Nursing Care and Self Efficacy Theory
Self-Efficacy Middle Range Theory,Contribution of Bandura, Sources of Judgement about Self Efficacy,Nursing Research Contribution,Self Efficacy Theory Implementation.
Self-Efficacy Middle Range Theory
The
theory of self-efficacy, which was originally developed by Bandura (1977), is
based on social cognitive theory. The theory conceptualizes person behavior
environment interaction as triadic reciprocally, the foundation for reciprocal
determinism.
Triadic reciprocally is the interrelationship among person,
behavior and environ ment; reciprocal determinism is the belief that behavior,
cognitive and other personal factors and environmental influences all operate
interactively as determinants of each other. (Resnick, 2003, p. 49)
Contribution of Bandura
Early
work by Bandura and colleagues attempted manipulation of the level and
strength of an individual’s self-efficacy to effect behavioral change
(Resnick).
Self-efficacy theory is at the middle range of abstraction, appealing
to nurses who are interested in a conceptual structure which will guide
practice and research focused on behavioral change.
To say the theory is at the
middle range means that it is more complex than simple hypotheses and yet
targeted enough to be applicable. Self-efficacy is defined as “an
individual’s judgment of his or her capabilities to organize and execute
courses of action” (Resnick).
The major concepts of self- efficacy theory
are self-efficacy expectations and outcome expectations. Resnick describes
self-efficacy expectations as judgments about one’s own ability to accomplish a
particular task; outcome expectations are judgments about what will transpire
if a particular task is successfully accomplished.
“Self-efficacy and
outcome expectations were differentiated because individuals can believe that a
certain behavior will result in a specific out- come; however, they may not
believe that they are capable of performing the behavior required for the
outcome to occur” (Resnick, p. 51).
For instance, a smoker might believe
that her frequent bouts of bronchitis would diminish if she would stop smoking;
however, she may not believe that she is able to stop. In this instance,
expected outcomes are dependent on self-efficacy judgments. Resnick also describes
times when outcome expectations are dissociated from self efficacy expectations
(behavior change is loosely linked or not linked to outcomes).
For example,
dissociated expectations would occur if the smoker previously discussed
believed that her bronchitis was related to the geographic area where she
lived. In this instance, smoking is not firmly linked to bronchitis symptoms in
the mind of the smoker, influencing likelihood of attempting behavior change.
Sources of Judgement about Self Efficacy
Resnick
(2003) discusses four information sources which influence judgment about one’s
self-efficacy:
(1) enactive attainment- actual performance of the desired
behavior
(2) vicarious experience-watching others who are similar to self-perform
the desired behavior
(3) verbal persuasion encouragement by others, noting the
individual’s capability for performing the desired behavior
(4)
physiological feedback-bodily experience while performing the desired behavior.
Each of these information sources becomes an avenue for nursing intervention to
affect behavior change in practice or to study behavior change in research. In
addition to information sources which may influence self-efficacy, experience
interacts with individual characteristics and environment to affect
self-efficacy and outcome expectations.
Nursing Research Contribution
Resnick
(2003) reports that within the decade more than 400 articles in nursing
journals incorporate self-efficacy theory when addressing behavior change.
These articles cover a broad range of topics including the education of nurses
and parental training, but the majority of these articles have been related to
chronic health problems and participation in health promoting activities, such
as exercise, smoking cessation, and weight loss.
Resnick herself has used
self-efficacy theory to develop interventions such as the WALC (Walk, address
unpleasant symptoms, learn about exercise, cueing to exercise) intervention,
the Exercise Plus Program, and the Seven Step Approach to Developing and
Implementing an Exercise Program.
She has used the theory to guide research
intended to influence elders’ participation in functional activities and
exercise (Resnick). When measuring self-efficacy, scale items query
respondents’ confidence (0 = not confident; 10 = very confident) regarding
specific factors that might affect behavior change.
“The development of
appropriate self-efficacy and out- come expectation measures enables the
testing of interventions designed to help participants believe in the benefits
and overcome the challenges of performing selected activities” (Resnick,
p. 60).
Self Efficacy Theory Implementation
In
less than 30 years since Bandura introduced self-efficacy theory, it has been
widely used by professionals from many disciplines. Its usefulness for nursing
stems from its relevance for health promotion through behavioral change.
The
theory could offer valuable guidance for undergraduate and graduate students
who wish to teach patients about changing health behaviors; it would provide an
evidence based framework for selecting potentially effective teaching
strategies.
Selfefficacy is a mature middle range theory, which has been
tested through research and has demonstrated application for practice.
Since
most of the research on the theory has focused on self efficacy expectations
(Res- nick, 2003), there continues to be a need for studying outcome
expectations and the relationship between self efficacy and outcome
expectations.
Nursing is well positioned to lead the way with continuing
development of this middle-range theory to promote further understanding of
factors influencing health promoting behavior change.