The cognitive work of acute care nurses: A hybrid model concept analysis

Nurses have long struggled to articulate the nature of their work, especially their mental work, which is complex, hidden, and intangible. The concept "cognitive work" describes the mental labor that nurses perform. Although nurses' cognitive work is consequential to patient safety and care quality, it has lacked formal conceptual analysis. Therefore, the purpose of this study was to clarify the essential attributes and measurement of cognitive work among nurses in acute care settings.

A concept analysis was conducted in adherence to the Schwartz-Barcott and Kim hybrid methodology. This study was preregistered on Open Science Framework in April 2024 (https://osf.io/fgj4w). Literature published between 2001-2024 was systematically collected from three online databases. Article screening and data extraction were conducted in Covidence using a standardized extraction tool. A total of 23 articles met inclusion criteria. During the fieldwork phase, eight observations were conducted on a critical care unit in a large, academic medical center. Data were collected using field notes and a structured qualitative data collection tool. Theoretical and fieldwork analyses included the use of inductive and deductive codes, which were clustered into emergent categories. In the final analysis phase, all findings were integrated into a final conceptual definition.

Nursing cognitive work is a concept that is rising in use across interdisciplinary scholarship. Nurses' cognitive work is shaped and constrained by personal, environmental, organizational, and technological factors, and encompasses thinking across multiple dimensions to support clinical work, care orchestration, and relational work. Results highlight the breadth and complexity of nurses' cognitive work, which includes absorbing and interpreting information, reasoning and forming clinical judgements, managing attention and multiple demands, problem-solving, prospective thinking, and accumulating knowledge over time.

Nursing cognitive work arises from nurses' existing knowledge, available information, and cognitive capacity. It is characterized by complex, nonlinear, dynamic, and multidimensional cognitive processes. Cognitive work has consequences for the development of nursing knowledge and expertise, nurses' mental strain and emotional exhaustion, and nurses' ability to provide safe, high-quality, efficient care, and support a positive working environment. The concept "cognitive work" is well-suited to reflect the breadth and complexity of nurse thinking, and it can be formally analyzed using a variety of measurement approaches. This definition may support future advances in nursing theory, research, and practice.