A Concept Analysis of Expertise Associated With Practicing Clinical Nurses in Hospital Settings

Journal of Advanced Nursing · 2026-01-03

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.

N-UNRAQ: Psychometric testing of the modified nursing Users’ Needs, Requirements, and Abilities Questionnaire for care robots in long-term care

Digital Health · 2026-02-01

Introduction: As care robots become increasingly common in long-term care (LTC), understanding the perceptions of those who provide patient care is critical to ensure technology aligns with workforce needs and enhances care. Methods: This cross-sectional study aimed to modify the Users' Needs, Requirements, and Abilities Questionnaire (UNRAQ) for LTC nursing staff in the United States and conduct initial psychometric testing. The modified instrument (N-UNRAQ) expands the original assistive role and social aspects domains into three subdomains (facility, staff, robot) and adds three LTC-specific assistive tasks (transferring/lifting, administering medications, and assisting with activities of daily living). Electronic surveys were distributed to nursing staff across a random sample of LTC facilities in Central Texas. Results: Responses from 122 staff across 28 LTC facilities were analyzed to assess reliability and validity. Results demonstrated excellent internal consistency across domains and the full questionnaire, with partial support for construct validity. Findings suggest that technological experience, rather than prior robot familiarity, influenced perceptions. Limited response variability in facility and staff domains suggested a ceiling effect that may constrain discrimination. Participants rated assistive and social tasks as important to their roles and facilities but expressed neutral attitudes toward robots performing them. Environmental monitoring and reminders were rated most favorably, while physical assistance tasks were rated less positively, suggesting staff are more comfortable with indirect rather than hands-on robot support. Conclusions: The N-UNRAQ offers a reliable tool for assessing nursing staff perceptions of care robots. Future work should refine the instrument and validate it across broader contexts.

Assessing Daily Antihypertensive Medication Compliance Among Black Adults Using Smartphone-Based Ecological Momentary Assessment

CIN Computers Informatics Nursing · 2025-07-30

Lower compliance to antihypertensive medication among the Black population, the gold standard for hypertension management, increases their risk of uncontrolled hypertension and serious health complications. One effective strategy for improving compliance with hypertension self-management involves real-time assessment of behavior using ecological momentary assessment in a person's natural environment. This allows for the determination of self-management behavioral patterns such as medication compliance, as well as overcoming the limitations of recall bias common in retrospective cross-sectional data. In the few ecological momentary assessment studies focused on hypertension self-management, individuals of Black descent are significantly underrepresented. We aimed to assess the feasibility and acceptability of smartphone-based ecological momentary assessment among Black adults with hypertension (n = 34), in the context of compliance to antihypertensives. Of the 952 assessment prompts delivered to participants' smartphones, participants responded to 918 (96.4%). Daily medication compliance was high among participants-25 days out of 28 (M = 24.71, SD = 6.79). Participants indicated they had a good experience with the assessment method and their intention to participate in future studies of this method. Our study demonstrated that a digitized smartphone-based ecological momentary assessment is a promising, feasible, and acceptable approach for assessing hypertension self-management behavior among Black adults.

Promoting Problem-Solving Among Low-Income Adults with Type 2 Diabetes: A Cluster-Randomized Controlled Trial of Mobile Diabetes Detective, an mHealth Intervention with Text Messaging (Preprint)

Journal of Medical Internet Research · 2025-08-12

Promoting Problem-Solving Among Low-Income Adults with Type 2 Diabetes: A Cluster-Randomized Trial of Mobile Diabetes Detective (Preprint)

2025-08-12

<sec> <title>BACKGROUND</title> Problem-solving skills are essential to the successful management of type 2 diabetes but challenging to develop for low-resource medically underserved individuals. mHealth interventions have shown positive impact on diabetes management but few focus specifically on problem-solving. </sec> <sec> <title>OBJECTIVE</title> To evaluate the efficacy of an mHealth intervention, Mobile Diabetes Detective (MoDD), for facilitating problem-solving and self-care among underserved adults with type 2 diabetes. </sec> <sec> <title>METHODS</title> This cluster-randomized non-blinded clinical trial included 219 participants with type 2 diabetes (HbA1c &gt; 7.5%) from 8 Federally Qualified Health Centers that serve low-resource communities. The intervention arm (n=111) used MoDD for 4 weeks and up to 1 year. The control arm (n=108) received standard diabetes education and usual care. The primary hypotheses were improvement in HbA1c, diabetes problem-solving abilities, and diabetes self-care behaviors from baseline to 4 weeks, 3 months, and 12 months. Secondary hypotheses were improvement in diabetes self-efficacy and diabetes distress. Data were analyzed for both within group change and between group differences at each study milestone. </sec> <sec> <title>RESULTS</title> Participants (n=219) were predominantly female (67%), ethnically and racially diverse (51% Hispanic, 42% African American), with mean glycated hemoglobin HbA1c=9.9% at baseline. There was no change in HbA1c at 4 weeks in either arm; both arms reduced HbA1c from baseline to 3 months (intervention: -0.58% (p=0.005); control: -1.03% (p&lt;0.001)); only the intervention arm reduced HbA1c from baseline to 12 months (intervention: -0.45% (p=0.01); control: -0.37% (p=0.047). There was no improvement in diabetes problem-solving, and mixed results in diabetes self-care behaviors. Both arms improved diabetes self-efficacy at 3 and 12 months; the intervention arm reported increase in diabetes distress at 3 and 12 months. The only difference in outcomes between study arms was in following a diabetes-specific diet at 12 months with the control arm reporting higher adherence (intervention: 4.48, control: 5.17, p=0.004). </sec> <sec> <title>CONCLUSIONS</title> All participants improved blood glucose management at 3 months but only the intervention arm sustained improvement over time; there was no change in diabetes problem solving abilities. These findings suggest potential benefits of using mHealth interventions for underserved individuals with type 2 diabetes and the need for further research on improving problem-solving with mHealth. </sec> <sec> <title>CLINICALTRIAL</title> NCT02021591 </sec>

Racially Equitable Homeless Services: Exploring Organizational Characteristics

Community Health Equity Research & Policy · 2025-02-20

Purpose Racial disparities in homelessness are pervasive and necessitate sustained effort on improving racial equity in homeless services. This study used a community-engaged approach and qualitative methods to describe the role of informal organizations identified by Black adults with lived experience of homelessness as preferred locations for accessing services and to explore the values and beliefs of these informal organizations. The study included representatives ( N = 19) of community organizations ( N = 17) in one southern city. Most participants ( n = 14, 73.6%) worked in paid positions and included executive directors as well as volunteers. Findings Thematic analysis identified three themes that characterized values and the ways in which these organizations interface with one another and with the formal homelessness response system (HRS): boots-on-the-ground, the homelessness response system is inequitable, and cautious collaboration. Findings reveal avenues through which local collaboration can be improved and potential policies to improve racial equity in homeless services. Conclusions Informal organizations fill critical gaps in services and can reach people experiencing homelessness who are unable or unwilling to access formal services. However, informal organizations often remain disconnected from the larger HRS which can exacerbate racial inequities. Community care hubs are a promising solution to incorporating smaller organizations and building a more integrated and equitable HRS.

Developing Psychosocial Phenotypes to Understand Engagement with Digital Health Technologies for Heart Failure

npj Digital Medicine · 2025-12-04

Digital health technologies (DHTs) such as wearables, smartphones, and connected devices have immense potential for supporting self-care in chronic disease management, yet engagement remains highly variable and is often measured by usage metrics alone. Guided by the AIM-ACT framework, this mixed-methods study examined how psychosocial and contextual factors shape DHT engagement among 146 adults with heart failure who completed a 6-month digital intervention involving multiple devices (ClinicalTrials.gov ID NCT05056129). Using k-medoids clustering of survey, ecological momentary assessment, and device-log data, we identified three distinct psychosocial phenotypes-Challenged Survivors, Activated Learners, Engaged Self-Regulators-reflecting differences in motivation, psychosocial resources, and interaction with DHTs. Qualitative interviews with 26 participants contextualized these phenotypes and revealed mechanisms linking psychosocial traits to DHT engagement quality. Findings underscore the value of psychosocial phenotyping for understanding heterogeneity in DHT engagement to inform the design of adaptive and equitable digital interventions that remain effective as they scale across diverse populations.

Author response for "A Concept Analysis of Expertise Associated with Practicing Clinical Nurses in Hospital Settings"

2025-10-11

System and policy challenges for adults with intellectual disability disorder who are experiencing homelessness

Health Services Research · 2025-04-01

Objective: To generate qualitative insights from, and with, patients, families, and community members about how to create a more integrated medical-social care system.Methods: We used qualitative human-centered design (HCD) methods.The research team, inclusive of four peer researchers trained in HCD, co-designed an interview guide assessing beliefs and attitudes toward the intersection of health care, human services, and communities.Interviews were conducted in English or Spanish, recorded, transcribed, and reviewed by experts in HCD, peer researchers, and pediatric clinicians.This multidisciplinary team then identified themes and intervention opportunities.Results: Peer researchers conducted 19 interviews, 14 in English and 5 in Spanish.Interviewees included previous patients, and patients' parents or grandparents, at Cincinnati Children's.Most identified as Black or Hispanic/Latino and lived in structurally-disadvantaged Cincinnati neighborhoods.Themes related to structural factors included: (1) difficulty navigating medical and social services; (2) need for more proactive medical and social care; and (3) poorly integrated medical and social care.Themes related to human factors included: (1) untrustworthiness of care institutions; (2) diversified care teams improve care delivery; and (3) optimal care requires empathy, clear communication, and partnership.Identified intervention opportunities across themes included: (1) proactive inclusion of community health workers or navigators in clinical settings; (2) "opt out" policies to destigmatize use of social care resources;(3) inviting community partners into waiting rooms to engage with patients and families; and (4) enhancing diversity in care teams. Conclusion:Collaboration with community partners and families is necessary for the development of concrete interventions capable of addressing systemic inequities.Incorporating social services into medical care plans could help overcome barriers and achieve better outcomes.

Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis

Western Journal of Nursing Research · 2024-08-19 · 1 citations

BACKGROUND: Qualitative studies have examined the experiences of subjective cognitive dysfunction in specific populations or specific disease stages, but there has not yet been a systematic synthesis and evaluation of findings related to perceptions of subjective cognitive dysfunction in nondementia-related chronic illnesses. OBJECTIVE: The aim of this study was 2-fold: (1) to undertake a systematic review of experiences of subjective cognitive dysfunction in people with nondementia-related chronic disease and (2) to develop an explanatory framework to describe the experiences of living with subjective cognitive dysfunction. METHODS: Four databases were systematically searched for studies on subjective cognitive dysfunction up to June 2023. Qualitative synthesis was conducted on the final sample (N = 25) using Sandelowski's adaptation of Nobilt and Hare's reciprocal transactional analysis method. Critical appraisal was completed using the Critical Appraisal Skills Programme checklist. RESULTS: Through constant comparison of key concepts, findings were organized within 4 interrelated themes that informed a conceptual explanatory model of adapting to living with subjective cognitive dysfunction: (1) symptoms, (2) health care, (3) perceptions of self, and (4) relationships. Participants highlighted how subjective cognitive dysfunction affected interactions in health care settings and involved other symptoms that in turn complicated meaning, self-enhancement, and mastery. CONCLUSIONS: Our model of the process of adapting provides a new way to conceptualize cognitive dysfunction in chronic illness and suggests opportunities for health care professionals to support patients and their families. The results highlight the need for more research to better understand the role of subjective cognitive dysfunction in nondementia-related chronic illnesses.The review protocol was registered in PROSPERO (CRD42021231410).