Enferm Clin.
2019;29(S2):252---256
www.elsevier.es/enfermeriaclinica
Nurses’ self-efficacy in Indonesia夽
Hanny Handiyani a,∗ , Anastasia Sari Kusumawati b , Rina Karmila c , Ade Wagiono d ,
Tres Silowati a , Ana Lusiyana e , Rika Widyana f
a
Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
b
Regional General Hospital of Yogyakarta City, Special Region of Yogyakarta, Indonesia
c
Grand Mosque Community Health Center, Aceh Besar, Aceh, Indonesia
d
Marzoeki Mahdi Hospital, Bogor, West Java, Indonesia
e
Public Hospital, Sintang, West Kalimantan, Indonesia
f
Dumai Public Hospital, Dumai, Riau, Indonesia
Received 13 November 2018; accepted 17 April 2019
Available online 24 June 2019
KEYWORDS Abstract
Nurse efficacy; Objective: The purpose of this study was to find out the overview of nurses’ characteristics and
Action self-efficacy; self-efficacy based on nurse characteristics.
Coping self-efficacy Method: This cross-sectional study used cluster sampling involved 12 hospitals in 6 provinces
in Indonesia, followed by proportionate random sampling, and obtained 1323 nurses. Data
collected by questionnaire.
Results: There were significant differences in self-efficacy of male and female nurses
(p = 0.009). There were significant differences in self-efficacy of nurses in private hospitals
and public hospitals (p = 0.005). The mean self-efficacy of nurses was 32.50 ± 4992 (81.25%),
the composition value of action-related self-efficacy (82.38%) was higher than coping-related
self-efficacy (80.15%).
Conclusions: Male nurses have higher self-efficacy than female. Nurses in private hospitals have
higher self-efficacy than nurses in public hospitals. Nurses in Indonesia have good self-efficacy.
Nevertheless, the nurse’s belief in the ability to strive for achieving goals is not as big as the
initial belief of the nurse in setting the goals.
© 2019 Elsevier España, S.L.U. All rights reserved.
∗
Corresponding author.
E-mail address: [email protected] (H. Handiyani).
夽 Peer-review under responsibility of the scientific committee of the Second International Nursing Scholar Congress (INSC 2018) of Faculty
of Nursing, Universitas Indonesia. Full-text and the content of it is under responsibility of authors of the article.
https://doi.org/10.1016/j.enfcli.2019.04.030
1130-8621/© 2019 Elsevier España, S.L.U. All rights reserved.
Nurses’ self-efficacy in Indonesia 253
Introduction Data analysis
Health quality service requires staff self-efficacy in dealing Data were analyzed in two stages: (1) descriptive statistics
with problems/various situations within the organization. included nurses’ self-efficacy, age, length of work, gen-
The organizational analysis is not only related to tradition der, education, hospital status and (2) bivariate analysis
but also shared values and beliefs about the organization’s between age and length of work with nurses’ self-efficacy
ability to innovate and be productive, the efficacy of being using Pearson Product moment, gender and hospital status
productive is an important part of organizational culture.1 with nurses’ self-efficacy using Independent t-test, educa-
Self-efficacy refers to the belief in one’s ability to regulate tion with nurses’ self-efficacy using ANOVA.
and carry out the actions needed to manage the situation
that will be faced.2 Efficacy affects how a person thinks,
Ethical aspects
feels, motivates himself, and acts. Self-efficacy shows the
level of ones’ ability to control themselves.2 Self-efficacy
Research permits and Ethics review information has been
is related to an individual’s ability to cope with challenging
obtained from the Dean and Ethics Committee of Faculty
and stressful events.3
of Nursing, Universitas Indonesia. Other agreements have
Self-efficacy is important in nursing practices. The self-
been obtained from the Director of the hospital, and writ-
efficacy of nurses influences the attitudes and behaviour of
ten approval from the respondent. Anonymity, voluntary and
nurses4 ; it is related to nurses’ knowledge of the existing
confidentiality principles have been explained to respon-
protocols and its actual implementation.5 Self-efficacy is a
dents.
mediator between knowledge and action and also influences
the treatment selection taken by nurses.5 Nurses’ self-
efficacy includes speaking or express when patient safety Results
is in danger, by not engaging the silence culture when there
are adverse effects related to patient safety.6 The impor- Majority nurses were female (76.9%), and diploma of nursing
tance of nurses’ self-efficacy in carrying out their duties (83.1%); most respondents work in public hospitals (96.6%);
and there has never been extensive research regarding the mean age of nurses 32.02 ± 7019 years; mean length of work
self-efficacy of nurses in various regions in Indonesia are of nurses was 8.75 ± 6.886 years; and the mean of self-
the reasons for this research. This study aims to describe efficacy of nurses was 32.50 ± 4992 (81.25%) (Table 1).
the self-efficacy of nurses in hospitals in various regions There was a significant difference in the mean of self-
in Indonesia and to find out the relationship between the efficacy between male and female nurses (p = 0.009). There
characteristics of nurses and self-efficacy. was no significant difference in the mean of self-efficacy
This study examines two factors found in the general of nurses based on education level (p = 0.333). There was
self-efficacy (GSE) scale instrument namely actions-related a significant difference in the mean of self-efficacy among
self-efficacy and coping-related self-efficacy.7 Self-efficacy nurses in public and private hospitals (p = 0.005). There was
related to action describes the initial belief (pre-intention) no significant relationship between age and length of work
while coping-related self-efficacy describes the beliefs with nurses’ self-efficacy (p = 0.492; p = 0.724) (Table 2).
shown (post-intention).8 The discussion begins by describing The composition value of the nurses’ action-related self-
the characteristics of nurses followed by describing self- efficacy (82.38%) was higher than the nurses’ coping-related
efficacy based on the characteristics of nurses. self-efficacy (80.15%) (Table 3).
Discussion
Method
Most nurses were female, and there was a significant dif-
Design, population, settings, and samples ference of mean self-efficacy between male and female
nurses. The mean self-efficacy of male was higher than the
The cross-sectional study involved 12 public and private female. Similar results found that there were significant dif-
hospitals in Indonesia in 6 provinces, namely Banten, Riau, ferences in mean self-efficacy between male and female,
Aceh, West Java, Yogyakarta, and Jakarta. This study used male had higher self-efficacy than the female.10 Male have
a cluster sampling technique to represent several regions more mature readiness in solving problems and finding solu-
in Indonesia and continued with proportionate random sam- tions, as well as thoughts than female, this is evidenced
pling to obtain 1323 nurses. Inclusion criteria are nurses who according to the analysis conducted from the self-efficacy
provide direct services to patients. questionnaire in the statement ‘‘I can find several solutions
to overcome a problem faced to me’’, male had a higher
level of self-efficacy (mean = 3.41, SD = 0.572) for this item
compared to female (mean = 2.90, SD = 0.889).10 The differ-
Data collection ences of ability development and competence lead to the
self-efficacy of the male is higher than female.1
The instrument used included the characteristics of respon- The majority of nurse was a diploma of nursing, and there
dents and General self-efficacy scale (GSES)9 with the Likert was no significant difference in the mean self-efficacy of
scale of 4. GSE has been translated into Indonesian and has nurses based on education levels. The level of education
been tested for validity and reliability with Alpha (0.671). was not related to nurses’ self-efficacy.11,12 Bandura in 1997
254 H. Handiyani et al.
Table 1 Descriptive statistics of nurses (n = 1323).
Measurement n %
Gender
Male 306 23.1
Female 1017 76.9
Education
High School of Nursing 15 1.1
Diploma of Nursing 1099 83.1
Ners (Bachelor of Nursing) 207 15.6
Master of Nursing 2 0.2
Hospital status
Public 1278 96.6
Private 45 3.4
n Mean (%) SD Min. Max.
Age 1323 32.02 7.109 21 58
Length of work 8.75 6.886 0 36
Self-efficacy of nurse 32.50 (81.25) 4.992 10 40
Table 2 Nurse characteristics and self-efficacy of nurses (n = 1323).
Independent variables Dependent variables p Mean (%) SD
Gender Self-efficacy of 0.009
Male nurses 33.16 (82.9) 5.097
Female 32.31 (80.77) 4.946
Education 0.333
High School of Nursing 30.60 (81.5) 3.906
Diploma of Nursing 32.55 (81.37) 4.004
Ners (Bachelor of Nursing) 32.29 (80.72) 4.948
Master of Nursing 26.50 (66.25) 10.948
Hospital status 0.005
Public 32.44 (81.1) 5.013
Private 34.24 (85.6) 4.046
p r
Age 0492 −0.019
Length of work 0724 −0.010
stated that individuals who have a higher level of education The allocation of nurses’ assignment which is not
usually have higher self-efficacy because they learn more well-differentiated will reduce the nurses’ self-efficacy.
through formal education so that they get more opportuni- Gloudemans,11 2013 stated that the allocation of nurses
ties to learn to cope the problems.1 The difference between assignment with diplomas and undergraduate degrees were
the results of the study and literature review can be caused not well-differentiated would have a negative impact on the
by the poor allocation of nurses’ assignments, for example confidence and self-esteem of the Bachelor degree nurse,
there is an equal division of tasks between Ners and Master this would lead to the self-efficacy decrease of nurses with
of Nursing backgrounds, Ners, and Diploma nurses. This will Bachelor’s degree than those with Diploma. The allocation
reduce nurses’ trust and self-esteem with Master of Nursing of well-differentiated assignment and position will lead the
and Ners background, and impact on the low self-efficacy. nurses to feel valued according to their abilities and educa-
Two nurses with a Master of Nursing background were still tional background, thus affecting their self-efficacy.
assigned as executive nurses because they just completed Most respondents work in public hospitals, and there are
their study for 1 year and there was no vacancy in the significant differences in the mean self-efficacy between
higher position. Nurses with Ners background mostly occu- nurses in public and private hospitals. The difference
pied nurse executive positions, this is because the higher in mean self-efficacy due to the differences in shared
positions such as Primary Nurse or Team Leaders are occu- values and belief systems between public hospitals and
pied by senior nurses even though with a lower level of private hospitals. Public hospitals and private hospitals
education. often have different values, visions or missions. Efficacy in
Nurses’ self-efficacy in Indonesia 255
results obtained in this study can be due to the differences
Table 3 Sub-variables values of nurses self-efficacy
in the experience of the respondents. As you get older,
(n = 1323).
the nurse’s experience will also increase. Individual expe-
Composition of Mean value (%) Rank rience influences self-efficacy. The longer a person works,
questionnaires the self-efficacy increases, remains or decreases depending
Efficacy of actions 16.48 (82.38%) 1
on one’s response to the successes and failures they experi-
Efficacy of coping 16.03 (80.15%) 2
ence during work.1 A person must have experienced severe
challenges and solved it with persistence and hard work so
that the self-efficacy can be formed.1
The mean score of nurses’ self-efficacy was 32.50
organizations relates to shared values and belief systems (81.25%) of the maximum score that could be obtained,
in organizations that establish formal and informal 40, this indicates that nurses in several hospitals in Indone-
practices.2 Culture in the organization influences self- sia have good self-efficacy. The higher the mean score the
efficacy by influencing the basic system of workplace higher/positive the self-efficacy of the nurse.9 Self-efficacy
organization. There are significant differences in self- cannot be felt thoroughly, to get a sense of self-efficacy,
efficacy based on individual perceptions of organizational complete the task successfully, get positive feedback
culture.13 Cultural differences in organizations between about the task completed, or observe other people who
public hospitals and private hospitals can lead to differences complete the work successfully.18
in nurses’ self-efficacy. In addition, this study has a much The results of various previous studies have shown
smaller number of respondents who work in private hospi- the importance of self-efficacy related to individual
tals than public hospitals (45: 1278). The number of nurse work. Self-efficacy is negatively correlated with burnout,
respondents in private hospitals that are quite small and emotional fatigue, depersonalization, work stress, and
only in one hospital can influence the results of the study. signs of stress.19,20 Self-efficacy is positively correlated
The mean of nurses aged 32.02 years, and there was with achievement, job satisfaction, positive aspects of
no relationship between age and self-efficacy of nurses the individual.12,19,20 Leadership-related research finds
(p = 0.492). Age is not related to self-efficacy.12,14 Differ- that self-efficacy is a predictor for supervisor/supervisor
ent research results found that personal characteristics performance.14 Self-efficacy is related to transformational
including age were related to nurses’ self-efficacy, older leadership, trust in leaders,20 and nurse performance.17
nurses had higher self-efficacy in giving caring to patients.15 The high/positive Self-efficacy of nurses plays an impor-
Increasingly mature and productive age will influence a per- tant role for nurses in working because it will affect in
son’s thinking and perception of their ability to perform improving the performance of nurses. Self-efficacy in nurs-
tasks, and it will affect the self-efficacy. Age is one of the ing is the main factor to improve work skills21 so that it
factors that affect a person’s self-efficacy.1 Age will effect can lead to job satisfaction. Nurses with strong self-efficacy
on how to think and work, the more mature a person is, the were also identified as having higher compliance to nursing
more mature he or she will be in thinking and the better the practice behaviour.22 Self-efficacy of nurse’s influences per-
performance.16 formance, compliance, care provided by nurses, and nurse
The results of the study showed that the average nurse, job satisfaction.
both young and old had a positive feeling towards their abil- Nurses who have high self-efficacy will have high confi-
ity to complete the task and could find a solution to solve dence in their ability to successfully perform certain tasks.
the problem. This can be seen from the value of the action High self-efficacy increases the capacity of staff to collect
self-efficacy statement of 82.38%, namely that the average relevant information, make the right decisions, and then
nurse perceives his ability well in carrying out the tasks, take appropriate action.23 Nurses’ self-efficacy affects self-
solving problems and finding solutions to these problems. confidence, the ability of nurses providing care to patients,
Self-efficacy of nurses is formed through the social learning collaborating with patients and families, and formulating
process in the entire life so that nurses can have differ- patient care plan goals.24 Self-efficacy of nurses greatly
ent experiences, whether it is a successful experience or determines the ability of nurses to improve the performance
a failure experience. Self-efficacy depends on how individu- and quality of nursing care.
als face the successes and failures they experienced during Research by Zhou (2015) gets two factors contained
work.1 Successful experience will increase self-efficacy, on in the questionnaire of general self-efficacy (GSE) scale
the contrary failure will reduce self-efficacy, but if failure that measures the action-related self-efficacy and coping-
experience is always faced by individuals by continuously related self-efficacy.7 The difference between these two
trying to improve performance, self-efficacy will increase types of efficacy is needed because this allows an indi-
as well.1 Increasing age leads to nurses to have more expe- vidual to be very confident in setting goals and taking
rience of failure or success. initiatives (have high action efficacy) but not so confident in
The average length of work of nurses was 8.75 years, their ability to pursue goals (coping efficacy).7 The nurses’
and there was no relationship between the nurses’ length coping-related self-efficacy sub-variables had a lower score
of work and self-efficacy. The results of different studies (80.15%) than action-related self-efficacy (82.38%) which
found that the length of work and the long-serving were meant that nurses’ beliefs in terms of their ability to
related to the self-efficacy (r = 0.277; p = 0.007 and r = 0.297; achieve goals were not as large as the nurses’ initial beliefs
p = 0.003).11 Length of work is weak but significant with in setting goals. Nurses need to increase self-efficacy, even
self-efficacy (r = 0.29; p < 0.0001). 17 The difference in the though the score was at 81.25%.
256 H. Handiyani et al.
Male nurses have higher self-efficacy than female. Nurses 9. Schwarzer R, Jerusalem M. Generalized self-efficacy scale mea-
in private hospitals have higher self-efficacy than in pub- sures in health psychology: a user’s portfolio. Causal Control
lic hospitals. Nurses in Indonesia have good self-efficacy. Beliefs. 1995;1:35---7.
Nonetheless, the nurse’s belief in the ability to strive for 10. Imus FS, Burns S, Weglarz DM. Self-efficacy and graduate edu-
goal achievement (coping efficacy) is not as large as the cation in a nurse anesthesia program: a pilot study. Am Assoc
Nurse Anesth J. 2017;85:205---16.
nurse’s initial belief in setting goals (action efficacy).
11. Gloudemans HA, Schalk RMJD, Reynaert W. The relation-
The female nurses need to improve self-efficacy more. ship between critical thinking skills and self-efficacy beliefs
Good allocation of assignments for nurses according to the in mental health nurses. Nurse Educ Today. 2013;33:275---80,
educational background is very necessary. Public hospitals http://dx.doi.org/10.1016/j.nedt.2012.05.006.
need to strengthen the organizational culture to strengthen 12. Semiatin AM, O’Connor MK. The relationship between self-
the basic system which in turn can improve nurses’ self- efficacy and positive aspects of caregiving in Alzheimer’s
efficacy. Nurses need to improve self-efficacy, especially disease caregivers. Aging Mental Health. 2012;16:683---8,
coping-related self-efficacy. http://dx.doi.org/10.1080/13607863.2011.651437.
13. Collins-Camargo C, Royse D. A study of the relationships
among effective supervision, organizational culture promot-
Conflict of interests ing evidence-based practice, and worker self-efficacy in
public child welfare. J Public Child Welfare. 2010;4:1---24,
The authors declare no conflict of interest. http://dx.doi.org/10.1080/15548730903563053.
14. Walumbwa FO, Hartnell CA. Understanding transforma-
tional leadership-employee performance links: the role
Acknowledgement of relational identification and self-efficacy. J Occup
Org Psychol. 2011;84:153---72, http://dx.doi.org/10.
This work is supported by Hibah PITTA 2018 funded by DPRM 1348/096317910X485818.
Universitas Indonesia No.1842/UN2.R3.1/HKP.05.00/2018. 15. Molinari DL, Monserud M. Rural nurse cultural self-efficacy
and job satisfaction. J Transcult Nurs. 2009;20:211---8,
http://dx.doi.org/10.1177/1043659608330350.
References
16. Robbins SP, Judge TA. Organizational behavior. 17th ed. Italy:
Pearson Education Limited; 2017. p. 747.
1. Bandura A. Self efficacy: the exercise of control. New York: W.H. 17. Lee TW, Ko YK. Effects of self-efficacy, affectivity and
Freeman and Company; 1997. collective efficacy on nursing performance of hospital
2. Bandura A. Self efficacy in changing societies. New York: Cam- nurses,. J Adv Nurs. 2010;66:839---48, http://dx.doi.org/10.
bridge University Press; 1999. 1111/j.1365-2648.2009.05244.x.
3. Boyle TA, Mahaffey T, MacKinnon NJ, Deal H, Hallstrom LK, Mor- 18. Zulkosky K. Self-efficacy: a concept analysis. Nurs
gan H. Determinants of medication incident reporting, recovery, Forum. 2009;44:93---102, http://dx.doi.org/10.1111/
and learning in community pharmacies: a conceptual model. j.1744-6198.2009.00132.x.
Res Soc Admin Pharm. 2011;7:93---107, http://dx.doi.org/ 19. Aftab N, Shah AA, Mehmood R. Relationship of self efficacy and
10.1016/j.sapharm.2009.12.001. burnout among physicians. SAVAP Int. 2012;2:539---48.
4. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospi- 20. Liu J, Siu OL, Shi K. Transformational leadership and
tal nurse staffing and patient mortality, nurse burnout, and job employee well-being: the mediating role of trust in the
dissatisfaction. J Am Med Assoc. 2002;288:1987, http://dx.doi. leader and self-efficacy. Appl Psychol. 2010;59:454---79,
org/10.1001/jama.288.16.1987. http://dx.doi.org/10.1111/j.1464-0597.2009.00407.x.
5. Berarducci A, Lengacher CA. Self-efficacy: an essential 21. Soudagar S, Rambod M, Beheshtipor N. Factors associated with
component of advanced-practice nursing. Nurs Connect. nurses’ self-efficacy in clinical setting in Iran, 2013. Iran J Nurs
1998;11:55---67. Midwifery Res. 2015;20:226---31.
6. Henriksen K, Dayton E. Organizational silence 22. De Wandel D, Maes L, Labeau S, Vereecken C, Blot
and hidden threats to patient safety. Health Serv S. Behavioral determinants of hand hygiene compliance
Res. 2006;41(4 II):1539---54, http://dx.doi.org/10. in intensive care units. Am J Crit Care. 2010;19:230---9,
1111/j.1475-6773.2006.00564.x. http://dx.doi.org/10.4037/ajcc2010892.
7. Zhou M. A revisit of general self-efficacy scale: uni- or 23. Heslin PA, Klehe UC. Self-efficacy. Encyclopedia Ind/Org Psy-
multi-dimensional? Curr Psychol. 2016;35:427---36, http://dx. chol. 2006;2:705---8.
doi.org/10.1007/s12144-015-9311-4. 24. Tyler S, Bourbon E, Cox S, Day N, Fineran C, Rexford D,
8. Schwarzer R, Renner B. Social-cognitive predictors of et al. Clinical competency, self-efficacy, and job satisfac-
health behavior: action self-efficacy and coping self- tion. J Nurses Staff Dev. 2012;28:32---5, http://dx.doi.org/10.
efficacy. Health Psychol. 2000;19:487---95, http://dx. 1097/NND.0b013e318240a703.
doi.org/10.1037/0278-6133.19.5.487.
