Findings
Anonymous survey responses were collected from all 16 surgical subspecialty nurses both prior and after familiarization with the nursing guide.The response rate was 100% with only a few incomplete responses excluded from the analysis. Three questions in the prefamiliarization questionnaire had no appropriate response, and 1 question in the postfamiliarization survey had no appropriate response.
Improvement was statistically significant in responses for questions 1, 3, 5, and 6 (P = .026, .008, .004, and .033, respectively). No significant differences were found for questions 2 and 4 (P = .974 and .116, respectively). It is possible that there was no significant difference in question 2 because prefamiliarization responses were already favorable. Even if nurses did not feel comfortable taking care of neurosurgical patients (as assessed in question 1), they noted confidence improvement by working on the ward and through informal assimilation of knowledge and skill, which would have accumulated naturally over 1 year.
Prior to familiarization with the guide, 7 nurses did not feel confident in assessing the need to contact a physician (question 4). After familiarization with the nursing guide, favorable responses increased from 9 to 14 nurses. Results trended toward but did not reach statistical significance, likely due to the small sample size.
Ultimately, in the 16 surgical subspecialty nurses surveyed, familiarization with the nursing guide was shown to improve comfort in taking care of neurosurgical patients and increase confidence in patient care skills. At the end of the QI project (6 months, 3 weeks), all nurses knew where to locate the bedside neurosurgical nursing guide and were familiar with it and its use. The guide remains accessible to the medical-surgical nurses and continues to be used.
Discussion
Nursing confidence has an undervalued effect on patient care.2 Confidence, or a belief in one’s own ability, varies directly with competence. Systematic quantification of nursing competence has been extensively studied using self-report questionnaires and clinical simulations.2,3 Competency can be quantified and normalized using formal assessment; however, confidence is somewhat intangible. Nursing confidence is a situation-dependent subjective feeling of security and is derived from an internalized assessment of skills that are commensurate with patient needs. Nursing confidence is further influenced by an intuited value within the care team, adequate knowledge of the patient’s condition, and procedures and protocols.4
A similar but less specific definition deconstructs nursing confidence as “significance of a professional network of coworkers” and the “importance of confirmation of professional role and competence.”5 The professional network of coworkers is invaluable as it underlies the essence of patient-centered care. The adaptive leadership framework is integral to the modern delivery of patient care, and via this framework frontline clinical staff, including nurses, are empowered.6,7
The second portion of Haavardsholm and Nåden’s definition, “importance of confirmation of professional role and competence” describes the association of the most easily augmented correlate of confidence: competency.5 Nursing competency is supplemented continuously with in-service training and recertification processes; however, despite this, demands placed on nurses can be technologically advanced and extremely varied. Nursing competency is known to directly correlate with increasing education, as nurses holding a master’s degree have been shown to outperform those with a bachelor of nursing degree.3
Increased formal education as well as increased work experience (> 5 years) are correlated with increased critical thinking ability.4,5 The critical thinking ability of health care providers can be fortified by clinical simulation, which leads to statistically significant improvement in clinical competency.2,3
A literature review of Medline and the National Library of Medicine PubMed online databases for search terms (nurs*, confidence, bedside, guide) was performed but did not result in original research assessing nurse confidence related to bedside guides. In this population, nurses were anonymously compared against their own historical data obviating any effect of education or experience on survey measures.
