Unit 3: Self-Efficacy

Bandura’s Self-Efficacy Theory

Bandura’s Self-Efficacy Theory is a social cognitive theory which is essentially, “the self-perceptions that individuals hold about their capabilities” (Pajares, 2009).

There are 4 sources that affect self-efficacy, including (Kitchie, 2014):

1.)    Mastery Experience—Previous achievement of a similar task

2.)    Vicarious Experience – Observing the success or failure of others attributes to the belief    of ones’ own capabilities (Peer Modeling)

3.)    Social or Verbal Persuasions – Positive verbal encouragement from others

4.)    Physiologic Reactions – Including somatic and emotional states (anxiety, stress and  mood)

Self-efficacy is a vital piece of teaching because it stands as a strong indicator for whether a particular health behavior will be carried out or not.  We, as health educators, need to be aware of what level a patient’s self-efficacy level is at.  We can play on the 4 sources of efficacy to increase the likelihood of our patients following their intended health plan. 

Since mastery experience is proven to be one of the biggest motivating factors for optimal self-efficacy, we need to investigate what other medical triumphs they have had in the past (Kitchie, 2014).  If we can relate the two behaviors with both positive outcomes, the chances of the patient coming through with the care plan will be much higher. 

Our greatest strength as a provider is to provide the necessary support and genuine encouragement and positive reinforcement to empower the patient to make a change.  I often use the analogy of “mind over matter”, keeping an open and positive mind set to overcome physical restraints brought on by medical illness.

  

 SELF-BELIEF (increased self-confidence) = SELF-EFFICACY 

Self-Efficacy in the ICU

I recently had a patient in the ICU with newly (within 2 months) diagnosed of pancreatic cancer with metastasis.  She was a 30 day readmit for recurrent bowel obstructions with severe deconditioning secondary to weakness and immobility.  On the second day of her hospital stay, her acute medical issues were resolving and we were progressing diet and implementing early mobility in hopes of overall improvement in her condition.  She was quite hesitant about getting out of bed because she was feeling so weak for so many days. 

To think of it, I couldn’t apply the mastery experience with her in regards to research on the pros of initiating early mobility in hospitalized patients on the first day but once we got out of bed with sufficient assistance to make her feel comfortable about not falling she felt much more motivated to get up the next day.  

From her mastery experience on getting up on day one, even though it was just to the edge of the bed, it highly motivated her to get up to the chair the next day.  I also used verbal persuasion with reasonable outcomes for her.  Physiologically, we managed her pain and kept her stress at a minimal, which also empowered her to increase her activity even more the next day.

References

Kitchie, S. (2014). Determinants of Learning, in S. Bastable (Ed.), Nurse as Educator: Principles of Teaching and Learning for Nursing Practice (pp. 113-158) Boston, Jones and Bartlett Publishers.

Pajares, F. (2009). Self-Efficacy Theory. Retrieved October 3, 2015, from http://www.education.com/reference/article/self-efficacy-theory/

Unit 2: Learning Theories

Health Belief Model and Theory of Reasoned Action

The Health Belief Model was developed in the 1950’s to address non-compliance with health screening programs, mostly concerning disease prevention.  Three key components were identified as influential aspects towards an individual’s likelihood to following health recommendations.  They included:

• Individual Perceptions of the disease:
• How severe is this disease?
• How susceptible am I to this disease?
• Modifying Factors or Variables:
• Sex, age, ethnicity, social class, peer pressure, prior knowledge or contact with this disease
• Cues or Trigger that prompts Action:  Media influence, advice from others, Reminders/Emails from clinic
• Likelihood of Action:
• Depends on the perceived benefit of preventative actions minus the perceived barriers to preventative action.

The Theory of Reasoned Action also stemmed from research that started in the 1950’s.  The main concept that it presented was that individuals behave in accordance with their beliefs and values as well as how others perceive their actions.

•   Our behavior can be determined by:

•   Beliefs, Attitude toward the behavior and Intention 
•   Motivation to be socially acceptable or be a part of a subjective norm.

The Health Belief Model and the Theory of Reasoned Action are both similar in that they take into consideration the outside influences of a person’s behavioral decision.  The Health Belief Model took into consideration modifying factors such as social class and peer pressure, where the Theory of Reasoned Action bought into play the subjective norms that we each strive to comply with.  However, they are very different in that the Theory of Reasoned Action is used to predict an intent to change a specific health behavior and the Health Belief Model is used to predict the likelihood of taking preventative action. 

Both the Health Belief Model and the Theory of Reasoned Action can be used and applied in my workplace.  We are continually concerned with the health prevention and maintenance of chronic conditions exacerbated by preventable complications that subsequently results in a hospital stay or even an ICU admission.  For example, we can use the Health Belief Model to determine why some patients with COPD do not follow through with preventative measures such as receiving the Influenza or Pneumococcal vaccination. The Theory of Reasoned Action can also be used to determine a teaching style for patients that continue to smoke with chronic pulmonary and cardiovascular conditions.

Overall, the models and theories presented in Chapter 6 help the nurse educator to understand a patient's reason for the health decisions they make and aides the educator to reformulate a teaching plan that will successfully influence and motivate the patient to make a behavior change that will benefit their health status.