Cognitive factors in the explanation of the mismatch between confidence and competence in performing basic life support

Abstract

The main approach to rectifying the well documented poor basic life support (BLS) skills of doctors and nurses, based on a Skills Model, has met with only partial success. This study compares the utility of a Skills Model with one that incorporates a cognitive component in predicting BLS skills. Outcome-expectancy, self-efficacy, training and experience of BLS, and BLS ability were assessed in 53 trained nurses. Ability was unrelated to training or experience of BLS. Nurses who scored highest on the BLS skills assessment perceived the procedure as significantly more successful than those with lower scores. Self-efficacy was unrelated to ability, but was related to status: senior nurses were significantly more confident but no more competent in performing BLS than junior nurses. Nurses who had attended more arrests, while more confident, were no more competent than those who had attended fewer. Assessment of BLS skills reduced self-efficacy beliefs. A model for predicting the relationship between self-assessed ability and objectively assessed skill is outlined.