflection ․ F: Facilitated Debriefing ․ A: Alert Empathy	․ S: Self-Aware Mindfulness ․ T: Therapeutic Use of Self
Healy & Sharry (2010)	Assessing and promoting health	2 semesters	․ Phase 1: Student self-assess their own knowledge and lifestyle practices around smoking, alcohol, exercise and diet with the aid of a health assessment form	․ Phase 2: Students work in pairs to obtain baseline records of pulse, blood pressure and respirations. Then a basic fitness test which posttest measures are recorded	․ Phase 3: Students are asked to complete a stress index scale where stress is measured incrementally using a Likert scale. ․ Phase 4: Relaxation process.
Engin & Cam (2009)	Self-awareness education program	24 sessions, twice/week	․ 12 Topics: awareness, anxiety, trust, dependence, flexibility, hope, loneliness, helplessness, loss, anger, guilt, power	․ The program involved sharing the feelings, thoughts, beliefs, and difficulties. Developing the nursing process for a patient	․ Writing the feelings shared and make a decision about next group discussion
Park et al. (2009)	Nursing communication curriculum	12 weeks, once/week, 100 min/session	․ Session 1: self-awareness for the need of communication, orientation ․ Session 2: self-rated questionnaire & lecture ․ Session 3: the type and the classification of communication and mall group discussion, role play, and presentation ․ Session 4~5: lecture ․ Session 6: review communication skill, and watch the videotape of non-therapeutic & therapeutic communication skill	․ Session 7: small group discussion, role play of presented situation, and video tape record the process by using e-Station Session 8: analysis, evaluation, and feedback of recorded videotapes ․ Session 9: large group discussion about self-awareness, encounter, effective communication factor, meaning, value of negative expression etc, question & answer; discussion	․ Session 10: understand self and others in aspects by MBTI ․ Session 11: communication in a large group and practice of communication in a large group; presentation of assigned individual counseling and self-analysis ․ Session 12: presentation of assigned individual counseling and self-analysis was continued and self-rated questionnaire
Williams et al. (2009)	Reflective journaling	1 semester, 15 weeks	․ Reflective journaling
Kim (2006)	Self-awareness program	6 session, 100 min/session	․ Session 1: program orientation Practice of Action Methods ․ Session2 : Transactional self understanding I	․ Session 3: Longitudinal self understanding I ․ Session 4: Longitudinal self understanding II	․ Session 5: In-depth self understanding ․ Session 6: Comprehensive self understanding

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