title: Confidence and impact on clinical decision-making and behaviour in the emergency department.
abstract: BACKGROUND
  Clinical competency is underpinned by the self-confidence of nurses to act. Confidence may be critical to the understanding of how practice choices are made and not made by nurses in extended practice roles. The aim of this study was to explore how emergency nurses perceived (i) self-confidence in undertaking an extended practice role; and (ii) the factors associated with confidence within clinical practice.
  
  
  METHODS
  A multicentred qualitative exploratory study. Fifty two participants were included in the study. Across three sites 36 (28 females, 8 males) face to face interviews and 16 non-participant observations (13 females, 3 males) were conducted.
  
  
  RESULTS
  The study generated new knowledge about self-confidence, self-efficacy and the role that contextual factors have in regulating behaviour. It shows that self-confidence is an important resource that sustains a nurse's ability to problem solve and to critically think in order to determine how best to act.
  
  
  CONCLUSIONS
  The development of self-confidence is important if we are to promote effective clinical decision-making. Education programmes need to identify strategies that can promote and support the development of self-confidence and resilience.
authors.affiliation: Nursing and Midwifery Directorate, Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Electronic address: margaret.fry@health.nsw.gov.au.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
authors.affiliation: Faculty of Health, University of Technology, Sydney, Jones Street, Broadway, NSW 2007, Australia. Electronic address: casimir.macgregor@uts.edu.au.
authors.forename: Casimir
authors.initials: C
authors.lastname: MacGregor
mesh_terms: D000328:Adult; D002983:Clinical Competence; D002985:Clinical Protocols; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009517:New South Wales; D009736:Nursing Process / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D017009:Professional Autonomy; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Clinical initiative nurse; Confidence; Emergency care; Extended practice; Self-efficacy