title: Emergency nurses' perceptions of the role of confidence, self-efficacy and reflexivity in managing the cognitively impaired older person in pain.
abstract: OBJECTIVE
  The study aimed to explore the practice of care among emergency nurses caring for older persons with cognitive impairment and who presented in pain from a long bone fracture, to highlight nurse confidence and self-efficacy in practice.
  
  
  BACKGROUND
  Cognitive impairment is an issue increasingly facing emergency departments. Older persons with cognitive impairment have complex care needs, requiring effective clinical decision-making and provision of care. Nurse confidence and self-efficacy are critical to meeting the necessary standards of care for this vulnerable patient group.
  
  
  METHODS
  A multi-centre study.
  
  
  METHODS
  The study was undertaken across four emergency departments in Sydney, Australia. Sixteen focus group discussions were conducted with 80 emergency departments of nurses.
  
  
  RESULTS
  Four main themes emerged: confidence and self-efficacy through experience; confidence and self-efficacy as a balancing act; confidence and self-efficacy as practice; and confidence and self-efficacy and interpersonal relations.
  
  
  CONCLUSIONS
  Our findings demonstrate that confidence, self-efficacy and reflexivity enabled the delivery of appropriate, timely and compassionate care. Further, confidence and self-efficacy within nursing praxis relied on clinical experience and reflective learning and was crucial to skill and knowledge acquisition.
  
  
  CONCLUSIONS
  Our research suggests that confidence, self-efficacy and reflexivity need to be developed and valued in nurses' careers to better meet the needs of complex older persons encountered within everyday practice.
authors: Northern Sydney Local Health District, Sydney, NSW, Australia.|School of Nursing, University of Sydney, Sydney, NSW, Australia.
authors: Margaret
authors: M
authors: Fry
authors: Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.|School of Social Science, Monash University, Melbourne, NSW, Australia.
authors: Casimir
authors: C
authors: MacGregor
authors: Manly Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
authors: Simone
authors: S
authors: Hyland
authors: Mona Vale Hospital, Sydney, NSW, Australia.
authors: Barbara
authors: B
authors: Payne
authors: University of Technology Sydney, Sydney, NSW, Australia.|Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia.
authors: Lynn
authors: L
authors: Chenoweth
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000150:complications / Q000451:nursing*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D009517:New South Wales; D024802:Nurse's Role; D010148:Intractable Pain / Q000150:complications / Q000451:nursing*; D020377:Self Efficacy
keywords: cognitive impairment; confidence; emergency care; older adults; self-efficacy; sociology