Self-Efficacy Theory

Self Efficacy and Nursing
Self-efficacy theory (SET) was first developed in 1977 by Albert Bandura. He first presented his theory in the Journal of Psychological Review. Titled “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” he proposed SET as the determining force of behavior change. Clearly, behavioral change plays a big part in both nursing education and nursing care.

What is Self-Efficacy?

Persons with low SET with often blame themselves for a lack of success. Whether the problem is minor or a major part of their lives, they will usually feel their lack of abilities makes it impossible for them to succeed. A person with high SET will usually not blame their own abilities if they fail. On obtaining a bad test score, someone with high SET might decide the test was unusually hard, or they did not study the right materials. The thought that they cannot learn the subject will never enter their mind. These people will try again until they succeed because they expect they can succeed.

Self-efficacy differs from self-esteem. People with high self-esteem are satisfied with themselves, regardless of their abilities. High self-esteem does not always translate to the ability to solve a crisis. Someone who has high self-esteem may not choose to take on a challenge because they are fine the way they are. A person with high efficacy will always jump at the chance, and they will often see solutions that are closed to other people.

Psychological Research

Given a choice between low efficacy and high efficacy, it is clear that high efficacy will lead to more satisfied life. In fact, this trait is about the ability to control situations that erupt around oneself. Parents will find that their children are happier if they help them develop a high sense of efficacy about life. Norwegian studies with twins have shown that 75% of self efficacy comes from family heritage and 25% from their environment. Clearly, mentors and parents can increase this characteristic in their children. Equally important is the effect this can have on nursing care.

Bandara lists the factors that affect SET:

• Experience
• Modeling
• Social Persuasion
• Physiological Factors

The most important to develop a high SET is mastery of tasks. The more success one has, the higher the SET. Next important is copying someone that the person perceives very similar to them. Social persuasion is the acceptance of other people’s opinions. Physiological response to stress can also limit success. Responses to each of these four components can be changed to increase one’s SET level.

Further studies by Bandura showed that there are three factors that make up one’s SET. These factors are:

(1) behavior,
(2) environment, and
(3) cognitive factors.

Of these, the most important to look at are the cognitive factors. According to Alberta Bandura, it turns out that SET is the main indicator of the ability to learn new behaviors.

SET in Health Care

According to Luszczynska and Schwarzer, “self-efficacy plays a role in influencing the adoption, initiation, and maintenance of healthy behaviors, as well as curbing unhealthy practices.” Low SAT levels can clearly prevent changes in behavior that clients often need to make to improve their condition, especially chronic symptoms and disease. Self-efficacy is becoming increasingly adopted as part of nursing theory due to its effect on learning, change and retention.

A client coming into the care has experienced a loss of control. He is not feeling well and has been unable to take care of the problem. If he or she is in the hospital, this loss of normalcy could be permanent and require major changes in their life going forward.

The success a patient has with a new condition, especially a chronic one, relates directly to their level of SET. The larger the changes and the lower the SET, the less likely the patient will be successful. Thus, it is reasonable for a nurse to access a patient’s SET. Nursing theory directs that nurses teach any required demonstrations, explain needed medical treatment, and how to deal with any problems or backsliding that might result once they return home. Each patient should have a plan that shows how to handle and difficulties that might arise. Guidelines need to be clearly established before leaving medical care that would trigger the need to return to care.

Nurses can organize their teaching to improve SET when needed. They can arrange demonstrations and lifestyle lessons in small increments. The more positive experiences, the better the low SET patient will respond. It is also important to access their cognitive level. One style of teaching will not fit all patients. As you would explain something to an adult differently than to a small child, nursing theory is clear that the teaching must be able to be understood by the patient.
Patients with high SET levels are also less likely to provide false information to medical personnel. Some patients don’t want to admit problems to nursing staff for fear of having to leave home or some other personal problem. A person with a higher SET will build trust with their care givers easier. This makes the patient more receptive to the information given by the nurse.

Ralf Schwarzer,, describes SET in his studies on cancer control as “cognitions that determine whether health behavior change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures.” Clearly, SET is important in every nurse’s practice and patient care. Yet, how many nurses access for learning readiness at all?


Besides looking at teaching patients, nurses also spend time mentoring or training other nurses. A SET assessment is useful for student nurses, too. Time spent raising the SET usually yields better learning retention and the ability to apply the learning to new patient situations. Nurses have been found to have low levels of SET. Including consideration of SET in a nursing training program means that program has a better chance for success. Persons with high levels of SET are more satisfied with their lives. Satisfied employees have less turnover resulting in a more seasoned staff.

Patients and staff with low SETs should not be assigned to the bottom of the heap. SET can be improved by exposure to the proper environment and structured learning. Including SET in nursing theory will result in more successful patient outcomes and great satisfaction by professional nursing staff.


Bandura, A (1977). “Self-efficacy: Toward a Unifying Theory of Behavioral Change”. Psychological Review. 84 (2): 191–215. doi:10.1037/0033-295x.84.2.191. PMID 847061.

Bandura, Albert (1982). “Self-efficacy mechanism in human agency”. American Psychologist. 37 (2): 122–147.

Luszczynska, A. & Schwarzer, R. (2005). “Social cognitive theory”. In M. Conner & P. Norman (eds.). Predicting health behaviour (2nd ed. rev. ed.). Buckingham, England: Open University Press. pp. 127–169.

Schwarzer, Balf. “Self Efficacy.” DCCPS: Health Behavior Constructs: Theory, Measurement& Research,