ABSTRACT Contemporary healthcare systems face a structural crisis driven by biomedical reductionism, institutional biopower, and corporate rationalization. In this context, professional enculturation in nursing has historically functioned to reproduce subalternity and institutional docility through a clinical hidden curriculum that privileges delegated biomedical routines over autonomous care. Drawing upon a transnational genealogy across four foundational paradigms (biomedical positivist, interpretive‐humanistic, disciplinary, and critical‐sociopolitical), this article deconstructs how organizational architectures constrain Care Science. Crucially, rather than framing role transition shock and moral distress as individual psychological fragility or resilience deficits, we conceptualize them as acts of legitimate epistemological resistance. To overcome this institutional alienation, we propose the Emancipatory Praxis and Care Sovereignty Paradigm (EPCSP). Grounded in critical pedagogy, feminist ethics, and systemic humanism, the EPCSP redefines nursing education and clinical practice. It establishes the ontological parity of care in relation to medical cure, equips practitioners with critical agency to dismantle institutional biopower, and provides the operational framework required to address complex chronicity, mitigate clinical iatrogenesis, and secure the disciplinary sovereignty of Care Science.
ABSTRACT Structural competency has advanced health‐professions education by orienting clinicians to the social, political, and economic structures that produce health inequities, yet its nursing applications treat experiential and sensory teaching methods as instructional delivery rather than explaining why such methods work, and assume rather than cultivate the perceptual acts, recognition, and responses that they depend on. This conceptual paper develops LUMEN, a multisensory pedagogy for teaching the structural determinants of health in nursing, and introduces structural perception as the foundational competency it cultivates. Through an argument‐based synthesis integrating structural competency, critical pedagogy, transformative learning, embodied and grounded cognition, social theory, and the arts with the nursing literature, we argue that structural determinants are pedagogically difficult because they are imperceptible, abstract, upstream, and naturalized, making the foundational educational task perceptual rather than informational. Because perception is sensory and embodied, multisensory pedagogy is its fitting mechanism. LUMEN operationalizes this through five domains, Look, Uncover, Mirror, Engage, and Navigate, sequenced across a three‐phase arc moving learners from structural blindness through critical consciousness to structural action. LUMEN names a competency the field has assumed and theorizes a mechanism it has used but not justified, offering nurse educators a theoretically grounded, testable foundation for teaching structural perception. We also subject the framework to critique, including the risk that adding another model to a crowded field could individualize what is ultimately an institutional problem.
ABSTRACT Intimate partner violence (IPV) is a pervasive public health crisis, with rural social and structural conditions creating additional challenges for survivors seeking safety and support. Existing applications of the Social–Ecological Model (SEM) have helped identify factors influencing IPV, but offer less explanation about how these factors interact to constrain survivors' agency and shape service navigation. This paper introduces the Rural Ecological Framework of Intimate Partner Violence (RE‐IPV), a conceptual framework informed by the SEM, structural violence perspectives, and a synthesis of empirical literature, with refinement through engagement with rural community partners, nurse scholars, and public health scientists. RE‐IPV illustrates how interacting societal, community, relational, and individual conditions shape the options available for rural women experiencing IPV. Central to the framework is constrained agency, which helps explain how survivors make decisions about safety, disclosure, and service utilization within circumstances that limit their available options. The framework also conceptualizes service navigation as a recursive process in which healthcare and advocacy encounters can influence survivors' trust, perceptions of safety, and subsequent help‐seeking decisions. By moving beyond a descriptive categorization of ecological barriers, RE‐IPV offers a rural‐specific perspective on how structural conditions shape survivors' agency and engagement with services. The framework provides a foundation for future conceptual development, empirical examination, and survivor‐centered nursing and healthcare practice. Trial Registration: Not applicable.
ABSTRACT Professional nursing standards documents codify what a discipline holds itself accountable to know and act on, and they face increasing political pressure to narrow their equity commitments. In April 2026, the American Association of Colleges of Nursing (AACN) released a revised edition of The Essentials: Core Competencies for Professional Nursing Education , originally approved by member vote in 2021, without a member vote or documented evidence base. This study examined how this revision reconstituted equity‐related discourse and what it makes sayable and unsayable in professional nursing education. Using a Foucauldian critical discourse analysis integrated with comparative document analysis. We treated the revision as an instrumental case study and compared both editions line by line. Of 76 document elements compared, 40 were revised, 6 removed, and 27 unchanged; the ten‐domain competency architecture remained intact. The terms structural racism, social justice, health equity, and diversity, equity, and inclusion, which appeared 20, 21, 9, and 17 times, respectively, in the 2021 edition, are absent from the 2026 edition except for a single retained reference to diversity, equity, and inclusion. Analysis identified two distinct mechanisms: substantive rollback, in which requirements such as holistic admissions were withdrawn, and discursive retrenchment, in which competencies were retained but their named equity terms were replaced with generalized, outcome‐neutral language. We argue that discursive retrenchment is especially consequential because it escapes standard accreditation review. We call for transparent, evidence‐driven governance of the profession's foundational educational documents, wherever they are produced.
ABSTRACT Borderline personality disorder (BPD) is a contested diagnosis that has been criticized for pathologizing women's responses to trauma, adversity, and relational harm. This paper examines how BPD, as a gendered, historically situated, and institutionally mediated diagnostic category, shapes community mental health nursing (CMHN) practice. Using a critical conceptual analysis, it synthesizes historical, feminist, psychiatric, nursing, and Mad studies literature, combining genealogical, critical feminist, and social‐structural perspectives. The paper argues that BPD functions not only as a clinical description of symptoms but also as an institutional category that influences documentation, referral pathways, eligibility criteria, and service design. Through these processes, the diagnosis shapes clinical visibility, therapeutic relationships, service access, and continuity of care. Moving beyond explanations of stigma that focus solely on individual clinician attitudes, the analysis demonstrates how diagnostic meanings are reproduced through organizational and health system structures, contributing to forms of structural stigma that constrain relational and trauma‐informed care. The paper concludes with implications and recommendations for nursing practice, education, service delivery, and policy, including trauma‐informed and relational approaches to assessment, non‐stigmatizing documentation practices, transparent referral and eligibility processes, investment in community‐based services, and strengthened clinical supervision and workforce supports.
