Using "Self" in the Nurse-Patient Relationship
Buchanan, Judith, Humane Health Care International
When one is stranger to oneself then one is estranged from others too. If one is out of touch with oneself, then one cannot touch others.
-- Ann Morrow Lindbergh
Correspondence and reprint requests: Judith Buchanan, Associate Professor, Department of Nursing, University of New Brunswick, P.O. Box 5050, Saint John, New Brunswick E2L 4L5, Canada.
Each partner within the nurse-patient relationship has a unique background and exterior life circumstances. The uncertainties of the human condition apply to both, and thus we can appreciate that, relatively speaking, the one giving nursing care is no different from the one receiving nursing care. However, through particular professional responsibilities, the nurse is in a position to be the helper. Without the ability to use "self"--the key to a helping relationship--how can the nurse fully assist the patient?
I currently teach nurses who have returned to school to earn a baccalaureate degree. As an educator, one of my goals is to foster critical thinking among the students about nursing practice issues; to encourage clarity, substance, and new dimensions in their thoughts on nursing. For example, using a reflective journal assignment, students are asked to examine issues critical to the use of "self" in their relationships with patients. Questions that students ask such as, "How can partnership relationships develop when in some nursing situations nurses are invisible, inferior, or inconsequential?" or "If I'm too busy being a `good nurse,' can I truly be a caring nurse?" are actually searches into "self' as a practitioner. Some students' inquiries led me to a reciprocal and ongoing examination of self as the key component within a therapeutic nurse-patient relationship.
I have usually provided one general reply to the collection of journal entries on a subject. In this, I give personal responses coupled with additional material from the professional or theoretical literature. Stimulated by the exercise of pooling and expanding on the students' writings, I have examined issues such as: What is self? What conditions self? Is self stable over time? How does one use self in a therapeutic way? This has encouraged me to seek alternative or new ways of thinking. My purpose in writing this paper is to record my experiential understanding of these issues, particularly the nurses' use of self in the helping role.
What Is Self?
Self is a process, not a product. (1) It is conditioned partly through the personality traits or mood characteristics that are determined genetically. Our "self" includes all of our conscious and unconscious aspects: an outer self that we express to others, and an inner self known (if at all) only to ourselves. Self-concept--that is, who we believe ourselves to be--takes shape early in life and changes over time. It is both complex and contextual. When we are exposed to new circumstances or to unexpected events, we test our notions of self and as a result our world view often changes. Life experiences reshape or redefine our attitudes and values and affect our self-concept, which in turn exerts a strong influence over our behaviour. Meeting life challenges effectively brings a fuller appreciation of one's coping capacity and a more expanded view of the self.
A reciprocity exists between persons and their environments. For example, Carl Jung considered self to be,
. . . an awareness on the one hand of our unique natures, and on the other of our intimate relationship with all life. (2)
George Herbert Mead also spoke of interconnections:
. . . selves can only exist in definite relationships to other selves . . . The individual possesses a self only in relation to the selves of the other members of his social group. (3)
In striving for growth and self-definition, maturing persons seek to integrate past and present experiences within a healthy self-identity, which is compatible with their social identity. …