Nursing is a unique profession where providers spend a significant amount of one on one time with patients and their families, in a time where patients are are often at their worse. As Perry (2011), states, “Nursing is a service profession, and those in its care must feel safe and reassured” (p. 218). A lack of self-self-confidence can make patients nervous or apprehensive about the care they are or will be receiving. It stands to reason that any invasive or intrusive procedure whether it be placement of an intravenous catheter, helping someone use the restroom, or surgery, can magnify patients nervousness or apprehension if the provider lacks confidence in themselves and their abilities.
The purpose of this concept analysis is to better understand the concept of self- confidence and its attributes, and to see if there are differences between the general understanding of the concept vs the clinical setting where clinical confidence could affect patients perception. It is important to note that the terms self-confidence and confidence will be used interchangeably throughout this concept analysis. Confidence from a professional, whether it be a primary care provider, your child’s school teacher, an automotive mechanic, or members of a surgical team, is an essential part of helping patients feel comfortable and at ease. Self-confidence is also essential to the development of autonomy. The purpose of this concept analysis is to examine the use and meaning of the word confidence as it applies in the clinical setting. Specifically, its importance to students in the
The word confidence has origins from Late Middle English and comes from the Latin word confidere – meaning “have full trust” (Merriam-Webster, online). Definitions from Merriam-Webster online dictionary include: “A feeling or consciousness of one’s powers or of reliance on one’s circumstances… faith or belief that one will act in a right, proper, or effective way… the quality or state of being certain… a relation of trust or intimacy… reliance on another’s discretion… support especially in a legislative body… a communication made in confidence.”
Dictionary.com also provides insight to the usage of the word confidence with idioms, such as, “in confidence, as a secret or private matter, not to be divulged or communicated to others; with belief in a person’s sense of discretion.” However, “confidence” can be use as an adjective, “of, relating to, or adept at swindling by false promises” (Merriam-Webster, online). Confidence is also common term used in statistical measurements, e.g., confidence interval and confidence level.
Confidence interval is, “the range of values that is formed to contain within its boundaries, with a predetermined level of confidence, the population value being estimated” (Biddle, 2013, p. 198). The concept of self-confidence includes, but is not limited to: nursing, sports, parenting, academics, education, relationships, business, leadership and numerous other disciplines. Confidence also plays a vital role regarding ones life; for example, someone lacking self- confidence may hesitate to apply for a job, or a child lacking confidence may be too afraid of water to learn to swim, or a student may lack such confidence that they avoid educational experiences due to fear of failure.
Maslow (1939), discusses two different aspects of pertaining to the concept of confidence; one is general self-confidence and the other is specific self-confidence. General self- confidence can be thought of as how a person views “the self or in the personality,” whereas specific self-confidence deals with abilities, situations, skills, or tasks. Maslow, provides an example of how a woman who feels as though she has low general self-confidence, may have high specific self-confidence, “in her home, cooking, sewing, or being a mother.” (p. 11). The definition selected for purposes of this concept analysis is provided by Shrauger and Schohn (1995), “Self-confidence refers to people’s sense of their competence and skill, their perceived capability to deal with effectively with various situations” (p.256).
A major defining attribute of confidence/self-confidence as related to this concept analysis is that of belief in oneself. Even in the definition of belief, the words truth, faith and confidence are used (Oxford dictionaries, online). Krueger and Brazeal (1994) discuss how self- confidence grows through past experiences, such as, social interactions, cognitive experience, physical experience, and successes. As belief in oneself grows so will their confidence. However, it is also important to note that if believe in oneself decreases, such as through unsuccessful actions from past experiences, their confidence may decrease in accordance.
The second defining attribute of self confidence is optimism. “Optimism is defined as the positive side of an emotion that is utilized to explain good and bad events (modified from Seligman 1998)” (Envick, 2004, p. 16). Envick (2004) discusses this further by providing two significant dimensions: permanence and pervasiveness. Permanence deals with time, and pervasiveness is related to space. Envick describes how pessimist and optimist view the same situation differently. With permanence for example, if a company looses a valued employee, the optimist will view this as a temporary loss and evaluate why the employee left, as well as what changes could prevent future employees from leaving. Whereas the pessimist will view this as a permanent loss that is unfixable. Hence the importance of the attribute “optimism” to one who has self-confidence. For without it there would be little motivation to keep moving forward and failure would ultimately ensue.
Mary is a nurse anesthesia student attending clinical at a local hospital. For the past 6 weeks Mary has been working on the labor and delivery unit learning to place epidurals, spinals, and manage the various aspects of anesthesia for obstetric patients. Part of Mary’s training is learning to interview new patients, formulate an anesthetic plan, and obtain anesthesia consent.
It is also required of Mary to disclose her position as a student, and have the patient sign a line on the anesthesia consent that states the patient agrees to have the student participate in their care, including placement of an epidural if desired. Mary believes in herself and is comfortable interviewing patients. As Mary interviews her patients she is professional, answers all questions with clarity and understanding, is knowledgeable of the anesthetic considerations for obstetric patients, comfortably discusses risks and benefits of anesthesia, and does so in a positive manner.
Jack is a nurse anesthesia student, who has just started a speciality rotation on the labor and delivery unit at the local hospital. Jack has years of experience interacting with patients and their families, and is comfortable doing so, however, as he prepares for his first interview on the labor and delivery unit he is nervous he will forget important aspects specific to this patient population. Jack, conducts his interview and needs to references his notes several times as to not omit any pertinent questions. Following the interview, Jack reflects on what he could have done differently, knowing that with a little time and practice he will be successful on the labor and delivery unit.
Morgan, is a nursing student and is among the top in her class, but often thinks her way is superior to others, including her preceptors. Today at clinical she needs to place a small bowel feeding tube. She has prepared for the procedure and knows what needs to happen, she says to her preceptor, “I know for a fact that I can place this feeding tube, because I am one of the smartest students in my class and I have place a feeding tube before.” This is an example of self- certainty, not self-confidence. Brain is attending his first day of clinical as a nurse anesthesia student. Brian has struggled in his academic classes and wonders how he made it to clinical since he sure he was going to fail out of school before this point. During the first case of the day, Brian’s patient has a low blood pressure shortly after induction of general anesthesia, and Brian’s preceptor asks him, “why do you think the patients blood pressure decreased, and what can we do about it?” Brian, didn’t know what to say, he thought he might know the answer, but was too afraid to say anything because he would probably answer incorrectly anyway.
An important antecedent of self-confidence is knowledge. “No amount of self-confidence can produce success when perquisite knowledge and some level of skill are not present” (Schunk and Pajares, 2005, p. 94). This required knowledge can be acquired through observation, failures, successes, formal education, mentoring, or various other forms of learning are essential to the development of self-confidence, especially with students in the health care profession.
Consequences of confidence are often beneficial for oneself and others. One beneficial consequence is that of gained self-confidence, where successful completion of a task, situation, or encounter causes one to further believe in themselves and therefore have greater confidence when similar circumstance arises. This ultimately leads to what White, (2009) describes as “Intrinsic Return: Establishment of Autonomy and Extrinsic Return: Positive Outcomes for Others (p.111). Establishment of autonomy because when one develops self-confidence they have in fact developed higher levels of belief in themselves, and the consequences of their actions. As self-confidence increases it will also benefit others as Polivy and Herman (2002) describe, that through success and experience, outcomes for others as well as oneself will improve (p.686).
Hicks, (as cited in National Council of State Board of Nursing, 2009, p. 9) is the Clinical Decision-Making Self-Confidence Scale (CDMSCS). This scale is a Likert-type scale and consists of 12 questions specific to the nurse clinical setting as related to patient deterioration, and how self-confident one is in dealing with a deteriorating patient. In this pilot study, researchers evaluated the effectiveness of simulation based training vs. actual clinical experience and how these training environments effected, “knowledge acquisition/retention, self-confidence and clinical performance of nursing students” (p.7).
Another example of an empirical referent is the Personal Evaluation Inventory (PEI) where Schrauger & Schohn, (1995) “attempted to develop stable measures of confidence in different domains, but also developed a subscale assessing current mood state to provide a physiologic context within which scores on other subscales might be interpreted or adjusted…”(p. 258). The PEI was initially tested on college students to help determine what they felt were the most important aspects of their behavior, that in turn influenced the amount of confidence they felt.
Conclusion
In conclusion, confidence/self-confidence and its attributes of belief in oneself, and optimism, are essential to nursing students as well as other providers. Students and professionals alike can expect increases in their own self-confidence as they continually acquire knowledge through study, situations, and various experiences. The uniqueness and breadth of the nursing profession facilitates endless opportunities to help, comfort, ease, and advocate for their patients well-being, and is often accomplished through self-confidence.
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