Evaluation of self-efficacy of nurses in symptom management practices: a systematic review of psychometric properties

BACKGROUND: Self-efficacy of nurses in symptom management plays a critical role in the quality of patient care. Although several instruments have been developed to assess this construct, their psychometric properties have not been systematically evaluated. This systematic review aims to support the selection and application of reliable and valid instruments that can be used to identify and evaluate the self-efficacy of nurses in symptom management. METHODS: The systematic review of measurement characteristics is conducted in accordance with the COSMIN guidelines. A comprehensive literature search was conducted in EMBASE, PubMed, Web of Science, CINAHL and PsycINFO databases for relevant studies published before January 1, 2025. The psychometric properties of the identified PROMs were appraised against the COSMIN standards and the evidence was synthesized with a modified GRADE approach. RESULTS: This analysis included 38 studies, each of which reported unique patient-reported outcome measures (PROMs). The participants were predominantly nurses and nursing students. The included studies generally lacked comprehensive psychometric property assessments, with content validity, structural validity and internal consistency being the most frequently evaluated characteristics. Insufficient evaluation of cross-cultural validity, measurement error and responsiveness meant that these PROMs could not be generalised. The results of the psychometric property assessments and overall ratings of the included PROMs varied considerably. Ultimately, six instruments were rated as recommended for use, indicating widespread methodological limitations of the remaining PROMs. CONCLUSIONS: This review recommends six of 38 self-efficacy scales for nurses’ symptom management, though most tools exhibited weak content validity. Future work should improve item evaluation in both target population and experts, and further assess cross-cultural validity of recommended scales. TRIAL REGISTRATION: PROSPERO (CRD42025641768). CLINICAL TRIAL NUMBER: Not applicable.