Self-efficacy of direct care workers providing care to older people in residential aged care settings: a scoping review protocol

Self-efficacy in caring refers to care workers’ beliefs or confidence in their ability to express caring behaviors and attitudes and to build compassionate relationships with their clients [1]. Confidence is an essential element to enhance competence to care and job satisfaction of care workers, as well as their perception towards managerial and practical aspects of care [1‐3]. The stronger the individual’s confidence, the more active the efforts of an individual to perform a specific behavior or skill [4, 5]. Manojlovich [6] found a greater influence of self-efficacy of care workers in their job performance than the support services of an organization, such as information, resources, and opportunities. While increased self-efficacy in caring may improve care workers’ performance, low self-efficacy may adversely affect how these care workers carry out their duties [3, 6]. It is, therefore, essential to understand the self-efficacy of care workers and discuss factors that may influence their efficacy to demonstrate caring behaviors.

According to the Social Cognitive Theory, an individual’s interaction with the physical and social environment determines the self-efficacy of that person [7]. Human functioning is a product of the interaction of intrapersonal influences, the behavior one engages in, and the environment they grow and live in [5, 7]. Bandura [7] stressed that the self-efficacy of a person differs depending upon the individual’s physiological state, experiences, social relationships, and other circumstances he/she is living or working in. Therefore, the self-efficacy of care workers can vary according to the nature of their work and the clients they are caring for.

Characteristics of acute care hospitals and aged care facilities are very different [8]. In hospital settings, the aim of care workers or nursing staff is to care for patients suffering from acute health conditions or chronic health conditions with acute manifestations. Patients are expected to return to their place of residence following treatment. However, aged care services are provided to older people who are unable to live independently without assistance because of frailty and other age-related conditions [9]. The high level of dependency on the care provider, accompanied by increasingly deteriorating health conditions with complex and multiple diseases or disorders, makes older people a unique group of care recipients. Nursing care needs presented by older people in aged care is, therefore, often challenging and multidimensional, including physical, psychological, and social dimensions [8]. Hence, it is imperative to comprehend the self-efficacy of aged care workers and factors that may affect their confidence to care.

A qualitative study by Coates and Fossey found increased dilemma among care workers in the process of caregiving due to the lack of confidence in their role [10]. A study in Canadian long-term care home found a high level of perceived self-efficacy to provide palliative care among the care workers though there was a knowledge gap on palliative care [11]. Factors such as the age of the care worker, formal education, experience, and psychological empowerment were found to influence the confidence in delivering palliative care [12]. Studies by Caspar et al. have shown that perceived ability to provide care among care workers is influenced by their self-determination, quality of relationship with their immediate supervisors, educational opportunities, and recognition of the performance [13, 14]. Similarly, an intervention study found an increase in staff confidence in seeking support from their supervisors and dealing with end of life care symptoms after receiving training on compassion, communication, end of life symptoms, and care [15]. However, it did not find any improvement in staff’s belief in their ability to discuss death and dying with residents and their relatives post-training. Dementia training and peer support programs were found to enhance the self-efficacy of the care workers to care for the people living with dementia [16‐18].

To understand the caring self-efficacy of aged care workers in general, we performed a literature search using broad search terms. However, we did not find any review article, which indicated a dearth of evidence synthesis in this area. Similarly, our preliminary search of the literature found that studies have utilized various instruments to measure self-efficacy, and interventions to address the self-efficacy of care workers are also not similar. Hence, a scoping review is planned to give an understanding of the self-efficacy of care workers in caring for older residents in residential aged care settings and identify factors that may influence care workers’ self-efficacy in caring.

This protocol complies with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015) [19] (see Additional file 1) and is guided by the Joanna Briggs Institute (JBI) Reviewer’s Manual for Scoping Review [20]. The review has been registered in the JBI Systematic Review Register with the title “A scoping review of factors influencing caring efficacy of direct care workers providing care to older people”. This proposed review will comply with the “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)” checklist to facilitate complete and transparent reporting of results [21].

A significant proportion of older people are receiving residential aged care in developed countries, and the number is increasing [9]. Quality of care to this population should be an important concern to their family members and aged care providers. Self-efficacy in caring has been identified as one of the factors that determine caring behaviors of care workers to their clients and eventually the quality of care [3, 6]. Identifying factors that influence the self-efficacy of aged care workers in caring could be a critical step in providing quality care to older people receiving aged care.

This scoping review aims to give an overview of the caring self-efficacy of aged care workers and identify factors that influence the caring efficacy of aged care workers. The inclusion of studies for this review will not be limited by the date of publication, source, or design of the study. Inclusion of grey literature as well as further search of the potential studies from the reference list of relevant studies will increase the comprehensiveness of this review. However, consideration of studies written in English only may limit the potential to understand self-efficacy of care workers from all parts of the world. Overall, the acquired result will provide documented evidence to policymakers and aged care providers to understand the self-efficacy of direct care workers in caring for older people and aid in identifying potential ways of enhancing their self-efficacy to improve their caring behaviors towards older residents living in residential aged care settings.