Hrev_master Healthcare in Low-resource Settings 2024; volume 12(s1):13040 [Healthcare in Low-resource Settings 2024;12(s1):13040] [page 135] Significance for public health Nurses currently employed face the ongoing challenge of effectively making professional contributions to society. The degree of self-efficacy plays a pivotal role in determining nurses' belief in their capabilities, ultimately influencing the quality of their performance. Programs that foster professional competency can play a significant role in bolstering nurses' perceived self-efficacy, thereby enhancing their confidence in establishing empathetic connections with patients, resulting in heightened patient contentment. From a public health perspective, heightened self-efficacy among wound care nurses equips them with the confi- dence to establish independent practices and offer home care. This enables individuals, especially those with chronic wounds, to access specialized wound care services. What factors influence clinical nurses' self efficacy after wound care training? A scoping review Rosdiana Saniapon, Kuswantoro Rusca Putra, Dina Dewi Sartika Lestari Ismail, Retno Lestari Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia Abstract The inadequate management of wounds carries significant implications for patients and challenges clinical nurses. Consequently, there is a need for wound care training to enhance self-efficacy. However, despite participation in such training, nurses often need more practical experience and educational back- ground to exhibit higher confidence levels. This results in a defi- ciency in self-efficacy when performing wound care. This study aims to amalgamate literature discussing the determinants influ- encing self-efficacy and present strategies for clinical nurses to enhance it after wound care training. The article search utilized the PRISMA method, with searches conducted in Google Scholar, Proquest, Science Direct, and Pubmed databases. Sixteen articles met the specified inclusion criteria, which required English-lan- guage articles published within the last five years (2018-2023) discussing factors affecting clinical nurse self-efficacy after wound training. Various factors, including competence, social support, and self-motivation, influence wound nurses’ self-effica- cy. Competence factors encompass structured training and educa- tion, while social support involves sharing experiences and engag- ing in case reflection. Additionally, motivational factors play a significant role, such as reinforcing values and attitudes when fac- ing obstacles and maintaining the belief that nurses can effectively adhere to wound care standards. Enhancing self-efficacy includes improving competencies through standardized wound training, increasing educational opportunities, self-experience, social per- suasion support, sharing experiences, high self-motivation, and managing emotions when assessing one’s ability to achieve goals successfully. Professional development programs designed to pro- vide structured training for nurses have enhanced their competen- cies, social support, and motivation, strengthening holistic wound care clinical skills and improving self-efficacy. Therefore, explor- ing additional factors that may further contribute to this positive outcome is advisable. Introduction In recent years, there has been a notable increase in the num- ber of patients seeking care from home and public healthcare units, many of whom present with chronic and challenging-to- treat wounds.1 These chronic wounds necessitate specialized attention from nurses, as they have substantial implications for healthcare services and the affected patients, leading to increased care costs and directly impacting the patient’s quality of life.2 Social isolation, feelings of burden on family and relatives, persis- tent pain, infection, and resistance to antibiotics are additional sig- nificant effects associated with chronic wounds.3 The persistent presence of chronic wounds is increasingly acknowledged as a significant issue in the healthcare sector, exert- ing a substantial impact on global morbidity and mortality remi- niscent of an “unrecognized epidemic.” The escalating prevalence of chronic wounds imposes a considerable burden on patients, healthcare providers, and the entire healthcare system. This affects the quality of life and influences resource allocation and health- care expenditures.4 In Europe, chronic wounds primarily affect the lower extremities in approximately 1.51% of the population and 2.21% of patients with mixed aetiology.5 Within Italy, an estimat- ed 24% of the population, approximately two million people, are affected by chronic wounds, mainly due to factors related to age- ing and lifestyle-related comorbidities such as diabetes, obesity, hypertension, and peripheral vascular disease.3 To address this issue effectively, the healthcare team must comprehensively understand the elements that define chronic wounds, the manage- ment of wound drainage, and the assessment of wounds while pro- viding wound care.2,6 Wound care is a specialized clinical area that demands multi- disciplinary teamwork, with nurses playing a pivotal role.5 Nursing professionals are responsible for contributing to society and are expected to maintain their professional capabilities in pro- viding direct care.7 Hence, it is imperative to conduct education and training programs to enhance nurses’ knowledge, attitudes, and skills, particularly regarding wound healing and care.8 In a prior study, it was shown that the training of community nurses in wound care led to significant improvements in their knowledge and practice (p<0.001). In addition to this, utilizing the TIME framework effectively provided wound care education, ultimately resulting in notable enhancements in wound care practice.9 Inadequate wound care represents a significant challenge for clinical nurses and has substantial implications for patient out- comes. Addressing this challenge necessitates specialized wound care training to enhance nurses’ self-efficacy. However, despite Non -co mmerc ial us e o nly participating in training programs, nurses often need more confi- dence due to insufficient experience and education, resulting in reduced self-efficacy in the provision of wound care. Bandura (1997) contends that self-efficacy is a cognitive process involving decisions, beliefs, and expectations about individuals’ perceived ability to execute specific tasks or actions necessary to achieve desired outcomes.10 Nurses’ self-efficacy denotes their faith in their ability to effectively undertake particular nursing care activi- ties. Augmenting nurses’ knowledge and experience in wound care represents a practical approach to enhancing competence, confi- dence, and service quality. By affording nurses opportunities to strengthen and refine their knowledge through training, self-effica- cy can be bolstered, thereby amplifying the nurse’s role in deliver- ing comprehensive patient care. The level of self-efficacy signifi- cantly influences nurses’ confidence in their abilities, which deter- mines their performance quality. Professional competency devel- opment programs can aid in elevating nurses’ perceived self-effi- cacy, fostering confidence in developing empathetic patient rela- tionships and ultimately enhancing patient satisfaction. Competency development programs, such as wound care training initiatives, are crucial. They empower nurses to gain a deeper understanding of wound conditions and improve their capacity to select appropriate treatment modalities and equipment for manag- ing complex wounds, consequently elevating nurses’ confidence. More literature on strategies to enhance self-efficacy following standardized wound care training programs is needed. Therefore, synthesizing articles that address the factors influencing self-effi- cacy and strategies utilized by clinical nurses to enhance self-effi- cacy post-wound care training is imperative.11,12 Materials and Methods The research design employed in this study involves analyzing 16 articles. These articles were sourced from various scholarly databases, including Google Scholar (n=13500), ProQuest (n=1154), Science Direct (n=676), and PubMed (n=1681). The search for articles was conducted using the PRISMA method, fol- lowing predefined criteria for inclusion and exclusion. To maintain the highest level of methodological integrity, the article search process strictly adhered to the PRISMA method (Figure 1), which involved a meticulous and thorough search pro- cess. The inclusion criteria were predefined and encompassed sev- eral specific parameters. These parameters included the require- ment for articles to be in the English language, address factors influencing nurse self-efficacy in clinical practice following wound care training, and have been published within the last five years (2018-2023). Conversely, exclusion criteria were carefully established to ensure the selection of relevant and accessible arti- cles. These criteria encompassed the exclusion of paid articles, articles without full-text accessibility in book or module formats, articles in the form of undergraduate theses, master’s theses, dis- sertations, and scientific papers, as well as articles not in English. The articles that satisfied the criteria were deemed to have met the specified requirements. Supplementary materials Table 1 shows the summary of articles. Results and Discussions The provision of wound care is integral to upholding patients’ health and overall well-being, constituting a fundamental aspect of nursing practice. Various studies have underscored nurses’ need to augment their expertise in this specialized care. This imperative often stems from the need for more clearly defined and standard- ized competency frameworks among nurses, particularly in consis- tent and efficient wound care administration.13 The proficiency of wound care nurses is influenced by various factors that can impact their self-efficacy. One significant factor is the need for some nurs- es to develop confidence in wound care post-training, primarily due to limited experience and education. This can lead to a deficit in self-efficacy when performing wound care. A closely related factor is nursing students’ relatively insufficient wound care edu- cation, particularly in contemporary moist care techniques. Nurses primarily acquire numerous skills based on empirical knowledge and experience throughout their clinical careers.2,8 One proven effective method for acquiring new skills and enhancing nurses’ performance is through training, leveraging pre- vious nursing experience as the most influential source. It is crucial to consider the influence of nurses’ educational backgrounds on developing essential skills required for providing optimal wound care to patients. Training programs facilitate a better understanding of wound status and enhance the nurses’ capacity to select appro- priate medical methods and equipment for managing complex wounds, consequently bolstering their confidence levels.2 To this end, nurses must augment their nursing competencies by undergo- ing wound care training programs and implementing these learn- ings in their daily practice. The domain of competency in wound care is intrinsically linked to theoretical knowledge and practical training, reinforced by the nurses’ educational background.14 According to the study, nurses who received specific training in wound care demonstrated significantly higher proficiency in providing wound care than those who did not. The research find- ings indicate that a substantial number of nurses needed to gain the necessary knowledge and skills in wound care, with over 40% fail- ing to offer comprehensive discharge planning related to wound 4th International Nursing and Health Sciences Symposium Figure 1. Flowchart of scoping review with selection process using PRIS-MA. [page 136] [Healthcare in Low-resource Settings 2024;12(s1):13040] Non -co mmerc ial us e o nly care education. This highlights the urgent requirement for well- structured educational and training initiatives that prioritize advancing nurses’ proficiency in wound healing and care while emphasizing the enhancement of academic standards in this criti- cal area of healthcare.15 This stands consistent with the research conducted by Welsh (2018), which underscored the deficiency in applying wound care theory to practice owing to the absence of structured education. Proficiency in wound care knowledge signif- icantly influences wound healing and care practices, with well- informed professionals more likely to adhere to recommended practices. Consequently, it can be concluded from these two stud- ies that trained nurses are more likely to possess up-to-date knowl- edge of wound care and can apply evidence-based practices obtained in wound care service settings. Enhanced knowledge in the care of patients with wounds can bolster nurses’ practical com- petence and self-efficacy, while also fostering evidence-based wound care practices.16 Competence, social support, and self-motivation significantly influence the self-efficacy of wound nurses. Nurses who have received comprehensive training are more likely to exhibit high levels of self-efficacy.17 Competence, rooted in a person’s interest and experience, is a behaviour-based characteristic influenced by motivation and attitude, thus directly impacting self-efficacy.7 Training and simulation can enhance nurses’ competence and skills, increasing confidence and self-efficacy.12,18 Allowing nurses to enhance their knowledge during exercise can improve self-effi- cacy and enhance their role in providing comprehensive nursing care to patients. Remember, nurses’ motivation is the key to your success.19 Moreover, social support from clinical nurse colleagues, reflection, sharing of experiences, and mentoring play a crucial role in enhancing nurses’ self-efficacy.13 Furthermore, it is impera- tive to consider environmental and resource variables, as well as knowledge, skills, and the impact of social and spiritual factors when seeking to enhance nurses’ clinical practice.20 A systematic continuing education program, delivered through a blended learn- ing approach, is essential for nurses caring for patients with wound problems, as it leads to better knowledge, clinical performance, and increased self-efficacy scores.21,22 Developing clinical nurses’ self-efficacy in their practice is of utmost importance. This involves augmenting their knowledge and expertise in wound care, fostering confidence in their clinical skills, and establishing standardized fundamental and advanced competencies. Additionally, it requires comprehensive wound nursing education and drawing on successful experiences from others to bolster self-efficacy.23,24 Providing enhanced social sup- port and encouragement for independent wound care performance is crucial. Equally important is the need for nurses to prioritize maintaining positive emotional and physical well-being, as it is a pivotal factor in achieving their objectives.25-28 Conclusions Nurses who have received training are more likely to possess knowledge regarding wound care and the capability to apply evi- dence-based practices within wound care services. This heightened expertise in tending to patients with wounds enhances nurse com- petence and boosts nurse self-efficacy when accompanied by ade- quate knowledge and competence. Moreover, structured training assists nurses in improving their competence, nurturing social sup- port capabilities, and igniting motivation to provide comprehen- sive wound care, enhancing nurses’ self-efficacy. Therefore, exploring additional contributing factors to improve evidence- based wound care practices is recommended. References 1. Al-Masslawi D, Fels S, Lea R, Currie LM. Nurse-centred design: homecare nursing workarounds to fit resources and treat wounds. DS 87-3 Proceedings of the 21st International Conference on Engineering Design (ICED 17) Vol 3: Product, Services and Systems Design, Vancouver, Canada, 21- 25082017. 2017;181–90. 2. Ielapi N, Costa D, Peluso A, et al. Wound care self-efficacy assessment of italian registered nurses and wound care educa- tion in italian nursing education system: a cross-sectional study. Nurs Rep 2022;12:674-84. 3. Lommi M, Raffaele B, Tolentino Diaz MY, et al. Nursing out- comes in wound care management: A mixed method study. Nurs Open 2023;10:2249-63. 4. Alzamani LMHI, Marbun MRY, Purwanti ME, et al. Chronic Ulcers: Recognizing Decubitus Ulcers and Diabetic Ulcers. Syntax Fusion J 2022;2:272–86. 4th International Nursing and Health Sciences Symposium [Healthcare in Low-resource Settings 2024;12(s1):13040] [page 137] Correspondence: Kuswantoro Rusca Putra, Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Jl. Puncak Dieng Eksklusif, Kunci, Kalisongo, Dau, Malang, Postcode: 65151, East Java, Indonesia. Tel.: +623415080686. E-mail: torro.fk@ub.ac.id Key words: clinical nurses; self-efficacy; wound training Contributions: the authors contributed equally to this research. Conflict of interest: the author declares no potential conflicts of interest. Funding: this study was financially supported by the Ministry of Health of the Republic of Indonesia. Clinical trials: not Applicable. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Ethics approval and informed consent: not applicable. Conference presentation: part of this article was presented at the 4th International Nursing and Health Sciences Symposium, from 27th-28th of October 2023, Universitas Brawijaya, Malang, East Java Indonesia. Acknowledgement: we are grateful to the Faculty of Health Sciences, Universitas Brawijaya Malang, Indonesia, for their support and encour- agement. Received: 5 November 2023. Accepted: 13 June 2024. Early view: 10 September 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12(s1):13040 doi:10.4081/hls.2024.13040 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Non -co mmerc ial us e o nly 5. Martinengo L, Olsson M, Bajpai R, et al. Prevalence of chronic wounds in the general population: systematic review and meta- analysis of observational studies. Ann Epidemiol 2019;29:8- 15. 6. Nagle SM, Stevens KA, Wilbraham SC. Wound Assessment. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482198/ 7. Fukada M. Nursing Competency: Definition, Structure and Development. Yonago Acta Med 2018;61:1-7. 8. Sürme Y, Kartın PT, Çürük GN. Knowledge and Practices of Nurses Regarding Wound Healing. J Perianesth Nurs 2018;33:471-478. 9. Dowsett C. Use of TIME to improve community nurses’ wound care knowledge and practice. Wounds UK. 2009 Sep 1;5. 10. Bandura A. Self-efficacy: Toward a unifying theory of behav- ioral change. Psychol Rev 1977;84:191–215. 11. Chuang ST, Lo SF, Liao PL, et al. Knowledge, attitude, per- ceived barriers of hard-to-healed wound care and the associa- tion with confidence: A cross-sectional study among commu- nity nurses. J Tissue Viability 2023;32:487-492. 12. Ehmke S, Swan M, Van Gelderen S, Bourdeanu L. Developing nursing students’ self-efficacy during simulated obstetric emergencies. Sci Talks 2023;5:100121. 13. Kielo-Viljamaa E, Suhonen R, Jalonen L, Stolt M. Areas of nursing competence in acute wound care: A focus group study. Collegian 2022;29:44–53. 14. Dung PT, Trang LT, Tung HH. Nurses’ Knowledge, Practice, and Confidence after the Training Program on Wound Care at the Agriculture General Hospital in Vietnam. Open J Nurs 2020;10:646–56. 15. Desta M, Tenaw M, Ayalew E. Level of Knowledge and Wound Care Practice at a Tertiary Referral Hospital in Ethiopia: A Survey in 180 Nurses [Internet]. 2020 [cited 2023 Aug 9]. Available from: https://www.researchsquare.com/arti- cle/rs-110089/v1. 16. Welsh L. Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review. Int Wound J 2018;15:53-61. 17. Mohamed E, Elmoniem AE, Zaki H, Shebl M. Effect of train- ing program on performance of nurses caring for patient with negative pressure wound therapy. IOSR-JNHS 2024;8:31-5. 18. Kielo E, Suhonen R, Ylönen M, et al. A systematic and psycho- metric review of tests measuring nurses’ wound care knowl- edge. Internat Wound J 2020;17:1209–24. 19. Yu S, Yao X, Sang Y, et al. Status of core competencies of wound, ostomy and continence nurses and their influence on career success: a cross-sectional study. BMJ Open 2022;12:e063239. 20. Gray TA, Rhodes S, Atkinson RA, et al. Opportunities for bet- ter value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community popula- tion. BMJ Open 2018;8:e019440. 21. Oh D, Choi YJ. Clinical Nurses' Continuing Education Needs in Acute Burn Care. J Contin Educ Nurs 2022;53:77-82. 22. Hong HS, Issenberg SB, Roh YS. Effects of Standardized Patient-Based Training on Surgical Nurses’ Competencies for Managing Hand Injuries. J Contin Educ Nurs 2020;51:189–96. 23. Lopez-Garrido G. Self-Efficacy: Bandura’s Theory Of Motivation In Psychology [Internet]. 2023 [cited 2023 Aug 9]. Available from: https://www.simplypsychology.org/self-effi- cacy.html. 24. Obilor HN, Omolara AB, Ani OB. A survey of nurses’ wound assessment knowledge, attitude and competence in Nigeria. Wound Practice Res 2021;29:140-7. 25. Gizaw MA, Negawo MK, Bala ET, Daba DB. Knowledge, practice, and associated factors towards postoperative wound care among nurses working in public hospitals in Ethiopia: A multicenter cross-sectional study in low resource setting area. Health Sci Rep 2022;5:e677. 26. Tegegne B, Yimam F, Yalew ZM, et al. Knowledge and Practice of Wound Care and Associated Factors among Nurses Working in South Wollo Zone Government Hospitals, Ethiopia. Chronic Wound Care Manag Res 2022; Available from: https://www.tandfonline. com/doi/abs/10.2147/ CWCMR.S366322. 27. Wilandika A. Students, Religiosity, And Self-Efficacy of HIV- Risk Behavior: A Study in a Muslim Perspective. Ponorogo: Uwais Inspirasi Indonesia; 2022. 28. Chao W-Y, Wu Y-L, Liao W-C. Psychometric Properties of the Taiwanese Pressure Ulcer Management Self-Efficacy Scale in Nursing Practice. Healthcare 2022;1:1900. 4th International Nursing and Health Sciences Symposium [page 138] [Healthcare in Low-resource Settings 2024;12(s1):13040] Online supplementary materials Table 1. Summary of articles. Non -co mmerc ial us e o nly