Demand-Matched Self-Efficacy and Perceived User Incivility in Healthcare: A Two-Wave Study and an Exploratory Training Intervention.

AIM(S): To examine which of three functionally distinct, demand-relevant self-efficacy beliefs showed the most consistent prospective association with baseline-adjusted changes in perceived user (i.e., patients, relatives and visitors) incivility, psychosomatic symptoms and job satisfaction among healthcare workers, and whether a targeted training programme can strengthen this resource in acute nursing settings.

designTwo linked studies: Study 1 used a two-wave change-over-time design, and Study 2 used an exploratory pre-post intervention design.

methodsIn Study 1, 74 healthcare workers completed measures at two time points over three months. Standardised residualised change analyses examined whether three baseline self-efficacy beliefs differing in their level of specificity and primary capability domain-self-efficacy in managing challenging user behaviour, regulatory emotional self-efficacy in managing negative emotions at work (RESE-W) and trauma-related coping self-efficacy (CSE)-predicted changes in perceived user incivility, psychosomatic symptoms and job satisfaction. In Study 2, 22 nurses from acute units participated in a unit-tailored training programme grounded in social cognitive theory. Pre-post analyses assessed changes in self-efficacy for managing challenging user behaviour and related communication competencies.

resultsIn Study 1, higher baseline self-efficacy in managing challenging user behaviour predicted more favourable changes in perceived user incivility, psychosomatic symptoms and job satisfaction. In contrast, CSE was associated only with psychosomatic symptoms, while RESE-W showed no significant associations. In Study 2, self-efficacy in managing challenging user behaviour showed a significant immediate pre-post increase following the intervention.

conclusionAmong the self-efficacy beliefs examined, self-efficacy in managing challenging user interactions showed the most consistent predictive pattern across the three outcomes. Preliminary findings indicate a short-term increase in this psychological resource following brief, context-sensitive training. IMPLICATIONS FOR NURSING MANAGEMENT: Assessing and supporting interaction-focused self-efficacy may complement broader organisational strategies for managing user incivility. Controlled studies are needed to determine whether targeted training produces durable improvements in occupational well-being or care quality and whether it can be scaled across settings. REPORTING

methodStudy 1 adhered to the STROBE guidelines; Study 2 adhered to the TREND and TIDieR guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.