Journal of Advanced Nursing最新文献

Aim: Analyse the concept of expertise among practicing clinical nurses in hospital settings.

Background: The generational loss of expert clinical nurses was exacerbated globally by the novel coronavirus. This ongoing loss combined with the increased complexity of hospitalised patients has prompted an urgent need to understand expertise among clinical nurses who practice in hospital settings.

Methods: Walker and Avant's concept analysis method was used. PubMed, Medline, CINAHL and Access Medicine were searched (1982-2025) for research studies and literature reviews published in English that addressed clinical nursing expertise in hospitals.

Results: Expertise is the knowledge and skills that are enculturated from immersion in a domain. Common attributes include obtaining salient information from different sources, interpreting patient situations rapidly and holistically, and performing actions that are individualised, immediate and appear instinctive. Common antecedents include deliberate accumulation of relevant experience and contextual connections within the hospital. Facilitating improved outcomes and facilitating improved outcomes are common consequences.

Conclusion: The attributes, antecedents and consequences of clinical nursing expertise are complementary and cross specialties. Experts' apparently instinctive actions are not intuitive but rather related to relevant past experiences, pattern recognition and skilled know-how. The requirements to develop expertise have evolved with the increased volume of available knowledge.

Implications for the profession: Expertise requires cultivating relevant experiences through active engagement with patients and creating contextual connections with others regarding hospital systems and processes. Experts should be formally included when developing processes and guidelines. Low-fidelity proxy measures like years of experience should be replaced with psychometrically validated instruments to measure expertise.

Impact: This concept analysis addresses the ambiguity of clinical nursing expertise by synthesising over 40 years of literature and provides insights for clinical nurses and researchers regarding the importance of context and the growing complexity of care delivery.

Patient or public contribution: No patient or public involvement.

Aim: To examine and define the concept of moral distress among family caregivers by identifying its key attributes, antecedents and consequences.

Design: Concept analysis.

Methods: This study was guided by Walker and Avant's concept analysis framework. A comprehensive literature search was conducted to identify relevant studies, with 12 articles included in this analysis.

Data sources: PubMed, CINAHL, Scopus and PsycINFO databases were searched for articles published between February 2000 and May 2025.

Results: Three defining attributes of moral distress in family caregivers were identified: self-directed negative emotions, internal conflict and feelings of powerlessness and helplessness. Antecedents included caregiving burden, role conflict, ethical dilemmas, complex decision-making and internal and external constraints. Consequences encompassed long-term health effects, social withdrawal, burnout and moral residue. These findings led to a conceptual definition of moral distress in family caregivers.

Conclusion: Moral distress in family caregivers is a significant and underrecognised issue that affects caregiver well-being and the quality of care they provide. This concept analysis offers a clear conceptual definition, providing a foundation for developing research instruments and interventions.

Implications for the profession and/or patient care: Healthcare professionals should recognise moral distress in family caregivers as a key factor impacting both caregiver well-being and patient care. Support through education, counselling and peer groups can reduce moral distress and foster more ethical, collaborative care environments.

Impact: This study addressed the lack of clarity surrounding moral distress in family caregivers. It identified key attributes, antecedents, and consequences, and developed a clear conceptual definition. These insights will inform research, practice and policy. The findings will benefit caregivers, improve patient care and support healthcare teams.

Reporting method: This study followed Walker and Avant's framework and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in article selection.

Patient or public contribution: No patient or public involvement.

Aim: To propose a conceptual model of dignity-centred care for hospitalised older adults using Levine's Conservation Model as a theoretical framework.

Design: A discursive approach.

Methods: Data were obtained from an extensive search of five databases and grey literature without date restrictions for information on patient dignity, dignified care for hospitalised older adults and the Levine Conservation Model.

Results: Dignity is a multifaceted concept encompassing an inherent self-worth and self-worth acquired through personal accomplishments and associations. Hospitalised older adults are at risk of dignity erosion due to complex health conditions, poor healthcare professional- patient communication, inadequate health information, loss of autonomy, inadequate privacy, and infrastructural and systemic barriers. Key components of dignified care include respect, autonomy, privacy, effective symptom management, effective communication and active patient involvement in decision-making. The proposed conceptual model integrates Levine's principles of conservation into a dignity-centred care framework. This model identifies threats to dignity in hospitalised older adults and outlines practical interventions to mitigate these threats in order to maintain or restore dignity.

Conclusion: The proposed conceptual model of dignity in care for hospitalised older adults, underpinned by the Levine Conservation Model, offers a practical framework to guide healthcare professionals in providing care that upholds the dignity and well-being of older adults. The model can serve as a foundation for developing institutional policies and training programmes that reflect the multidimensional nature of dignity in care for older adults.

Impact: The study addressed both the conceptual ambiguity and skills gap surrounding dignity-centred care for older adults by offering a practical guide for integrating dignity-centred principles into routine clinical practice. The findings hold substantial relevance for healthcare practice, providing a structured, theory-informed model to advance dignity-centred care and protect the dignity of hospitalised older adults.

Patient or public contribution: Not applicable.

Aim: To examine the concept of midwifery agency when using Maternity Early Warning Tools.

Design: Concept analysis using Rogers' evolutionary method.

Methods: Data were collected from interviews with midwives working in various Australian maternity settings. A subset of the dataset was collected and analysed (2021-2022) to examine how agency functions when midwives use Maternity Early Warning Tools.

Results: Three conceptual attributes fundamental to agency were identified: considered judgement, reasoned clinical decision-making, and collaborative action. These attributes reveal how midwives navigate the interface between structured risk management tools and relational, woman-centred care.

Conclusions: Maternity Early Warning Tools can either limit or enhance professional agency. When used reflexively, they become artefacts that support learning, communication, and sound clinical judgement. Viewing these tools as enablers rather than enforcers sustains midwifery expertise and strengthens interdisciplinary collaboration.

Implications for the profession and/or patient: Sustaining midwifery agency protects both professional integrity and the quality of woman-centred care.

Impact: What problem did the study address? How the use of Maternity Early Warning Tools influences midwives' agency.

Aims: To examine factors influencing emergency nurse turnover and retention pre- and post-COVID-19 and inform planned Participatory Systems Mapping research.

Design: A scoping review of the literature reporting reasons emergency nurses leave, intend to leave or stay.

Methods: Following the Joanna Briggs Institute methodology and a pre-registered protocol, databases and grey literature were systematically searched in January 2025 (updated August 2025). Literature published after 1st January 2010, was included. Two reviewers independently screened records, and 10% of extractions were cross-checked. Data were grouped thematically on a visual coding system using the Miro platform. Pre- and post-COVID-19 sources were categorised and analysed using a two-dimensional framework of intensity and frequency.

Data sources: MedLine, CINAHL, PsycINFO, Web of Science, Cochrane and grey literature.

Results: Ninety-three sources were included. Burnout, workload, staffing and workplace violence (WPV) were linked across study designs to turnover, while job satisfaction, supportive leadership and team cohesion appeared to support retention. Problem-focused and resilience-based coping were associated with retention across study designs (n = 5); emotion-focused strategies were linked with poorer outcomes (n = 3). In a subset of 86 sources, traditional protective factors (leadership support and team camaraderie) appeared weakened post-COVID-19. A novel theme of moral obligation to remain, despite personal risk, emerged. Adaptive coping gave way to downshifting and emotional suppression.

Conclusion: The included evidence indicates that multiple, interacting factors shape emergency nurse turnover and retention, whilst systemic strategies aligning operational demands with psychological safety and core nursing values may contribute to sustainable retention.

Implications for the profession: Workforce interventions should address the psychological legacy of COVID-19 and focus on rebuilding trust, flexibility and moral sustainability in emergency departments.

Impact: While individual drivers of turnover are known, their complex interplay and retention factors are underexplored. This review identifies themes transcending boundaries and recurring across the turnover pathway, underscoring the need for multi-level interventions relevant to both nurse managers and policy makers.

Reporting method: Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR).

Patient or public contribution: This study did not include patient or public involvement in its design, conduct or reporting.