Artificial intelligence systems are increasingly drawn upon to inform nursing practice, education, and health policy, often on the assumption that they produce stable, broadly consistent knowledge. This paper challenges that assumption by examining how seven widely accessible large language models, developed in distinct socio-technical and geopolitical contexts, interpret a shared global nursing challenge. Through comparative qualitative analysis of responses to a standardized zero-shot prompt on the global nursing shortage, four competing policy logics were identified, namely workforce, efficiency, equity, and mobility, with patterns that appeared consistent with aspects of the institutional environments associated with those systems' development. Each response was internally coherent and presented with substantial authority, yet none acknowledged the situatedness of its own framing. The paper argues that such outputs in nursing should be understood as situated artifacts rather than as neutral knowledge, and offers a framework of questions to guide discretion for nurses, educators, and policymakers engaging with these tools. Recognizing this plurality is necessary for safe, contextually grounded decision-making and for governance that addresses both interpretive variability and accuracy.
Tokenism has become an increasingly visible feature of contemporary research and scholarship, particularly in contexts where expectations of diversity and inclusion are institutionally embedded. While often presented as evidence of progress, tokenism raises critical questions about power, participation and the conditions under which knowledge is produced. Tokenism is more than simply a failure of inclusion, it is a functional feature of contemporary research systems, enabling the appearance of equity while preserving existing distributions of power. This paper examines tokenism as a form of inclusion that is more symbolic than substantive, projecting an image of progress while leaving existing hierarchies intact. We argue that tokenism in nursing research is not simply a problem of representation, but a form of epistemic injustice that shapes who participates, whose contributions are recognised and what knowledge is legitimised. In doing so, tokenism can obscure expertise, distort perceptions of competence and position individuals as representatives of identity rather than as authoritative contributors. These dynamics have ethical and epistemic consequences, including the reproduction of marginalisation, the generation of partial knowledge and the erosion of trust. Addressing tokenism requires a reorientation towards collaborative and justice-oriented practices in which participation and epistemic authority is shared.
Nursing research has developed unevenly across history, shaped by shifting institutional structures, professional aspirations and societal demands. Yet existing historical reviews have largely adopted descriptive approaches, while few have applied an explicit theoretical lens to explain why this unevenness persists. This paper addresses that gap by examining the historical development of nursing research through Greenwood's trait-based professionalisation framework. Drawing on a narrative historical review spanning seven chronological periods, the analysis reveals a recurring pattern of partial professionalisation; nursing has consistently generated specialised knowledge yet has struggled to secure organisational infrastructure to embed and control that knowledge within clinical practice. The historical analysis suggests that knowledge production alone within a profession does not guarantee epistemic control.
Contemporary nursing research increasingly generates large and complex textual corpora from interviews, open-ended surveys, clinical documentation, policy discourse and professional narratives. Although these materials contain rich representations of professional reasoning, organisational dynamics and patient experiences, their analysis remains largely confined to thematic qualitative approaches or variable-based quantitative models, which may struggle to examine how meanings are organised across extensive corpora. This article introduces the Multidimensional Interpretative Textual (MIT) design as an epistemological and methodological framework for corpus-based discourse analysis in nursing research, rather than a specific analytical technique or software procedure. The MIT design conceptualises discourse as a structured empirical object and examines textual data at the corpus level. By integrating multidimensional statistical formalisation with interpretive reasoning, it renders patterns in the organisation of meanings empirically observable before theoretical significance is attributed to them. The article outlines the design's epistemological foundations, analytical object and research logic and proposes principles of methodological rigour, including analytical-interpretive separation, corpus structural adequacy, procedural traceability, interpretive arguability, structural-interpretive proportionality and theoretical interpretive transferability. The MIT design thus provides nursing science with a coherent research architecture for examining and comparing recurring patterns of meaning, professional reasoning and organisational logics across empirical contexts.
Nursing theory has long treated "person" and "human being" as interchangeable, reflecting philosophical traditions that prioritize autonomy and individualism. Thinkers such as John Locke distinguish the biological human organism from the person, defining personhood through inward-looking psychological capacities. This cognitive, individualistic model has shaped conventional nursing theories that frame the person as a self-contained unit. In contrast, African relational ontologies conceptualize personhood as a moral, communal, and developmental achievement. Traditions such as Ubuntu, Ukama, and Consciencism, and the writings of Mbiti, Menkiti, Gyekye, Imafidon, and Wiredu, emphasize that personhood is constituted through relationships, communal belonging, and progressive moral maturation. A human being is born with ontological potential, but personhood is conferred through participation in communal life and alignment with shared values. This paper introduces the Theory of Communal-Relational Person-Becoming, a nursing theory that integrates African relational ontologies to reinterpret the metaparadigm concepts. The theory reframes personhood as dynamic becoming, health as holistic harmony, and nursing as a communal, relational, and moral act. Its novelty lies in offering a nursing framework that explicitly contrasts Western psychological individualism with African relational personhood and systematically integrates African philosophies into nursing theory, thereby expanding the discipline's conceptual repertoire and addressing epistemic exclusions.
This paper critically examines the evolution of nursing leadership over the past century, exploring how changing historical, social and professional contexts have influenced styles and their ongoing relevance to contemporary nursing practice. Using a historical analysis guided by Lewenson and Hermann's framework, primary sources, including archival materials and foundational texts, were examined alongside secondary scholarly literature and historical commentaries. Leadership approaches were reviewed by decade and mapped against key nursing theories, healthcare developments and broader social movements to construct a timeline of leadership discourse. Findings demonstrate a progression from predominantly hierarchical, autocratic and bureaucratic leadership models characteristic of the early and mid-20th century, particularly during wartime and post-war periods, toward more relational, collaborative and adaptive approaches. Transformational leadership emerged alongside nursing professionalisation during the 1980s, while servant and authentic leadership gained prominence in response to growing emphasis on equity, inclusion and person-centred care in the 2010s. More recently, adaptive, emotionally intelligent and ambidextrous leadership styles have become increasingly important for addressing healthcare complexity, workforce resilience, innovation and change. The analysis highlights nursing leadership as a dynamic, context-dependent and deeply relational construct. Understanding its evolution can support nurse leaders, educators and other healthcare providers to critically reflect on practice, foster inclusive and resilient teams and apply evidence-informed leadership strategies that promote sustainable, patient-centred care in rapidly changing healthcare environments.
Workplace violence in clinical learning environments is increasingly recognised as a threat to nursing education and workforce sustainability, yet it is often understood as a series of isolated incidents rather than as a condition shaped by broader cultural and organisational forces. This study explored how workplace violence was experienced by nursing students, clinical nurses and clinical instructors in Indonesian hospital placements. Drawing on descriptive phenomenological accounts, the analysis shows how hierarchical relations, patient authority, collectivist expectations and gendered professional identities normalised endurance, constrained speaking up and blurred the boundaries between learning, care and vulnerability. Participants described pervasive verbal abuse alongside bullying, dehumanisation, sexual harassment and episodic physical aggression, with cumulative emotional, psychological and professional consequences that eroded safety, dignity and engagement in learning and practice. Coping responses reflected tensions between professional expectations, personal safety and relational harmony, with ambivalent reporting due to limited organisational follow-through. These findings address an important gap in understanding how workplace violence may become culturally and organisationally sustained within clinical education, rather than merely occurring as isolated interpersonal events. By conceptualising workplace violence as a sustained cultural-organisational climate rather than a set of discrete events, this paper contributes to critical nursing inquiry and highlights the need to examine education and practice settings together when addressing safety, supervision and justice in clinical learning environments.
Healthcare systems worldwide face mounting pressure to deliver high-quality care while enhancing efficiency and sustainability. Nurse-led interventions have emerged as promising strategies to optimize care delivery, particularly within value-based health systems. However, a comprehensive understanding of their clinical impact and economic value remains limited. This systematic review conducted following PRISMA guidelines, searched nine international databases to identify and synthesize formally evaluated nurse-led interventions, programs, and strategies. Twenty-eight studies were included, encompassing diverse care settings and patient populations. Most studies reported improvements in clinical outcomes, including reduced hospital readmissions, enhanced quality of life, and improved chronic disease management. Several interventions analyzed effectiveness, particularly those involving advanced nursing roles such as nurse practitioners and case managers. Findings suggest that clinical effectiveness does not necessarily translate into increased professional authority: nurse-led interventions consistently generate value across patient, organizational, and systemic dimensions, yet nursing leadership remains structurally subordinate within healthcare governance. A systematic agenda for rigorous economic evaluation embedded in nursing research programs is urgently needed, alongside structural reforms that redistribute authority-not merely develop competencies-within healthcare organizations.
This discussion paper examines how care-based nursing judgement becomes recognised, narrowed or excluded as professional knowledge within healthcare organisations. Nursing care is often described as relational, ethical, practical or compassionate, yet these descriptions may obscure its epistemic content: trained perception, contextual interpretation, anticipatory reasoning, moral judgement, continuity work and practical synthesis under uncertainty. Drawing on epistemic injustice, nursing knowledge development, care ethics and organisational governance, the paper argues that injustice in nursing knowledge is not only interpersonal but organisational. It identifies three mechanisms through which care-based nursing knowledge may be downgraded: credibility distortion, interpretive narrowing and restricted epistemic uptake. The paper further develops the idea of reductive recognition: care may become visible in organisational systems only after being translated into categories that diminish its nursing rationality. Five organisational conditions are proposed for recognising care as knowledge: credible reception, hermeneutic infrastructure, shared knowledge governance, educational preparation and balanced standardisation. The central contribution is to shift the question from whether nurses possess knowledge to how healthcare organisations decide which forms of nursing knowledge are allowed to count.
This paper critically examines Florence Nightingale's legacy and its ongoing relevance to contemporary patient safety. Drawing on Notes on Nursing, the study highlights Nightingale's emphasis on hygiene, cleanliness, environmental factors, and systematic care as foundational to reducing harm and improving patient outcomes. Her insights laid the groundwork for infection prevention and control practices that remain central to modern nursing and healthcare safety protocols. Nightingale's principles align closely with current patient safety frameworks and global initiatives, such as the World Health Organization's Global Action Plan, emphasizing the social responsibility of healthcare professionals. Despite scientific advances and evolving healthcare systems, her legacy continues to influence nursing practices by reinforcing systematized, ethical, and patient-centered care. This enduring relevance underscores the critical role of nursing in safeguarding health and promoting safety in diverse clinical settings. This study advocates for ongoing recognition and integration of Nightingale's principles to enhance patient safety and care quality in modern healthcare. Her legacy remains an epistemological and practical resource for advancing nursing theory, patient-centered care, and critical reflection in healthcare. Trial Registration: Not applicable.
This paper argues that segmentation within Turkish nursing is a major factor holding back the modernisation of nurse management. Since the millennium Türkiye's healthcare system has been transformed by NPM-style reforms that changed financing mechanisms and strengthened aspects of performance management, but had only limited impact on nursing management. The entrenched power of the medical profession and persisting influence of a civil service 'officer culture' have been major obstacles to change, but a third factor is division within the nursing workforce. Our qualitative study identifies four orientations among hospital nurses. Plans for innovation proposed by bureaucratic modernisers and professional modernisers are resisted by traditionalists and pragmatists, and modernisers themselves disagree about the way forward. Western discourses concerning nurse professionalisation and leadership have had uneven impact. Interdisciplinary working is largely absent, as are the hybrid management/clinical roles and movement of nurses into executive management positions. Instead, nurse managers seek to advance a curtailed form of professional development centring of continuing professional education, evidence-based practice, guideline development and creating spaces to exercise limited autonomy. Given the huge political difficulties of reducing medical power and achieving civil service reform, the best prospect of progress is to address the tensions within nursing itself.
Workplace violence against nurses and midwives intensified during the COVID-19 pandemic, exposing and amplifying longstanding structural marginalization in health systems across Latin America. This study analyzes how different forms of violence were experienced and described by nursing professionals during this period. A secondary qualitative analysis was conducted using text-based responses from an international online survey developed by the Global Consortium, which included 3860 nurses and midwives from 18 Latin American and Caribbean countries. Data were examined through Descending Hierarchical Classification using IRaMuTeQ, followed by reflective thematic analysis for interpretive integration. The analysis identified five lexical classes, reorganized into three interconnected themes: direct violence related to care delivery and system collapse; stigma, fear, and disruption of social belonging; and ethical-political suffering associated with structural blame, moral suffering, and moral injury. Despite contextual differences across countries, narratives revealed recurring patterns of emotional overload, professional delegitimization, and exposure to multiple forms of violence. These findings position violence against nursing professionals during the pandemic as a structural and multifaceted phenomenon rooted in historical inequities and institutional fragility, underscoring the need for sustained policies that strengthen workforce protection, ethical accountability, and institutional support in both routine healthcare settings and future public health emergencies.
Bathing Without a Battle is a widely circulated video training resource in residential dementia care, but the assumptions it advances about bathing, refusal, and appropriate nursing practice have received limited critical attention. This paper analyzes how the text constructs resistance to assisted bathing and how it frames legitimate nursing responses to that resistance. A three-part Faircloughian critical discourse analysis is used, attending to social structures, processes of production and dissemination, and the textual features through which meaning is enacted. The bulk of the analysis focuses on genre, discourse, and style to examine how the video governs practice and moral reasoning. Findings indicate that the program positioned itself as an early form of clinical practice guideline by linking instructional conventions with the authority of academic research. It also illuminates the lexical choices used to portray cleanliness as a non-negotiable objective, while clients' refusals are positioned as problems (of technique, discomfort, or pathology) to overcome rather than expressions of agency. Finally, the paper demonstrates how the video's emphasis on pleasure operates as a stylistic and moral device that shapes nurses as responsible for producing care that is both hygienic and affectively acceptable. The paper concludes by considering the ethical implications of this framing for autonomy in dementia care and the normalization of persuasion when care outcomes are predetermined. Trial Registration: Clinical trial registration is not applicable, as this study did not involve a clinical trial.
AI-based systems increasingly operate in socially and ethically sensitive domains such as healthcare, raising pressing questions about responsibility. This article focuses on a specific form of moral responsibility-answerability-in the context of AI-based care robots. Although such systems are not moral agents in a human-like sense, their actions are embedded in social practices in which demands for explanation play a significant role. The article develops a structured analytical framework that conceptualizes answerability as comprising both a subjective dimension (the actor's reasons and justifications) and an objective dimension (the comprehensibility and moral quality of explanations). It thereby clarifies the conditions under which demands for explanation arise and how they can be normatively assessed. Applying this framework to care robots, the article argues that these systems can be meaningfully treated as answerable, even though they are not accountable-in human terms. Concrete care scenarios illustrate that affected individuals may be entitled to demand explanations from robots, despite their technically mediated and limited responses. While current systems can only approximate the requirement of sincerity in a minimal sense, future developments may enable more sophisticated forms of technical answerability without necessarily grounding full moral responsibility.
Impostor phenomenon (IP) is widely recognised among doctoral candidates but remains insufficiently understood, particularly within nursing academia. It is commonly framed as an individual deficit, overlooking the broader social and linguistically mediated experience that shapes scholarly identity. This discursive exploration draws on Fairclough's Critical Discourse Analysis (CDA) to examine micro, meso and macro social orders across diverse textual sources and reflexive accounts, exploring how language and institutional norms position nursing doctoral candidates as impostors. Findings reveal tensions between professional, social and ideological expectations and the formation of a doctoral nurse identity, where dominant discourses individualise systemic constraints, reproduce hierarchies and marginalise nursing expertise through gendered, caring and knowledge-ownership narratives. Doctoral preparation can disrupt these dynamics by fostering visibility, authority and knowledge production, yet limited support and persistent hierarchies intensify impostor subjectivities. Shifting from deficit framings to critical discourse perspectives enables supervisors, institutions and candidates to cultivate relational, reflective and inclusive practices that mitigate impostor experiences and strengthen nurse-academic identity. Doctoral education thus becomes a vehicle for structural transformation, advancing nursing's research leadership, policy influence and patient care outcomes.
The horizontal growth of nursing education globally over recent decades has not been matched by a corresponding vertical breakthrough in professional autonomy. Nurses remain structurally subordinated within clinical governance, resource allocation, and institutional decision-making. This discursive paper argues that this gap persists because three mutually reinforcing mechanisms remain intact: historically entrenched institutional path dependence, operational deficits in competency-based evaluation frameworks, and persistent gaps in how leadership translates structural and educational reforms into clinical authority. Applying a historical institutionalist lens, we trace how early critical junctures locked nursing into a doctor-led, nurse-subordinate configuration that subsequent reforms have failed to disrupt. We then examine how the absence of structured entrustment-supervision scales prevents competency standards from conferring genuine decision-making power. Finally, we analyze how conceptual overlap among leadership constructs, and unaddressed measurement threats like social desirability bias, weaken the evidence base for leadership interventions. To resolve this, the paper contributes an integrated analytical framework proposing that institutional restructuring, educational framework enhancement, and leadership development must operate synergistically, not in isolation. This coordinated pathway offers a strategy for achieving sustainable nursing empowerment.
Compassionate nursing practice frequently requires nurses to navigate competing obligations, conflicting patient needs and constrained resources. While compassion motivates responsiveness to suffering, it does not always provide sufficient guidance for determining how such conflicts should be resolved. We argue that contemporary forms of utilitarianism may offer a useful framework for structuring compassionate practice in nursing within ethically pluralistic clinical environments. Drawing on contemporary utilitarian thought, particularly preference utilitarianism, the paper examines how attentiveness to suffering, preservation of dignity and responsiveness to patient vulnerability may be reframed around ethical deliberation under competing demands. Through clinical examples, we explore how compassionate nursing practice often involves the weighing of competing preferences, the prioritisation of morally significant needs and the allocation of finite professional attention. We argue that preference utilitarianism can fruitfully provide a structured ethical resource for evaluating actions according to their capacity to reduce and prevent suffering while respecting individual preferences and circumstances. The paper does not propose a foundational moral theory for nursing. Rather, it argues that preference utilitarianism can function as a complementary ethical resource alongside care ethics, virtue-based approaches and other relational perspectives, particularly in situations where nurses must navigate conflicting ethical duties. It therefore demonstrates how compassionate actions can be morally justified and systematically assessed, supporting a move from isolated acts of care towards more sustained and context-sensitive ethical practices within healthcare systems.
Advance care planning (ACP) non-initiation is commonly attributed to information deficits or low motivation. I argue here that a more fundamental barrier exists: ACP may not yet have become cognitively and relationally available as a meaningful option within a person's everyday horizon. Drawing on a concept-oriented review of the theoretical and empirical literature, I develop a participatory framework built on four linked preconditions. First, decision readiness describes the pre-decisional state, in which future care becomes sufficiently thinkable to enter dialogue. Second, the cognitive repertoire reconceptualises ACP learning as the formation of latent resources -values, questions and interpretive frames-that can be activated when life circumstances make future care salient. Third, self-disclosure highlights that, even when internal readiness exists, participation depends on relational and emotional conditions that make concerns speakable. Fourth, supportive nudging describes the deliberate design of environmental and relational conditions that allow already-existing concerns to surface without compromising autonomy. Altogether, these preconditions suggest that ACP non-initiation is better understood as a problem of option accessibility than one of information transfer. This reframing has direct implications for how ACP interventions are designed and evaluated and extends to the broader questions of patient and public participation in future-oriented care.
Clinical recognition is not produced by nursing judgment alone. Building on Fricker's account of epistemic injustice and extending critical theories of legibility, classification, measurement, and the clinical gaze, this article advances clinical legibility as a foundational theoretical construct for nursing. Clinical legibility names the structural condition under which patient testimony, bodily signs, and nursing concern can be captured, recognized, documented, transmitted, and acted upon equitably across populations. It shifts recognition from the individual knower's mind to the infrastructures that make patient reality actionable, distinguishing clinical legibility from epistemic injustice, implicit bias, structural bias, diagnostic error, and failure to rescue through its focus on the prior problem of recognizability. Three interlocking conditions structure clinical legibility: instruments that produce valid inferences across patient populations, educational repertoires adequate to diverse bodies and presentations, and documentation and escalation systems capable of preserving patient testimony and nursing concern as actionable knowledge. For nursing, clinical legibility clarifies how surveillance, documentation, advocacy, escalation, and care all depend on recognition infrastructure capable of holding patient reality. Reforming that infrastructure is not peripheral to nursing's disciplinary project; it is a condition of ethical care and a disciplinary obligation.
