# Situation: The nurse at a Rural Health Unit (RHU) holds a monthly class on breastfeeding and infant feeding for pregnant women and mothers of young infants. A first-time mother says, "I know breast milk is best, but I just can't get my baby to latch right." She has already watched other mothers breastfeed in the class, and she tenses up whenever her baby cries. According to Social Cognitive Theory, which strategy will MOST strongly build her self-efficacy?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627292  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The nurse at a Rural Health Unit (RHU) holds a monthly class on breastfeeding and infant feeding for pregnant women and mothers of young infants.

A first-time mother says, "I know breast milk is best, but I just can't get my baby to latch right." She has already watched other mothers breastfeed in the class, and she tenses up whenever her baby cries. According to Social Cognitive Theory, which strategy will MOST strongly build her self-efficacy?

## 보기

1. Show her a video of another mother latching her baby with ease
2. Teach her slow breathing to help her relax before each feed
3. Tell her warmly that most mothers learn to breastfeed with time
4. Coach her as she latches her own baby until she succeeds **✔ 정답**

**정답: 4**

## 해설

Self-efficacy is built by mastery experience, vicarious experience (modeling), verbal persuasion, and physiological and emotional states. Each option uses one of these sources, but mastery, succeeding at the behavior herself, is the strongest. She has already had vicarious experience without gaining confidence, and relaxation helps but gives her no proof that she can latch her baby; hands-on coaching until she succeeds does.

## 심화 해설

The question asks which strategy most strongly builds self-efficacy according to Social Cognitive Theory. Self-efficacy refers to a person’s belief in their own ability to succeed in a specific behavior—here, achieving a proper latch during breastfeeding. Bandura’s framework identifies four main sources of self-efficacy: enactive mastery experience, vicarious experience, verbal persuasion, and physiological/emotional states. Among these, enactive mastery experience—actually performing the behavior successfully—is consistently the most powerful source [1].

In this scenario, the mother has already observed other mothers breastfeed in the class. That is vicarious experience, or modeling. She has seen the behavior performed, but watching others has not translated into confidence in her own ability. This is an important clinical cue: when vicarious experience alone does not raise self-efficacy, the nurse should move toward a more direct, performance-based strategy [1]. Observing a role model can help, but it is weaker than personal success because it does not provide direct evidence that the learner herself can perform the task.

Option 2, teaching slow breathing, addresses the physiological and emotional state domain. Reducing tension before a feed is useful because high anxiety can lower perceived self-efficacy and interfere with the let-down reflex. However, relaxation alone gives the mother no proof that she can actually latch her baby. It may make her feel calmer, but it does not create a success experience. In the Breastfeeding Self-Efficacy framework, physiological states such as fatigue, stress, and anxiety are considered secondary influences compared with mastery [1][3].

Option 3, warm reassurance that most mothers learn with time, is a form of verbal persuasion. Encouragement from a trusted provider can modestly raise self-efficacy, especially when it is specific and credible. But generic reassurance is the weakest source because it is not tied to the mother’s own performance. Research on breastfeeding self-efficacy shows that praise from partners or mothers can have a positive influence, yet it remains less potent than direct successful experience [1].

Option 4, coaching the mother as she latches her own baby until she succeeds, is the correct choice. This is enactive mastery experience—the mother performs the behavior herself and achieves a successful outcome. Mastery experience is the strongest builder of self-efficacy because it gives the learner direct, personal evidence of capability. The hands-on coaching provides real-time feedback and allows the mother to adjust her technique until the latch works, which creates a success memory she can draw on in future feeds. A systematic review and meta-analysis of educational interventions for breastfeeding self-efficacy supports that interventions emphasizing practical, performance-based components are effective in improving maternal confidence . Similarly, observational studies using the Breastfeeding Self-Efficacy framework show that higher self-efficacy predicts longer breastfeeding duration, underscoring the clinical importance of building confidence through actual successful experiences [3].

The key contrast among the options is shown in the table below.

| Source of self-efficacy | Example in this scenario | Relative strength |
| --- | --- | --- |
| Enactive mastery experience | Coaching the mother until she latches her own baby successfully | Strongest—direct personal success |
| Vicarious experience | Watching other mothers breastfeed or a video of successful latching | Moderate—depends on perceived similarity of the model |
| Verbal persuasion | Telling her that most mothers learn with time | Weak—not tied to her own performance |
| Physiological/emotional state | Teaching slow breathing to relax before each feed | Supportive—reduces anxiety but provides no proof of skill |

Key point! The mother has already received vicarious experience by watching others in the class, yet her self-efficacy remains low. Therefore, the nurse must escalate to the strongest source—mastery experience—by guiding her through a successful latch herself.

Watch out! Do not confuse reducing anxiety with building skill. Relaxation techniques may improve the emotional state, but they do not produce the performance success that mastery experience provides. In test questions, when a client has already tried observation or received encouragement without improvement, the correct answer is usually the option that lets the client perform the behavior successfully with support.References (research sources)

- [1]Exploring breast-feeding self-efficacy.Research articleKingston D, Dennis CL, Sword W (2007) · DOI: 10.1097/01.JPN.0000285810.13527.a7

- [3]Breastfeeding Duration and the Theory of Planned Behavior and Breastfeeding Self-Efficacy Framework: A Systematic Review of Observational Studies.Meta-analysis/systematic reviewLau CYK, Lok KYW, Tarrant M (2018) · DOI: 10.1007/s10995-018-2453-x

## 임상 시나리오

Building Self-Efficacy in Patient EducationApplying Social Cognitive Theory to Clinical Coaching
According to Social Cognitive Theory, the strongest source of self-efficacy is mastery experience—the learner successfully performing the behavior herself. In breastfeeding support, this means hands-on coaching until the mother achieves a proper latch.

The four sources of self-efficacy are mastery experience, vicarious experience, verbal persuasion, and physiological/emotional states. When a learner has already observed others without gaining confidence, the nurse should move toward performance-based strategies rather than repeating modeling alone.

CautionDo not rely on verbal reassurance or relaxation techniques as primary interventions when a patient lacks confidence in a skill. These may reduce anxiety but do not provide direct evidence of competence. Prioritize guided practice with feedback until the patient succeeds.

## 핵심 개념

- **Self-efficacy** — A person's belief in their own ability to succeed in a specific behavior or task.
- **Mastery experience** — Successfully performing a behavior oneself; the strongest source of self-efficacy according to Bandura.
- **Vicarious experience** — Observing others perform a behavior successfully; also called modeling.
- **Verbal persuasion** — Encouragement or feedback from others that one can succeed.
- **Physiological and emotional states** — Internal cues such as anxiety or relaxation that influence perceived self-efficacy.

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