Cynthia Lee Brown Dakin, PhD
“Predictive Value of Emergency Department Patients’ Self-Efficacy and Outcome Beliefs Regarding Wound Care”
About the thesis: The purpose of this predictive study was to explore the relationship between self-efficacy, outcome beliefs and wound healing, as well as the relationship of self-efficacy and outcome beliefs to following wound care discharge instructions after suturing. Bandura’s Social Cognitive Theory was the theoretical framework for this study.
Introduction: A sample of 100 participants admitted to the Emergency Department (ED) with a diagnosis of laceration requiring closure with sutures was included in this study. Participants were asked to complete an informed consent form and the Wound Care Questionnaire (WCQ), a questionnaire measuring self-efficacy and outcome beliefs regarding wound care. Additional information was collected on the Biographical Data Form. When patients returned to the ED a nurse researcher assessed the laceration for degree of healing using the Wound Healing Assessment Instrument (WHAI). All patients not returning to the ED for follow-up within fourteen days of suturing were contacted by telephone and asked if stitches were removed and by whom.
Results: Analyses of the WCQ indicated a high level of internal consistency (Confidence Cynthia Lee Brown Dakin-University of Connecticut, 2001 scale a = .84 and Importance scale a = .87). Interobserver agreement estimates for the WHAI indicated a high level of concordance (wound description k = 1.00 and wound appearance k = .79). Logistic regression was the method of analysis used to explore the relationship between self-efficacy and outcome beliefs as predictors of return to the ED to have stitches removed. The logistic model identified self-efficacy beliefs for following wound care instructions (p < .05), self-efficacy beliefs for returning to the ED (p < .01), and age (p < .01) as significant predictors. Descriptive statistics including chi-square and correlational analyses were used to interpret the relationship between self-efficacy and outcome beliefs and wound healing. Analyses did not identify any significant predictors of wound healing. The research indicated, for the first time, that use of Social Cognitive Theory, specifically self-efficacy, in the ED by nurses could assist health care providers in identifying patients who may not return for follow-up visits to have stitches removed. This study demonstrates that Social Cognitive Theory is applicable for research and practice in the ED.