Nursing Team Cohesion: A Concept Analysis Using Walker and Avant’s Method

Abstract

Nursing team cohesion is increasingly recognized as a critical determinant of communication quality, collaborative decision-making, staff well-being, and patient safety; however, the concept remains insufficiently defined and is often conflated with related constructs, including teamwork, collaboration, and psychological safety. This concept analysis aimed to clarify nursing team cohesion as a distinct construct within nursing science by identifying its defining attributes, antecedents, consequences, empirical referents, and conceptual boundaries. Walker and Avant’s eight-step method guided the analysis, supported by a systematic search of peer-reviewed English-language studies published between 2020 and 2025 in Google Scholar, OpenAlex, and PubMed Central. Using PRISMA 2020 procedures, 28 studies were selected and thematically synthesized. The analysis identified five defining attributes: mutual trust and respect, effective communication, shared goals, interpersonal harmony, and emotional intelligence. Key antecedents included transformational leadership, conflict resolution training, emotional intelligence, and structured team-building initiatives. Consequences were evident at individual, team, and organizational levels, including improved job satisfaction, reduced burnout, enhanced collaboration, greater psychological safety, better patient outcomes, and lower turnover. Empirical referents included the Team Climate Inventory, TeamSTEPPS instruments, and qualitative assessments. Overall, nursing team cohesion emerged as a multidimensional, measurable construct with substantial relevance for leadership, workforce stability, intervention design, and healthcare quality improvement.