Title : Exploring capability related self-efficacy among nurse practitioners in Taiwan: A phenomenological study
Abstract:
Aims: The scope of nurse practitioners’ (NPs) practice has evolved from demonstrating competence—the performance of defined clinical tasks to achieving capability, which involves exercising professional judgment, adaptability, and autonomy in complex and unpredictable healthcare situations. Within Taiwan’s distinct regulatory and cultural framework, NPs make substantial contributions to medical interventions but remain legally restricted from independently diagnosing or prescribing, necessitating close collaboration with physicians. Guided by Bandura’s self-efficacy theory, which posits that individuals’ beliefs in their ability to perform tasks influence their confidence and actual performance, this study explores how NPs develop capability-related self- efficacy within this constrained practice environment.
Methods: Data were collected through online focus groups guided by semi-structured interview protocols over a seven-month period beginning in January 2025. A purposive sampling strategy was employed to recruit certified frontline clinical NPs working in hospital settings, while those in family, anesthesia, or administrative roles were excluded to maintain sample specificity. Carney’s data analysis approach, implemented using NVivo software, ensured analytical rigor, consistency, and transparency throughout the coding and interpretation process. Ethical approval was obtained from the relevant institutional review board, and all participants provided informed consent before participation.
Results: A total of 30 NPs from hospitals of varying levels and specialties participated in the study. Among them, 80% held a bachelor’s degree, while 20% possessed a master’s or doctoral degree, with an average of 10.2 years of clinical experience. Through thematic analysis, four major themes and eight subthemes were identified:
1. Capability Exceeds Competency Mastery of Practice and External Validation; Impact of Clinical Errors and Frustration.
2. Role Model-Guided Growth Skill Acquisition and Behavioral Modeling; Peer Knowledge Transfer and Experience Sharing.
3. Linguistic Interaction and Competence Verification Clarification of Decision-Maker Trust and Responsibilities; Impact of Negative Evaluation and Role Conflict on Confidence.
4. Self-Interpretation of Stress and Emotional Responses Calm Response and Decisive Action in Crises; Anxiety Reactions and Self-Doubt in High- Pressure Situations.
Conclusions: This study demonstrates that NPs develop capability related self-efficacy through clinical experience and emotional regulation, which in turn strengthens their professional confidence and clinical effectiveness. These findings underscore the need to integrate reflective learning, mentorship, and emotional competence training into NP education to foster adaptive capability in complex clinical environments. Healthcare institutions should establish supportive structures, such as peer learning and feedback systems, to promote professional growth. Meanwhile, policy reforms should expand the scope of practice for NPs, recognizing their demonstrated capabilities. Collectively, these implications highlight the importance of aligning education, practice, and policy to enhance the autonomy, quality, and sustainability of advanced nursing practice.
