Self-Efficacy
Self-efficacyis a belief that personal abilities and
efforts affect the events in our lives (Bandura, 1997).
A person who believes that his or her behavior will
make a difference is more likely to take action. Peo-
ple with high self-efficacy set personal goals, are self-
motivated, cope effectively with stress, and request
support from others when needed. People with low
self-efficacy have low aspirations, experience much
self-doubt, and may be plagued by anxiety and de-
pression. Bandura (1997) suggests that rather than fo-
cusing on solving specific problems, treatment should
focus on developing a client’s skills to take control of
his or her life (developing self-efficacy) so that he or
she can make life changes. The four main ways to do
so are as follows:- Experience of success or mastery in over-
coming obstacles - Social modeling (observing successful people
instills the idea that one also can succeed) - Social persuasion (persuading people to
believe in themselves) - Reducing stress, building physical strength,
and learning how to interpret physical sensa-
tions positively (e.g., viewing fatigue as a
sign that one has accomplished something
rather than as a lack of stamina)
Hardiness
Hardinessis the ability to resist illness when under
stress. First described by Kobasa (1979), hardiness
has three components:- Commitment: active involvement in life’s
activities - Control: ability to make appropriate deci-
sions in life activities - Challenge: ability to perceive change as ben-
eficial rather than just stressful
Hardiness has been found to have a moderat-
ing or buffering effect on people experiencing stress.
Kobasa (1979) found that male executives who had
high stress but low occurrence of illness scored higher
on the hardiness scale than executives with high stress
and high occurrence of illness. Study findings sug-
gested that stressful life events caused more harm
to people with low hardiness than with high hardi-
ness. Other studies have found that hardiness seems
to have a moderating effect on burnout among nurses
(Lease, 1999).
Hardiness also has been studied in relation to
chronic illness. Pollock (1986) studied people with
diabetes mellitus and found that those with higher
hardiness exhibited better physiologic adaptation to
their illness than did those with low hardiness scores
138 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
each week reported an improved emotional state, but
during the 2 weeks before their hospital admission,
they had reduced or stopped walking altogether. The
findings of this study suggest that walking positively
influenced these clients’ health and that cessation of
walking was an indicator of declining health.
Response to Drugs
Biologic differences can affect a client’s response to
treatment, specifically to psychotropic drugs. Eth-
nic groups differ in the metabolism and efficacy of
psychoactive compounds (Mohr, 1998). Some ethnic
groups metabolize drugs more slowly (meaning the
serum level of the drug remains higher), which in-
creases the frequency and severity of side effects.
Clients who metabolize drugs more slowly gener-
ally need lower doses of a drug to produce the de-
sired effect. Mohr (1998) reported that, in general,
nonwhites treated with Western dosing protocols
have higher serum levels per dose and suffer more
side effects. Although many non-Western countries
report successful treatment with lower dosages of
psychotropic drugs, Western dosage protocols con-
tinue to drive prescribing practices in the United
States (Mohr, 1998). When evaluating the efficacy
of psychotropic medications, the nurse must be alert
to side effects and serum drug levels in clients from
different ethnic backgrounds.
Assess client’s physical health