Nursing theory, integral to self-reflection, is incorporated in theories at all levels on the ladder of abstraction. Examples of grand theories in which self-reflection is inherent are Rogers’ Science of Unitary Human Beings (SUHB), Barrett’s Power Theory, Dossey’s Theory of Integral Nursing (TIN), Watson’s Caring Science, and Newman’s Theory of Health as Expanding Consciousness (HEC). Smith and Liehr’s Story Theory is an example of self-reflection embedded in a middle-range theory.

Barrett’s Power Theory formulates that “power is the capacity to participate knowingly in change.”^13p48 It also consists of appraising “four inseparable dimensions—awareness, choices, freedom to act intentionally, and involvement in creating change.”^13p49 Knowing participation on the part of the nurse and client/patient within a reflective practice is more than knowing what tests are to be performed and performing one’s clinical skills with expertise. Knowing participation means the nurse and the patient are both aware to the degree possible (the nurse) and as much as desired (the patient) of her or his field patterning. Without this awareness, neither the nurse nor the patient can act intentionally.

Dossey developed her Theory of Integral Nursing (TIN) as praxis, theory in action.¹⁴ (See Chapter 1.) One component of TIN is represented in a model with four quadrants. Each of the quadrants, the “I” individual interior (personal/intentional), the “IT” individual exterior (objective, behavioral), the “WE” (collective interior), and the “ITS” (collective exterior), formulate how we view and describe our reality. Dossey explains that the development of the “I,” or self-awareness, is critical to becoming a healthy nurse. When the nurse engages in self-reflection, she or he develops insight into patterns and behaviors and is able to create a new future. In the WE space, the nurse engages with the client in a coparticipatory process. Key to this process, the nurse acts with intention, which arises from self-reflection.¹⁴

Newman’s Theory of Health as Expanding Consciousness (HEC) defines “consciousness as the information of the system: The capacity of the [human] system to interact with the environment [system].”^16p33 HEC is a coparticipatory consciousness, where one’s experience and the meaning derived from it expands beyond the physical self into the greater consciousness of the unified field of awareness, which includes one’s self, the environment, patients, and families. Health is not defined by the presence or the absence of disease, but rather by the transformation through chaos to a higher order of complexity and understanding. Chaos brings uncertainty, which is a component of unknowing pattern appreciation essential to the practice
of self-reflection in action. The more comfortable the nurse becomes with uncertainty, the greater the possibilities for transformation, both for the nurse and the client/patient.¹⁷ Without self-reflection, chaos remains chaos. The nurse, then, through the practice of self-reflection and reflective practice, facilitates increasing coherence and expanded consciousness.

Watson expresses that a caring science perspective is rooted in a relational ontology of being-in-relation, with unity and connectedness composing the worldview. She explains that caring science embraces multiple approaches to inquiry and is open to exploring other ways of knowing such as aesthetic, poetic, personal, intuitive, and spiritual among others.¹⁸ Self-reflection as a process can assist the holistic nurse to access these realms.

Rogers’ Science of Unitary Human Beings (SUHB) describes several important concepts essential to self-reflection. The concepts of wholeness and openness regard the person as an “irreducible, indivisible, multidimensional (now called pandimensionality) energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from the knowledge of its parts.”^19p7 The heart of the Rogerian ontology is the fundamental unity of the universe and that the universe is more than and different from the sum of its parts.²⁰ Pattern recognition is what identifies the nurse and client in their inherent uniqueness as well as their wholeness. Pandimensionality is a nonlinear domain with time and space as nonlocal and nontemporal. The self-reflective practitioner attunes to the pandimensional field, allowing the process of unfolding to occur, creating new patterning as desired.

Smith and Liehr’s Story Theory holds assumptions consistent with unitary and neomodernist perspectives and is at the middle range level of abstraction.²¹,²² Story Theory is built on the foundations of three concepts: intentional dialogue, connecting with self-in-relation, and creating ease. The concept of connecting with self-in-relation comprises personal history and reflective awareness.²² The individual’s personal history is described as his or her unique story that he or she uncovers through reflection on his or her life. Reflective awareness is explained as a person’s ability to be in touch with his or her experiences, thoughts, and feelings in the present moment. Intentional dialogue between nurse-person is what engages the human story and affords the nurse the ability to connect with self-in-relation to create ease.²²