Association Between Self-Efficacy and Knowledge, Attitudes, and Practices Regarding pulmonary rehabilitation Among Clinical Nurses: A Cross-Sectional Study

Chronic Obstructive Pulmonary Disease, or COPD, is a condition that makes breathing increasingly difficult, affecting millions of people worldwide. For those living with moderate to severe cases, doctors recommend a standard treatment called pulmonary rehabilitation. This is not a single pill or a quick procedure, but a comprehensive program that combines education, exercise training, and behavioral changes to help patients manage their symptoms and improve their daily lives. While medical evidence strongly supports this approach, it remains surprisingly underused. A major reason for this gap is that the healthcare professionals who are supposed to guide patients often lack the necessary knowledge, confidence, or resources to refer them to these programs effectively.

In this context, nurses play a critical role. They are often the first line of contact for patients, responsible for assessing needs, offering education, and managing symptoms. However, their ability to facilitate rehabilitation depends heavily on what they know, how they feel about the treatment, and what they actually do in their daily work. Researchers also suspect that a nurse's belief in their own ability to succeed—known as self-efficacy—might be a powerful driver of these actions. If a nurse feels confident in their skills, they are more likely to engage with the complex tasks required to help a patient recover. A recent study set out to explore exactly how this confidence connects to the knowledge, attitudes, and practices of clinical nurses regarding pulmonary rehabilitation.

The researchers conducted a survey involving 679 nurses working in public hospitals. They asked these professionals to fill out questionnaires that measured three specific areas: their knowledge of pulmonary rehabilitation, their attitudes toward it, and their actual practices in recommending or supporting it. Alongside these questions, the nurses also answered a set of questions designed to gauge their self-efficacy, or their confidence in their ability to encourage patients to participate in rehabilitation programs. The study aimed to see if there was a clear link between how confident a nurse felt and how well they performed in the other three areas.

The results painted a clear picture of the current landscape. On average, the nurses in the study had a moderate level of knowledge, attitudes, and practices, but there was significant room for improvement. A striking finding was that only about 22 percent of the nurses had received any specific training on pulmonary rehabilitation. Those who had received this training scored significantly higher on the knowledge and practice scales than those who had not. This suggests that formal education is a key factor in building competence. Furthermore, the nurses' job location mattered; those working in internal medicine departments tended to have better scores than their colleagues in surgery, intensive care units, or other departments, likely because they encounter COPD patients more frequently in their daily rounds.

The most significant discovery of the study, however, centered on the power of confidence. The data showed a strong, positive connection between a nurse's self-efficacy and their overall performance in knowledge, attitudes, and practices. Even after the researchers accounted for other factors like age, gender, years of experience, and whether the nurse was a head of a department, the link remained. In simple terms, for every small increase in a nurse's confidence score, their overall score for knowledge, attitude, and practice also went up. This relationship held true regardless of the nurse's background or job title. It suggests that a nurse who believes they can successfully help a patient is more likely to know the right things to do, feel positive about the process, and actually take the steps to help.

Interestingly, the study also uncovered a counterintuitive detail regarding how nurses judged their own knowledge. When nurses were asked to rate their own understanding of pulmonary rehabilitation, those who claimed to have a "good" or "full" understanding actually scored lower on the objective tests than those who admitted to knowing less. This phenomenon, where people with limited knowledge overestimate their competence, highlights the danger of relying solely on self-assessment. It implies that a nurse might feel they know enough to help a patient, but in reality, they may be missing crucial information. This finding underscores the need for objective testing and targeted training rather than assuming that experience alone guarantees expertise.

The study also noted that nurses in leadership roles, such as head nurses, tended to have higher scores than staff nurses. This is likely because leaders have more opportunities to attend seminars, access new research, and stay updated on best practices. Meanwhile, the vast majority of nurses in the study were not clinical teachers and worked in tertiary hospitals, yet the gap in training remained wide. The researchers concluded that while many factors influence a nurse's ability to support pulmonary rehabilitation, self-efficacy stands out as a key independent factor.

Ultimately, this research points to a straightforward path forward. To improve care for patients with COPD, hospitals and medical administrators should focus on two main strategies: providing widespread, accessible training programs and finding ways to boost nurses' confidence in their abilities. By combining education with interventions that build self-efficacy, the medical community can empower nurses to become more effective advocates for pulmonary rehabilitation. This, in turn, could lead to better health outcomes for the millions of people living with chronic lung disease, ensuring they receive the standard of care they need and deserve.