Personal Awareness as a First Step to Self-Care

 According to the U. S. Bureau of Labor Statistics (2014), nurses comprise the largest work sector in the healthcare industry, totaling 2.7 million in 2012.  The majority of registered nurses work in the hospital setting.  Researchers have demonstrated that stress has a negative impact on an individual’s mental, physical, spiritual, and emotional well-being.  Nursing professionals face extraordinary stress in the present healthcare environment.  Many reasons for nurses feeling stressed are linked to the nature of the profession.  Factors that contribute to nurses experiencing emotional exhaustion and burnout, include working extended hours, providing emotional support in the face of patients’ suffering, increasing nurse to patient ratios, and challenging computer documentation shifting the care away from the patient’s bedside. 


            Nurses require self-care tools for developing stress resilience and personal hardiness.  A task force for the World Health Organization (1998) defined self-care as actions taken by individuals “to establish and maintain health, prevent and deal with illness” (p. 2).  The American Holistic Nurses Association (AHNA) is an organization that recognizes self- care as a core value of holistic nursing (AHNA, 2013).  The AHNA recognizes that self-care is essential component for nurses’ personal development.  Nurses who incorporate self-care practices into their lives choose healthier lifestyle behaviors.  Self-care improves the nurse’s ability to better manage stress and increases his/her personal self- awareness.


The North American Nursing Diagnosis Association International (NANDA-I, 2007) is the organization that establishes nursing diagnoses.  The diagnoses are categorized into 13 domains, that include health promotion; nutrition; elimination and exchange; activity and rest; perception and cognition; self-perception; role relationships; sexuality; coping and stress tolerance; life principles; safety and protection; comfort; and growth and development.  Each domain provides nurses an opportunity for self-reflection and to explore their own patterns of self-care, self-healing practices.  Questions derived from the domains create an opportunity for nurses to reflect on the different aspects of their lives.  The following seven domains may provide insight into self- awareness with specific questions focused on each of the domains.


Health Promotion:  Health management entails more than the absence of disease, it entails recognizing the patterns in your life that have increased or decreased your health status.  Questions to ask yourself: When was the last time you felt the happiest and healthiest?  Do you know your patterns in your life that caused your weight gain or weight loss? What behaviors do you perform to increase your physical, emotional, spiritual, and mental health?


Nutrition: Good nutrition and mindful eating practices are essential for optimal wellness.  Questions to ask yourself:  Do you take the time to make a healthy lunch for work?  Do you drink sufficient water in the workday to maintain hydrated?  Do you leave your unit to eat and eat mindfully?


Elimination and Exchange: Exploring the mechanisms of elimination and exchange incorporates the integrity of one’s urinary system, gastrointestinal system, integumentary system and pulmonary system.  Questions to ask yourself:  Are you aware of your breath?  Do you breath deeply or shallowly?  Do you apply sunscreen regularly when you are exposed to sunshine?


Activity and Rest:  Sleep is important for an individual’s overall health and well-being. According to the Centers for Disease Control and Prevention (2014) adults should sleep 7 to 8 hours daily.  Questions to ask yourself:  How many hours of restful sleep do you get daily?  Do you sleep with the television on?  Are you at risk for sleep apnea?


Perception and Cognition:  Perceptions and cognition as a set of activities that provide individuals the ability to proceed through the world, avoiding danger, making decisions, and preparing for action (Goldstein, 2008).  Questions to ask yourself:  Do I see the world around me in a positive manner or a negative one?  How do I perceive my work environment?  How do I perceive my home environment?  How do I perceive my co-workers?  Do I react when I feel challenged by another individual?  Am I aware of my implicit biases?  


Self-Perception:  Increasing self-awareness in an objective manner is a key element to self-perception and in determining how we act in the world.  Questions to ask yourself:  Do I see myself as inadequate?  Do I see myself through a clear lens?  Am I living an authentic life?  Are my fears holding me back from moving forward?  Do I keep repeating the same mistakes in my relationships?


Role Relationships: Healthy, nurturing relationships are essential for optimal wellness. Relationships help us create connections with others by providing companionship and friendship.  Questions to ask yourself:  Do I look forward to going home to my family after work?  Are my friends a positive or negative influence in my life?  Do I not pick up the phone when certain friends call?  Who are the negative people in my life and what am I doing to create a shift in the relationship?  Who are the positive people in my life, what, and I doing to nurture the relationship?


Coping and Stress Tolerance:  Research has demonstrated the negative impact of stress and its role in creating disease.  Stress resilience is essential to maintain one’s physical, emotional, spiritual, and mental health.  Questions to ask yourself:  Am I aware how my body physically reacts to the early onset of stress?  Do I have emotions that are difficult to control?  What situations cause me to react in a stressful manner?  Do I have tools or practices in place to decrease my stress level?


Personal awareness supports the nurse when focusing on delivering patient-centered care while being a catalyst of healing.  Nurses, who develop personal awareness, realize they cannot facilitate healing if they are in the process of healing themselves.  Nurses complete assessments on patients routinely as part of their responsibilities in the inpatient and outpatient settings.  Self-assessment is the first step in developing self-awareness of personal behaviors that are conducive to self-care or creating obstacles to self-healing.  Nurses who demonstrate self-awareness may have tools for better managing stress and delivering patient-centered care.


Mariano, C.; American Holistic Nurses’ Association; & American Nurses Association (2013).  Holistic Nursing: Scope and standards of practice (2nd ed.).  Silver Spring, MD: American Nurses Association.

Bureau of Labor Statistics (2012).  Occupational outlook handbook: Registered nurses.  Retrieved from United States Department of Labor [Website] at

Centers for Disease Control and Preventions (2014).  Are you getting enough sleep?  Retrieved from

Goldstein, E.B. (2008).  Cognitive psychology: connecting mind, brain, and everyday experience (2nd edition).  Belmont, CA: Cengage.

NANDA International (NANDA-I; 2007).  NANDA International Taxonomy II.  Retrieved from

World Health Organization (1998).  The role of the pharmacist in self-care and self-medication.  Retrieved from