What you think of your self, impacts your patients’ care. A confronting statement I found.

Its high pressure in critical care, we know that. However there’s an element to the delivery of this care that I don’t hear discussed; how your sense of self-efficacy affects your patient care. The term self-efficacy develops further on the more commonly known term self-confidence. Self-efficacy is the belief one has in their own abilities to achieve a desired goal (Arabani & Saleh, 2017). We know our decisions affect patient care, but how does our sense of self-efficacy affect our decision making?

With the familiarity of our day to day stressors comes the danger of complacency, and if our sense of reflection and self evaluation slowly degrades over time, we are in danger of never improving much further than our current state. Unless we consciously make an effort to reflect on situations and assess how our sense of self might have influenced our decision making at the time. Ultimately affecting the course of treatment our patient will befall. Our sense of self-efficacy has more to do with the success of care delivery and team performance than we may realise.

I pondered two elements: 1. How your inherent value affects patient care 2. Why you should consider self-efficacy when delivering patient care.

How your inherent value affects patient care

In the world of Human Factors a strong leader owns their decisions and confidently believes in their abilities. Delivery of good patient care all starts with the belief in our abilities to do so. Valuing your own experience and knowledge gives you confidence in your practice, and adds weight to your competence (Fry & MacGregor, 2013). This in turn encourages confidence in all members of your team and reassures your patient they are in good hands. When self-efficacy is poor, and one is continually looking to external confirmation for their decisions, self doubt becomes prolific. This affects team performance and weakens patient confidence. Self-efficacy is a key component in preventing this.

We can assess the level of self-efficacy we hold for ourselves, by utilising peer review and self-reflection on the level of doubt experienced during challenging times. Why did you doubt? Was it because you are struggling with understanding the fine line between actual and perceived skill? The first step towards improving self-efficacy is coming to an understanding of your actual skill level and compare it to your perceived skill level. Often there is a large disparity between the two. If you consciously analyse this, you will come to an improved understanding of your belief in actual abilities. Confidence and competence are pivotal in creating strong leaders, but self-efficacy is the fundamental fuel to power these. Without it, delivery is less efficient and compromised by self-doubt.

Consider self-efficacy when delivering patient care

Self-efficacy influences decision making in more ways than one. A plethora of care options could be excluded, based purely on the clinicians belief in their inability to deliver the care (Bandura, 1999). Lack of self-efficacy can disadvantage patient care by excluding plausible options, which may in fact be most appropriate for their treatment. If a practitioners ceiling of self-efficacy is low, this can compromise appropriate treatment options that may be more complex in delivery, but most suitable for their care. The more complex and challenging a treatment option i.e. thoracotomy, the more self-efficacy one must hold to overcome the challenges of its application. After all, it is the belief that you can complete it that ultimately overcomes the challenge.

Reflect on the moments you have doubted, and question why? Was it for good reason? What can you change to prevent this doubt from re-occurring? Use peer review and self reflection as a tool to realistically assess your level of skill and improve your self-efficacy based on achievement of these.

References

1. Arabani, P.P & Saleh, B. S. (2017). What do nurses actually need? Is it competence or confidence? Global Journal of Nursing & Forensic Studies, 2: 1

2. Bandura, A. (1999). Social cognitive theory: An agentic perspective. Asian Journal of Social Psychology, 2: 21-41

3. Fry, M. & MacGregor, C (2014). Confidence and impacts on clinical decision-making and behaviour in the emergency department. Australasian Emergency Nursing Journal, 17: 91-97