NU500-8B discussion WEEK4 Discussion2

 Discussion Question/Prompt [Due Friday]

Please read the following introduction and complete the following steps for your initial discussion post:

In the Chinn and Kramer (2018) reading, chapter 5, the authors discuss personal knowing and its impact on nursing theory and nursing practice. Consider professional development of nursing and apply the concepts of personal knowing on the development of nursing practice.

Please respond to all of the following:

• What is personal knowing; how does your personal knowing affect your personal professional development?
• Identify and discuss 2 professional strengths and 2 weaknesses that you have?
• How can you apply nursing theory to address your weaknesses and further develop your strengths?
• Be sure to supplement your discussion with your personal and professional experiences.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position. 
Please be sure to validate your opinions and ideas with citations and references in APA format.  
Please review the rubric to ensure that your response meets the criteria.
Estimated time to complete:  2 hours

References:

• Chinn, P. & Kramer, M. (2018) Knowledge development in nursing: Theory and process (10th ed.). St. Louis, MO:  Elsevier. ISBN 9780323530613

8

CHAPTER 5

Personal Knowledge Development

Self is a dynamic concept, ever deepening as we expand and broaden our relationships with others. The Self is created in relation to others.

Beverly Hall and Janet Allan (1994, p. 112)

The opening quote for this chapter suggests that people know who they are through their relationships with others, and that who a person is changes over time. In this context, the idea of relationships does not imply only close or intimate relationships, as with a partner or spouse. Rather, relationships include contacts and interactions with the people you relate to from day to day. These relationships can be close in varying degrees, casual, and even so subtle as to go unnoticed. In addition, in the context of personal knowing for this text, you can also have a relationship with your Self that reflects who you really are compared with the Self you project or you want others to see.

 Consider This…

A young woman named Alia might be characterized a “jet-setter.” Alia has much wealth at her disposal and has not had to work or become educated to maintain her standard of living. She is hospitalized because she was driving while alcohol impaired and sustained multiple injuries when her sports car ran off a cliff.

Christie is assigned to care for Alia. Christie has come to know her own personal Self as a hardworking person who is responsible. Christie knows this largely because her parents and teachers have reflected to her and her brothers the importance of “making something of themselves.” Her parents taught their children to work hard, to get a good education, and to contribute meaningfully to society. Christie did this, although it was not easy. Her parents also reflected to the children that those who have wealth and do nothing productive are undeserving if not contemptible. As a result, as a nurse she has a deeply held value that worthiness is a byproduct of being responsible and socially productive. At the same time, Christie was also taught in her nursing program that each person deserves to be respected and cared for as an individual, despite who they may be, and that each person is inherently valuable. Because of who Christie is, as a personal Self, if she did become aware that her nursing care for Alia was lacking in any way, she would be distressed.

As Christie cares for Alia, it is inevitable that who Christie is as a person—her core Self—will affect her nursing care. Without fully realizing it, because of her background, experiences, and values, Christie might hold resentments or stereotypes about people who are wealthy and privileged. She might become slightly punitive and withhold comfort measures just a little while longer than she otherwise would, or she might conveniently forget to call the kitchen when a special menu request is made, explaining to Alia that she became busy with another patient. She might not make an effort to understand anything about Alia as a human being, but rather focus on her care as just another situation to tolerate and get through. In this example, the Self of Christie and her care would benefit by a focus on personal knowing.

Personal knowing is the basis for the expression of an authentic or genuine Self. It is also essential for a healing relationship and fundamental to the essence of what it means to be human (

Green, 2009

; Zolnierek, 2014). In the “Consider this” example of the nurse caring for Alia, assume that Christie was able to tolerate Alia despite her feelings toward wealthy people and thus was able to provide acceptable care. Tolerance alone does not engender the growth of personal knowing. If Christie began to reflect on how she truly felt about Alia, she could then begin to recognize the basis of her feelings and how those feelings affect her nursing care. As Christie reflects on her background and how it influences who she is, she can make a conscious choice about the person that she wants to be as a nurse. Through this process, the nurse becomes more genuine and authentic. Her actions grow to be more in harmony with what she would choose them to be: compassionate and caring toward Alia, just as they would be toward any other person.

In this chapter we examine various meanings of personal knowing, and various ideas that are related to, or influence the development of, personal knowing. In a sense, all knowing is personal, because people can only know their own understandings, mental images, perceptions, experiences, memories, and thoughts (Bonis, 2009). However, for the purposes of this text and for the construct of patterns of knowing in nursing, we use the concept of personal knowing to refer to a process of Self-knowing that is conscious; it is developed deliberately to know fully who you are and to understand your actions and relationships. Personal knowing is shaped by your relationships with others, and it also shapes your relationships when caring for others. As such, personal knowing is a conscious process that cultivates your wholeness and the wholeness of others.

Fig. 5.1

 provides an overview of the personal knowing pattern of our model for knowledge development in nursing. Nurses bring to their practice the Self they are. As they care for others and reflect on their caring practices, knowing arises as they ask critical questions: “

Do I know what I do?

” and “

Do I do what I know?

” The creative processes of opening and centering flow from these questions, and these creative processes foster the development of formal expressions of personal knowing. As seen in Fig. 5.1, the integrated expression of personal knowing in practice is the therapeutic use of the Self.

Table 5.1

 lists the processes of creating personal knowing, showing the dimensions that we explore in this chapter—the processes of opening and centering, and the formal expressions of personal knowing—the genuine Self and the stories that reflect the genuine Self in written form. This chapter opens with an exploration of the conceptual meanings of personal knowing in nursing and then details the critical questions, creative processes, and formal expressions of personal knowing.

FIG. 5.1 Personal Knowing and Knowledge.

TABLE 5.1

Dimensions of Personal Knowing

Dimension	Personal
Critical questions	Do I know what I do? Do I do what I know?
Creative processes	Opening Centering
Formal expressions	Personal stories Genuine self
Authentication processes	Response Reflection
Integrated expression in practice	Therapeutic use of self

Personal knowing requires that you be in touch with who you are and understand that who you are as a person affects your behavior, attitudes, and values both positively and negatively. Personal knowing involves much more than simply knowing basic characteristics that define who you are—your weight, birthdate, certain personality characteristics, tendencies, preferences, biases etc. Rather, knowing the Self—personal knowing—involves awareness of your inner experience in each situation, recognition of the ways you are interacting in the moment and bringing together in the moment your understanding and insights. Through personal knowing, you live your life with deliberate intent; your actions come to be in harmony with your deepest intentions. In short, personal knowing is the dynamic process of becoming a whole, aware Self and of knowing the other as being valued and whole. It brings you to a place of knowing what you do and doing what you know.

 Think About It…

• What is the difference, for you, between “knowing about the self” and “knowing the Self”?

• How has your Self-knowing benefited or compromised your nursing care?

• Have you ever cared for someone who you simply cannot relate to or who represents something you cannot accept? How was care affected?

• Is there anything about your Self that you know you would like to shift in order to be a better nurse?

• How difficult or easy would it be for you to change some aspect of your Self? What would it require?

Personal Knowing in Nursing

Personal knowing as knowledge of the Self is perhaps the most difficult pattern to understand, because the nature of the Self and knowing the Self are elusive concepts. The ideal of personal knowing is to become a more whole and authentic Self. To know who you are, you need to embrace, internalize, and reflect on the responses that you receive from others as a clue to the Self that you are. As you more fully understand your Self, you realize possibilities for who you might become in the future as you grow and develop.

Personal knowing is expressed as the Self: the person you are. In other words, you are known to others because of who you are. Initially, people recognize you because you have a certain appearance; your face and other features of your physical self are recognizable. People begin to know you by name. As they come to really know you as a person, people recognize not only your physical appearance but qualities of your Self that are expressed through your actions and the daily choices that you make. You might be known as someone who has a great sense of humor, who likes beans but not carrots, who loves to dance, or who is afraid of heights. All these things and many more constitute the “you” that others come to know, and these make you distinctly recognizable as you and not someone else. Others experience and know you as unique by virtue of your personal qualities that are conveyed through being in the world within the context of the culture.

You know your Self as the person you are in part because of how others perceive you. You may not appreciate your sense of humor, for example, unless other people come to recognize this in you and give you feedback. You might not be aware that your food likes and dislikes are so obvious to others, and once you sense how they react to your being a certain kind of eater, you might decide to learn to change how you approach your food choices. At a deeper level, you may begin to see yourself as somewhat selfish or insensitive. Regardless, as you reflect not only on the reactions of others but also on how it feels to you to be you, you begin to make deliberate choices about the type of person you really want to be in the world. This process is what we refer to as personal knowing. It is an ongoing process that leads to change and growth toward wholeness, authenticity, mind-body-spirit congruence, and genuineness.

One formal expression of personal knowing is the genuine Self. The genuine Self conveys directly, without words, who one is. Personal or autobiographic stories are also formal expressions of personal knowing but are less direct than the actual Self (i.e., the person you are in the world). Personal stories are limited in their capacity to convey the fullness of the person, but they provide a means of communication with a wide audience and illuminate various paths to the creation of a more genuine Self.

Response and reflection are the authentication processes within the personal knowing pattern. Response and reflection in relation to personal knowledge expressions are necessary for us to know who we are as individuals, and they are the basis for continued growth. According to our model, nurses who practice using personal knowledge that has been strengthened through the authentication processes of reflection and response will increasingly improve with regard to the ability to use the Self therapeutically.

Conceptual Meanings of Personal Knowing

Carper’s early description of personal knowing points directly to transcendent interpersonal encounters as central, defining qualities of personal knowing:

One does not know about the self; one simply strives to know the self. This knowing is a process of symbolically standing in relation to another human being and confronting that human being as a person. This “I-Thou” encounter is unmediated by conceptual categories or particulars abstracted from complex organic wholes. The relation is one of reciprocity, a state of being that cannot be described or even experienced—it only can be actualized (1978, p. 

18

).

For Carper, personal knowing is connected to an “I-Thou” encounter that actualizes the Self in a way that is instantaneous and transcendent. If you have ever had an experience, most likely a powerful and memorable one, during which you “just knew” or “understood” something about another and your Self without contemplating or thinking about the person, you most likely have experienced what Carper conceptualized personal knowing to be. This sort of personal knowing happens in a compelling human-to-human moment, and it is both transcendent and immediate. For Carper, personal knowing actualizes the wholeness and integrity in each encounter and immediately knows and affirms the Self of the person.

 Consider This…

Examples are difficult because personal knowing as conceptualized by Carper is not explained or recounted, it is only experienced. However, an encounter described by a young nurse, Rebecca, serves as an example. A young man she was caring for was slowly dying from an abdominal gunshot wound sustained while committing a petty crime. One day, during the course of care, this young man motioned for Rebecca to come to his bedside. As she approached, he held out his arms, pulled her in close to his face, and whispered, “You are the best nurse I ever had.” In that moment, this young man was fully known not as a criminal or a dying man but simply as a person. It was an unmediated and unexpected knowing of Self and other that just was. To this day, the recollection of this moment that occurred more than 40 years ago is still vivid and powerful for Rebecca. We believe that this type of in-the-moment knowing of another is the “I-Thou” experience that Carper associated with personal knowing.

Personal Knowing as Spiritual in Nature

Personal knowing has been linked with spirit and to what is sometimes referred to as spiritual understanding (

Barnum, 2010

; 

Bishop & Scudder, 1990

; Pesut, 2008; Pesut, Fowler, Taylor, Reimer-Kirkham, & Sawatzky, 2008; 

Register & Herman, 2010

). Spirit is a term derived from the Latin word for “breath” and “breathing,” which are basic to sustaining life and being (

Huebner, 1985

).

The term spiritual is often associated with religion, a tradition that 

Hall (1997)

 identified as deriving from the fact that Western culture limits the expression of what is known either to science or to religion. Because of this, alternative conceptualizations of the spiritual have not been as visible as those that associate spirituality with religion. Many people do connect their spirituality with religious beliefs; however, that which is spiritual does not of necessity link with religiosity (

Campesino & Schwartz, 2006

; 

McSherry & Cash, 2004

; Pesut, 2016; Pesut et al., 2008; 

Tinley & Kinney, 2007

). Rather, the spiritual is a complex combination of values, attitudes, and hopes that is linked to the transcendent and that guides and directs a person’s life. It is particularly associated with life experiences that bring one to the brink of uncertainty: the “existential boundary issues” of life and death, good and evil, hopes and dreams, and despair and suffering. Personal knowing, when viewed as being spiritual in nature, provides a way for people to understand and shape their lives as they confront difficult challenges. This form of spirituality helps people to face the inevitable realities of life that create vulnerabilities and that cannot be overcome. Spirituality nurtures a personal agency for relating to such vulnerabilities (

Hart, 1997

).

Hall (1997) presented a conception of human spirit and spirituality as reaching within to learn to accept, love, and value what you find there and learning to be yourself authentically and with confidence. What you find may not be what you want to find, but you either change or come to live with, accept, and love what is within. This spirituality is not a process of self-centered exploration, nor is it linear. Rather, it is an unfolding process that is grounded in the context of everyday experience in relationship with others.

 Think About It…

• Would you describe the experience of Rebecca who was told she was the best ever to be a spiritual one?

• Have you had what you would describe as spiritual experiences during the course of caring for others?

• What characteristics make such experiences spiritual?

Personal Knowing as Self-in-Relation

Hall and Allan (1994)

 explained the vital link between personal knowing and relationships with others in their concept of Self-in-relation. Personal knowing and wholistic nursing practice are possible through Self-in-relation, which is the core of caring and healing. These authors’ ideas are grounded in traditional Chinese medicine, which philosophically views the mind, body, spirit, and environment as an integrated whole. The embodied Self is an open system that belongs to a social world. The caring relationships that nurses enter into can reflect four dynamics that nurture Self-in-relation, as follows:

Caring by giving requires being present and involved in relation with others. In this process, mutual sharing develops the Self and the other by giving to one another and by affirming the value and purpose of each life.

Empowerment develops a sense of the Self as being responsible for one’s own health and involves the context in which health is possible for everyone. Empowerment in relationship gives rise to the ability to influence one’s own health outcomes. When the self is fully in relation with the other, both are empowered, and unconditional love occurs. Both learn the joy of reciprocity, which occurs when what each brings to the interaction is deeply valued.

Knowing the value of a human life comes from a mutual quest to find meaning in life. In a healing relationship, questions of living and dying come to the surface, thus inviting an openness to explore what is possible in a particular time and space. Openness while fully engaging with another person in this quest develops the self in each.

Sense of community is the most important and yet the most elusive concept. Basically, this dynamic means that a supportive and caring community is required for the development of Self-in-relation.

Personal Knowing as Discovery of the Self and the Other

Moch (1990)

 defined personal knowing as the discovery of the Self and other that is arrived at through reflection, the synthesis of perceptions, and connecting with what is known. She identified three overlapping components of personal knowing: (1) experiential knowing, (2) interpersonal knowing, and (3) intuitive knowing.

Experiential knowing is the understanding and knowledge that comes from participating in the events of daily living; it is deepened by attending to the experience, studying the process of the experience, and connecting the experience to previous understandings. Attending to the experience involves being aware of what one is feeling and sensing, and observing the Self and others. For Moch, both cognitive and spiritual processes contribute to deriving meaning from experience. Interpersonal knowing is increased awareness as a result of interaction or being with another. It emerges from intense attending to the moment, opening the Self to the other, and conveying feelings to one another. Intuitive knowing is the immediate knowing of something without the conscious use of reason.

Moch (1990) identified the following attributes of personal knowing:

• Personal knowing can be viewed only in the context of wholeness; there is no knowing apart from the knower.

• Personal knowing includes a process of encountering. The ideal encounter is one of mutual respect that affirms those involved in the encounter.

• Personal knowing involves passion, commitment, and integrity. Passion affirms something as valuable, commitment motivates the search for personal meaning, and integrity brings thought and action together as an authentic whole.

• Personal knowing is the instantaneous “aha” experience during which one’s perspective shifts, either consciously or unconsciously.

Personal Knowing as Unknowing

Munhall (1993)

 reflected Carper’s point that knowing the other sets aside personal assumptions and generalizations. She stressed the nature of a genuinely authentic encounter by conceptualizing a pattern of “unknowing” to signify the openness to the other that must occur during such an encounter. Unknowing creates a stance that is completely open to the experiences and perceptions of others as they experience them and not filtered by the nurse’s own structures of understanding. Unknowing means setting aside all that is assumed to be known about the other, as well as previously held organizing structures that make sense of the world. This requires a “decentering” from the perspective of the Self and a movement toward considering the perspective of the other. This occurs when the nurse takes a deliberate stance of complete openness and receptivity to the unique subjectivity of the other and remains open to a deep knowledge of the other, to different meanings and interpretations, and to varying perceptions of the world. Unknowing is similar to the phenomenologic process of “bracketing” but specifically refers to a type of personal openness that is more than intellectual; it is a full mind-body-spirit openness that creates existential availability to know another deeply.

 Discuss This…

Ask a trusted friend or colleague to share with you his or her impressions of who you are as a nurse. Let the person know that you are not seeking compliments or praise but that you want an honest reflection of how you come across to others in your practice. Reflect on the perceptions that this person shares with you. Are there aspects of his or her perceptions that you feel are not fully consistent with who you are? Did he or she describe traits that you would like to develop in different ways?

Summary: Common Meanings for Personal Knowing

Despite certain distinctions in each of these conceptualizations of the meaning of personal knowing, important threads are common to all. These threads form the conceptual understandings on which our approaches to developing personal knowing are based, as follows:

• Personal knowing grows out of relationships and interactions with others and out of deep reflection on experiences with others.

• Personal knowing goes beyond cognitive reasoning; it depends on reflection that brings about an awareness of meaning and direction in one’s life.

• Personal knowing brings about congruence between one’s actions and one’s values.

• Personal knowing brings about a wholeness that embraces the entirety of existence and experience.

Dimensions of Personal Knowing

Personal knowing is fundamental to nursing because interpersonal relationships are inherent in nursing practice. Meaningful interpersonal connections do not occur in a vacuum and are not happenstance. Well-developed personal knowing is a requirement for being fully present with another. Personal knowing can be nurtured and encouraged as an important dimension of competent, quality care (

Pai, 2015

).

The label “personal knowing” can be misleading in that it can imply a solitary and individual process that involves only the unique perceptions of the individual. However, as shown by our overview of the conceptualizations of personal knowing, relatedness is essential for the development of personal knowing. Personal knowing does require deep inner reflection that is sometimes solitary and that comes from within the individual; in other words, it involves a form of the Self in relation with the Self. However, personal knowing also requires openness to experience the world and to have mutual meaningful interactions with others. Contemporary popular notions of self-actualization and individuation reinforce images of the individual on a lone, often self-indulgent journey of discovery. Moreover, contemporary cultures that primarily value empiric knowing reinforce the limited and mistaken notion that people are essentially rational egos who seek individual autonomy, rights, and freedoms (Hart, 1997). Despite these dominant cultural contexts, personal knowing is not a quest of a rational, autonomous ego. Rather, personal knowing as we view it is intimately connected to relationships with others. In the following section, we focus on the epistemological aspects of how we come to know and express the whole, genuine Self and enhance the authentic being of the other.

Critical Questions: Do I Know What I Do? Do I Do What I Know?

In our model of knowledge development in nursing, the pattern of personal knowing requires asking two critical questions: “Do I know what I do?” and “Do I do what I know?” These questions, as with the other patterns, can be asked apart from the context of practice or in the moment of practice. These questions assess the character of the Self and the extent of the therapeutic use of the Self in care situations, and they initiate the ongoing process of personal knowing.

 Think About It…

Think about caring for a person whom you typically view in a negative light. We use the examples of an older person with dementia, a morbidly obese woman with diabetes, and a homosexual man with acquired immunodeficiency syndrome. The care provided for people with traits that are often stigmatized is often jeopardized and influenced by the typical stereotypes associated with who they are and what they are experiencing. You may not want to face some of your own inner thoughts and feelings, but facing your inner Self honestly is a necessary part of knowing the Self.

All nurses bring to their work an understanding of the Self that guides how they use that Self therapeutically. Asking the critical question “Do I do what I know?” creates an awareness of the values of the good nursing care that you believe in and reflection on the extent to which you are providing that form of care in this situation. The critical question “Do I know what I do?” brings about reflection on what you know to be the care you are providing and the realization that perhaps your practice is falling short because of the stigma and stereotyping that prevail with regard to particular individuals.

Each of the critical questions points to important aspects of the experience and processes involved in developing personal knowing. As you honestly ask and answer these questions, you will uncover areas for growth of the Self toward authenticity so that you will move toward doing what you know and knowing what you do.

 Consider This…

You are supervising nursing students and Sally has been assigned to care for 54-year-old John. John was born with a genetic condition that resulted in severe body disfigurement. Although mobile with a walker and persistent, his legs are twisted and it is a struggle for him to move about. His chest is enlarged and he has severe scoliosis. Other significant abnormalities of the head and chest area are also apparent as a result of his genetic makeup. As you make your rounds to see how the students are progressing you find Sally standing outside John’s room looking at his electronic record. Sally has not been in to speak to John yet and you are somewhat surprised when Sally says, “I just don’t know what to do.”

Is Sally’s personal knowing deficient, or is she doing what she knows?

• What, for Sally, might need to change in order for her to productively care for John?

• Might fear to approach another who is different suggest a need to work on personal knowing?

• How might getting to know John as a person add to personal knowing for Sally?

Creative Processes: Opening and Centering

As you or others ask the critical questions, the extent to which your “knowing Self” and your “doing Self” are congruent becomes clearer, and creative processes that acknowledge and develop your personal knowing can be initiated. The creative processes involved in developing personal knowing evolve in unique and individual patterns throughout a person’s life, but there are ways to develop personal knowing that can be described and carried out.

The ability to grow toward becoming a more genuine and authentic Self requires deliberate preparation and intent. 

Fig. 5.2

 depicts the creative processes of opening and centering. Over time, these processes ground the individual in the center of the Self (represented by the heart in the figure) so that the Self is known, valued, affirmed, and loved for what it is. Specific opening and centering practices that can be used are journaling, meditation, and various body-mind-spirit practices such as yoga, tai chi, labyrinth walking, drumming, and chanting. These types of meditations bring mind-body-spirit into wholeness, create a time-space of inner calm and peace, and bring personal intentions and meanings to realization at a deep level that transcends consciousness. Such practices also make it possible to bring deeper meanings to conscious awareness to shape your actions in harmony with your inner intentions.

FIG. 5.2 Creative Processes of Opening and Centering.

From time to time, realizations that come from private opening and centering processes enter into shared experiences with others, thus providing the opportunity to exchange responses and to integrate new perceptions and reflections. As you return to your private time-space of opening and centering, responses that you have received from others deepen and enrich your experience of your Self. In the figure, the inner dotted loops represent reflection as it moves through opening and centering, back and forth between the heart center of the Self and the interactive responses of others, to depict the circular movement among the aspects of opening and centering. Opening and centering provide the core strength and character that are necessary to enter into an authentic encounter in which the heart center or the Self of the person opens to be fully present with and for the other. The larger dotted oval represents how private opening and centering processes that are shared with others to create a more genuine and authentic Self in turn foster increasingly authentic encounters with others and support the therapeutic use of the Self.

The processes of opening and centering to grow in personal knowing are different from therapy or counseling. Therapy can assist a person with his or her quest for personal knowing, but therapy involves other purposes that focus on returning one’s Self from a troubled or disturbed situation to one that is less troubled and more able to cope with life’s difficulties. Therapy often involves an unequal relationship in which one person provides therapeutic guidance and the other receives it. Many practices that are used for opening and centering (e.g., meditation, journaling, labyrinth walking, tai chi) can also be used for therapeutic purposes. However, opening and centering are vital processes that are required to fully know the Self and to constantly deepen inner knowing and self-wisdom, regardless of therapeutic or healing needs.

For some, opening and centering can be closely linked to the concept or experience of prayer. Prayer is often thought of as a process of communing with a higher power, a divine being, or the universe. Meditative opening and centering are ways of listening to your own heart, your own Self, and your own inner wisdom (

Hall, 2008

). For those who have a spiritual view of the divine or universal essence as residing within, or part of the Self, this experience is very close to our concept of opening and centering

The creative processes of personal knowing can be integrated into daily life and can provide a focus on knowing the Self as a whole, authentic being. These processes contribute to self-healing and focus the energy of the Self without interference from outside sources. Opening and centering can be facilitated by others or enhanced by joining with others to share in a particular self-healing practice. However, opening and centering require one’s own deepest intentions and attention. When opening and centering to nurture Self-knowing, the individual reaches into an attentive mind-body-spirit center to come to know and love what resides within.

Opening and centering are interrelated and occur in many different ways and in many different contexts. The processes of opening and centering focus on your lived experience and the meaning of that experience. These processes can be engaged spontaneously or can be deliberately scheduled as individual, solitary processes that contribute to self-knowing (

Beckerman, 1994

).

In the following section we discuss two specific practices that you can use for opening and centering: journaling and meditation. These practices nurture Self-knowing and prepare the Self for authentic encounters. Although we focus here on journaling and meditation, you may find and use many other approaches to the creative processes of opening and centering.

Opening and Centering Practices: Journaling and Meditation

Journaling is an avenue for opening and centering that nurtures Self-knowing. It is a private encounter with the inner Self. Through journaling, you can be your Self without fear of judgment by others. You can acknowledge those things about your Self that might otherwise be hidden. Journaling provides a platform for understanding the Self, for growth, and for change (

Banks-Wallace, 2008

).

Meditation often goes hand in hand with journaling. Meditation requires clearing the mind and inviting a deep inner awareness to emerge. Both journaling and meditation benefit from consistent and regular practice, time devoted to the practice, and solitude away from other people and things. There are many different reasons for journaling. In the context of developing personal knowing, what you write is never to be shared with others unless you choose to do so. To be a useful practice for full discovery and knowledge of the Self, your journal should be something that you write with the intention of keeping it private to maintain your sense of safety for the expression of whatever feelings and perceptions emerge from deep within. In your journaling, you can let fears, anxieties, anger, and fantasies surface without even your own censoring. There are no critics peering into the inner Self; even your own critical judgment is withheld as you seek to know and understand your deepest Self.

We reserve the term journal for the type of private opening and centering process writing that is not to be shared with others. If you do decide to share something from your journal but you are not comfortable sharing it in the form in which it appears in your journal, you can extract and revise segments from your journal with the intent of sharing with others for response. Alternatively, you might be required to write what someone refers to as a “journal” as an assignment that must be shared with one or more other people. When you write something that you are required to share or that you plan to share, consider starting with the kind of private writing that we describe here, to gain the deepest insights so that your inner knowing can flourish. You can then revise your private journal into a document that can be shared, and you can include only what you are willing to share with others (

Nelson, 2010

).

As you settle into a time for journaling, begin with meditation: Sit still and quietly, turn your focus to your breath, and take several deep breaths. Let the sense of your being settle into a centered space. You can repeat a sound, a mantra, or an affirmation that brings your focus closer to your center and to your deepest intentions, hopes, and desires. Affirmations should begin with “I” and be stated in the present tense. In addition, they should be positive, reflect your personal way of talking, and be stated as if what you want to become has already happened. For example, you might repeat an affirmation such as “I am a loving and accepting person” or “I am at peace with the path of my life” (

Chinn, 2013

).

When you feel ready, move to your journal to begin to bring your inner perceptions to the page. Journaling can include recounting facts and events, but it should move beyond these to explore how you feel and what is going on inside of you. As other people enter your reflections, you can move back to your own center and explore your sense of being in the situation and the relationship. When journaling as an approach to personal knowing, it is important to let your innermost thoughts come to the surface, however difficult it may be. Acknowledging the nature of our deepest Self is critical to realizing our full, genuine, and authentic Self.

Journaling is a process of working from both the conscious and the subconscious and of engaging in an inner experience with the Self. The inner experience sensitizes your perceptions of events, people, and situations and brings you to a place of harmony and wholeness with who you are in relation to your world (Beckerman, 1994).

As you journal, abandon rules about written expression to express your feelings and perceptions fully. You can doodle, draw, and let nonverbal images find expression on the page. Let the unexpected emerge without censorship or judgment. Imagine what you hope and dream for and what your deepest desires are. If you feel drawn to analyze and judge what is coming forth, move back to nonverbal meditation, focus on your breath, and turn your attention once again to being open and feeling unconditional love and value for who you are. Insights will come from your journaling that enhance your ability to analyze and rationally think through problems, so you can let go of anything that is drawing your attention toward the rational processes of problem solving while you are journaling. Use journaling to deepen your own inner sense of worth and self-love, which will grant you greater clarity and strength to address the issues that you face day to day. While you are meditating and journaling, always treat yourself as if you totally love yourself (Nelson, 2010).

You can enter into journaling with a specific intent, or you can enter the time-space with no particular intent other than to let your perceptions of your inner being come to the surface. If you are new to journaling, or if you have had an experience or are involved in a situation that is saturating your consciousness, you can use a specific intent to focus your journaling and meditation. Again, the intent is not to solve problems but rather to explore a particular aspect of your inner Self. Images can also be used to focus your journaling and to draw you into your inner Self. 

Beckerman (1994)

 used works of art that depicted caring and focused her journaling on her perceptions of caring within the works of art. You can create an intention around your hopes and dreams, around memories, or around experiences. For example, you could write a prayer to express your deepest hopes and dreams. You could spend time journaling about different “selves” you have been throughout your life, such as your child Self, your afraid Self, and your confident Self. Typically, starting with a focus simply opens doors and begins the journey to deep reflection; the path of the reflection then moves in directions of personal change and growth.

The creative processes of opening and centering assist with the knowing of the genuine, authentic Self and with coming to understand and love who and what we are. It is this self-knowing and self-love that subsequently mobilize and allow us to continue to grow and change in ways that continue to heal and create wholeness in the Self and in others and to create a Self that is therapeutic in the context of care.

 Think About It…

Think back about Sally who is assigned to care for John (see p. 

123

).

• What sorts of things do you imagine Sally would journal about?

• How might the meditative exploration of her feelings about John lead to personal knowing and mitigate her fear?

• What factors about Sally might be revealed in her journal that account for her fear?

• Was there ever a patient or family you feared? How did you deal with it? What did you learn about your Self in this situation? Would meditative journaling been useful?

• Have you left a nursing care situation feeling regret or sadness at how you behaved? What would you say in your journal about it?

Formal Expressions of Personal Knowing: Personal Stories and the Genuine Self

Personal stories and the genuine Self are the formal expressions of personal knowing that emerge from the creative processes of opening and centering. The genuine Self, as 

Carper (1978)

 initially proposed, is the active, acted-in-the-world form of expression of personal knowing.

Personal stories provide a written form of expression of personal knowledge (

Banks, 2014

). Formally developed stories written in the first-person voice of the nurse provide a means of conveying personal knowing in a form that can be widely communicated within the discipline. Personal stories can recount an instance that occurred in practice that conveys to others something about the experience of the therapeutic use of the Self.

Personal stories developed from your journal are a way of sharing insights that come to you from journaling while keeping your journal a protected and private document. You may have journaled about feelings and emotions surrounding a situation without writing the story of the situation. As you identify what you want to share, you might not include anything from your very personal journaling, but rather use your journal to bring you back to the experience as a way to develop the story for sharing. Your journal will also draw you into deeper reflection regarding the meaning of the situation, which you can weave into your story in language, metaphors, analogies, or symbols. In some instances, you may find excerpts that you do want to extract and share or to integrate into a written or verbal story (Nelson, 2010).

Personal stories provide a glimpse of who you are in a form that is not confined to the time and space of the moment. Personal stories are limited in their capacity to convey the fullness of the Self but provide a means of communication about who you are with a wide audience. Personal stories convey essences of experience that are not communicated in theories or clinical histories. Personal stories are not trivial pastimes or entertainment; they are vital within a discipline that depends on meaningful interpersonal connections. In addition, personal stories are important to the discipline to create a shared understanding of what it means to know and develop the Self. The written expression of personal knowing opens opportunities for responses from others as well as for possibilities for deeper reflection.

Personal stories are distinct from other types of stories in that they are personal accounts of your own experiences. They reveal the thoughts, feelings, insights, and values that come from your own inner Self. Other characters and players may enter into your story, but it is your own thoughts, words, and feelings that are the focus of the story. For example, if you compose a story about your encounter with a person who is dying, the story provides a window into your experience, not into the experience of the dying person. Your story might include dialogue with the person you cared for or may recount what you observed about that person, but the main content of the story is how you felt and what you experienced as you cared for this person.

As formally developed personal stories are created and shared within the discipline, the insights conveyed in the stories give others in the discipline an opportunity for reflection and response that involves their potential for conveying the nature of the therapeutic use of the Self. When made available to others, these stories have the potential to enrich and deepen personal knowing as they inspire others to change the nature of the Self. Although written stories are in one sense limited in their capacity to convey the essence of a person, they are rich in that they convey inner processes and meanings that are not easily perceived as part of the interpersonal experience. These personal stories provide vicarious experiences that enrich those experiences provided by response and reflection in relation to the Self alone.

In addition to personal stories as a form of expression of personal knowing, personal knowing is expressed as the genuine Self. In other words, who you are as a person and your being in the world is an ongoing and living expression of your personal knowing.

 Think About It…

Have you encountered a story about nursing that has stayed with you, a story that you cannot forget? Why is this story so powerful for you, and what does it reflect about the nature of nursing? What insights about the nature of nursing does this story reveal?

Has there been a nurse you know who you feel is fully authentic and genuine. How might you approach a personal story about this nurse as a way to help your classmates understand the nature of a genuine Self?

Conclusion

In this chapter we have explored various conceptualizations of personal knowing in the nursing literature. For us, personal knowing is seen as knowledge of Self that is examined by asking the critical questions: “Do I know what I do?” and “Do I do what I know?” Journaling and meditation facilitate the creative processes of opening and centering that are central to the ongoing development of personal knowing. The formal expressions include the embodied Self or the human person, as well as stories that reflect personal knowing.

References

Banks J. And that’s going to help black women how? Storytelling and striving to stay true to the task of liberation in the academy. In: Kagan P, Smith M, Chinn P, eds. Philosophies and practices of emancipatory nursing: Social justice as praxis. New York, NY: Routledge Taylor & Francis Group; 2014:188–204.

Banks-Wallace J. Eureka! I finally get IT: Journaling as a tool for promoting praxis in research. The ABNF Journal: Official Journal of the Association of Black Nursing Faculty in Higher Education, Inc. 2008;19:24–27.

Barnum B.S. Spirituality in nursing: The challenges of complexity. 3rd ed. New York: Springer Publishing Company; 2010.

Beckerman A. A personal journal of caring through esthetic knowing. ANS. Advances in Nursing Science. 1994;17:71–79.

Bishop A, Scudder J. The practice, moral and personal sense of nursing. New York, NY: National League for Nursing; 1990.

Bonis S.A. Knowing in nursing: A concept analysis. Journal of Advanced Nursing. 2009;65:1328–1341.

Campesino M, Schwartz G.E. Spirituality among Latinas/os: Implications of culture in conceptualization and measurement. ANS. Advances in Nursing Science. 2006;29:69–81.

Carper B.A. Fundamental patterns of knowing in nursing. ANS. Advances in Nursing Science. 1978;1:13–23.

Chinn P.L. Peace & power: New directions for building community. 8th ed. Burlington, MA: Jones and Bartlett Learning; 2013.

Green C. A comprehensive theory of the human person from philosophy and nursing. Nursing Philosophy:. An International Journal for Healthcare Professionals. 2009;10:263–274.

Hall B.A. Spirituality in terminal illness: An alternative view of theory. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association. 1997;15:82–96.

Hall B.A. Surviving and thriving after a life-threatening diagnosis. 2nd ed. Bloomington, IN: AuthorHouse; 2008.

Hall B.A, Allan J.D. Self in relation: A prolegomenon for holistic nursing. Nursing Outlook. 1994;42:110–166.

Hart H. Conceptual understanding and knowing other-wise: Reflections on rationality and spirituality in philosophy. In: Olthuis J.H, ed. Knowing other-wise. New York, NY: Fordham University Press; 1997:19–53.

Huebner D.E. Spirituality and knowing. In: Eisner E, ed. Learning and teaching the ways of knowing. Chicago, IL: University of Chicago Press; 1985:159–173.

McSherry W, Cash K. The language of spirituality: An emerging taxonomy. International Journal of Nursing Studies. 2004;41:151–161.

Moch S.D. Personal knowing: Evolving research and practice. Scholarly Inquiry for Nursing Practice. 1990;4:155–165.

Munhall P.L. “Unknowing”: Toward another pattern of knowing in nursing. Nursing Outlook. 1993;41:125–128.

Nelson G.L. Writing and being: Taking back our lives through the power of language. Novato, CA: New World Library, Kindle Edition; 2010.

Pai H.-C. The effect of a self-reflection and insight program on the nursing competence of nursing students: A longitudinal study. Journal of Professional Nursing:. Official Journal of the American Association of Colleges of Nursing. 2015;31(5):424–431. 

https://doi.org/10.1016/j.profnurs.2015.03.003

.

Pesut B. A conversation on diverse perspectives of spirituality in nursing literature. Nursing Philosophy:. An International Journal for Healthcare Professionals. 2008;9:98–109.

Pesut B. There be dragons: Effects of unexplored religion on nurses’ competence in spiritual care. Nursing Inquiry. 2016;23(3):191–199. 

https://doi.org/10.1111/nin.12135

.

Pesut B, Fowler M, Taylor E.J, Reimer-Kirkham S, Sawatzky R. Conceptualising spirituality and religion for healthcare. Journal of Clinical Nursing. 2008;17:2803–2810.

Register M.E, Herman J. Quality of life revisited: The concept of connectedness in older adults. ANS. Advances in Nursing Science. 2010;33:53–63. 

https://doi.org/10.1097/ANS.0b013e3181c9e1aa

.

Tinley S.T, Kinney A.Y. Three philosophical approaches to the study of spirituality. ANS. Advances in Nursing Science. 2007;30:71–80.

Zolnierek C.D. An integrative review of knowing the patient. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2014;46(1):3–10. 

https://doi.org/10.1111/jnu.12049

.