Nursing Inquiry

This paper presents an overview of the health impacts associated with anthropogenic climate change and examines the interconnection between human health and the environment. It highlights the nursing profession's stance on environmental issues, drawing attention to the disengagement of nurses from advocacy initiatives related to climate change and how this relates to the nursing metaparadigm. Moreover, this paper supports a multidirectional approach to address climate change solutions, with a particular emphasis on both adaptation and mitigation strategies. Ecofeminism is proposed as a critical framework to address the shortcomings of the metaparadigm and the approaches to climate change solutions. It examines the potential for integrating ecofeminism into nursing research and practice by reconceptualizing the concept of the environment, adopting an ethic of the environment, and critiquing oppressive social structures. The benefits of ecofeminism for nursing include enhancing nurses' responsiveness to the health consequences of climate change, facilitated by using a critical voice that promotes inclusion and collective action.

Aesthetic leadership in nursing constitutes a disruptive conceptual proposal that questions and redefines traditional leadership models within healthcare settings. This article develops an original theoretical framework that incorporates the aesthetic dimension as a structuring category of care, emphasizing the role of beauty, presence, and relational ethics in transforming healthcare delivery. Grounded in ontological, epistemological, ethical, and phenomenological dimensions, aesthetic leadership is framed as a praxis that transcends technical competence and operational management, aiming at transforming the caregiving experience and strengthening authentic bonds between nurses and patients. Based on a critical review of established nursing theories, including those proposed by Jean Watson, Imogene King, Betty Neuman, Madeleine Leininger, Patricia Benner, and Dorothy Johnson, a reconceptualization of leadership is proposed, integrating a holistic vision that articulates ethical, aesthetic, existential, and emotional dimensions in clinical practice. This theoretical model highlights the need to incorporate artistic, expressive, and symbolic resources into caregiving processes, with the purpose of enriching the caregiving experience, preserving human dignity, and promoting meaningful intersubjective relationships. Finally, it is argued that aesthetic leadership represents a pertinent pathway for the rehumanization of care in contemporary clinical contexts, proposing future research directions aimed at evaluating the impact of aesthetic practices on care quality, patient experience, and the professional well‐being of nurses.

There is extensive evidence for gendered inequities in the intensity and complexity of unpaid care labor for family members with life‐limiting illnesses, and in the harmful physical, emotional, and socioeconomic impacts of this labor on those who provide it. Women caring for parents experience disproportionate harms associated their care labor, and those experiencing conflict and lack of choice are especially at risk; yet violence and constraints of agency in the context of care for parents have been largely ignored in nursing scholarship. In this study, we used a feminist poststructuralist theoretical framework to deconstruct dialogic narratives with 16 women who provided end‐of‐life care to mothers who maltreated them in childhood. We identified “the good family” as a dominant discourse obscuring three subjugated narratives: “recursive assaults on subjectivity,” “making a good death for a bad mother,” and “medical complicity.” These narratives illuminate mechanisms whereby dominant discourse constitutes, and is constituted by, violence perpetrated against daughters in the public and private realms of unpaid care labor for mothers with life‐limiting illnesses. By creating and disseminating composite narratives exposing parallel processes of dehumanization and exploitation in cis‐hetero‐patriarchal family and medical systems, we present a new form of emancipatory praxis for nursing scholars.

The Strong Black Woman schema is a deeply ingrained sociocultural construct that promotes resilience, independence, and self‐sacrifice among Black women. While often seen as a source of strength, this schema also imposes profound psychological and professional burdens, particularly in nursing leadership, where Black women are expected to navigate systemic inequities while demonstrating unwavering fortitude. This paper critically examines the paradox of the Strong Black Woman schema within nursing, arguing that the same resilience that empowers Black women also contributes to emotional suppression, burnout, and systemic barriers to advancement. Drawing from interdisciplinary literature, we explore how the nursing profession's culture of caregiving and self‐sacrifice reinforces this schema, perpetuating racialized and gendered expectations that limit Black women's capacity to seek support and express vulnerability. Integrating Cheryl Woods‐Giscombé's Superwoman Schema, we demonstrate how the psychological and physiological consequences of this paradigm impact Black nurses' well‐being and leadership trajectories. We advocate for a redefinition of strength that embraces vulnerability as a leadership asset and calls for systemic changes in nursing education and practice. By shifting the discourse from mere endurance to a more inclusive and humanizing leadership framework, we challenge the dominant narratives that empower and constrain Black women in nursing.

In mental health, the safety and risk concept refers to a complex phenomenon with strong connections to risk management strategies, simultaneously influenced by the ideals of patient involvement and empowerment. The aim of this paper is to analyze discourses linked to patient involvement and the management of risk and safety, as articulated in the protocol for the Early Recognition Method (ERM) risk management strategy. As an analytical tool, we have drawn inspiration from the discourse theory of Michel Foucault and utilized Hall's six elements for discourse analysis. Our analysis indicates that the ERM protocol rests its discursive authority upon two main discourses: one, a scientific medical discourse and the other, a discourse strongly linked to empowerment and patient involvement. These two discourses are interrelated in a complex fluctuation of power dynamics in which they sometimes complement each other and, at other times, are in conflict. We claim that by applying a Foucauldian angle on discourse, power, and knowledge, our analysis may facilitate a critical awareness of the power dynamics inherent in risk management discourses and provide valuable insights into how articulations of safety and risk – combined with ideals of participation and empowerment – contribute to reframing practices in mental health care.

Diversity, Equity Inclusion, and Access (DEIA) initiatives are necessary and the bare minimum of what needs to be implemented to the systemic inequities in education and healthcare, particularly in nursing. Recent laws and proposed legislative rollbacks threaten to reverse decades of progress by dismantling affirmative action, defunding workforce diversity grants, and restricting DEIA programs in academic and clinical settings. The nursing profession, historically reflective of broader societal discrimination, has made strides toward inclusivity, yet persistent racial disparities in hiring, leadership, and patient care underscore the continued necessity of equitable and inclusive policies. Drawing from the Sullivan Commission (2004) and The Future of Nursing reports (2010, 2021), this paper examines the implications of these policy changes for workforce diversity, health equity, and nursing education in the United States. The discourse surrounding DEIA has been reframed as a political issue rather than a structural correction and moral responsibility, despite overwhelming evidence that diverse healthcare workforces lead to improved patient outcomes. As a profession rooted in advocacy and social justice, nursing must oppose regressive policies by upholding inclusive hiring, education, and training practices. By exploring historical, legal, and ethical perspectives, this paper argues that dismantling DEIA initiatives is not a restoration of meritocracy but rather a reinforcement of systemic barriers that perpetuate inequities in healthcare access and outcomes.

Research is needed to better understand how public health nurses (PHNs) contribute to promoting health equity in communities. Our study aimed to fill this gap by exploring what activities PHNs describe they undertake in advancing health equity as well as examining their skills, proficiencies, and training needs specific to health equity work. We collected qualitative data via interviews with 18 PHNs across the US and developed major themes using a thematic analysis approach. We also analyzed quantitative survey data to compare health equity competencies among PHNs versus non‐PHNs in local health departments. Most participants identified as female (N = 15); years of experience as a PHN ranged from 1 to 37. Participants described four major themes related to their health equity work: foundational elements of health equity work, components of health equity work, how nurses are equipped to do health equity work, and barriers to engaging in health equity work, which included a need for a more diverse PHN workforce and the opportunity to practice at the top of their scope. Quantitative analyses highlighted PHNs confidence in addressing core health equity concepts, such as the social determinants of health. Findings provide a deeper understanding of how PHNs contribute to advancing health equity, underscoring the value they bring to public health and demonstrating ways that health equity is at the core of what they do. Further work is needed to address barriers, including establishing recruitment pathways for those from diverse backgrounds to facilitate growth of this valuable sector of the public health workforce.

Professional education for licensed nurses in Australia is a complicated matter involving two education systems—vocational education and training, and higher education—each characterized by a different curriculum model. The contribution of the two systems follows a division of the workforce into Enrolled Nurses and Registered Nurses, with vocational education serving the first division and higher education the second. Although the systems are intended to provide connecting educational and career pathways, it results in a binary education landscape featuring two distinct forms of curriculum and contrasting assumptions about knowledge. This discursive discussion analyses the impact of the competency‐based curriculum on Enrolled Nurses' education, entry to the profession of nursing, and their aspirational educational pathways towards registered nursing. Many Enrolled Nurses successfully articulate to become Registered Nurses; however, we argue that traversing between the two distinct curriculum approaches creates barriers to these transitions. We also argue that apart from undermining the learning trajectories of nurses, the influence of the competency‐based curriculum model threatens the coherence of the profession at a time when conditions of work are both intensified and globalized, calling for a solution in the form of curriculum harmonization.

Stereotypes in mass media depict harmful and inaccurate portrayals of nurses and nursing work. As memes are understood to be units of culture, they may be examined as artifacts, deepening understandings of contemporary culture. This critical qualitative analysis of nursing memes from two popular social media platforms seeks to identify current cultural narratives and social meanings of nursing reproduced within the public domain. Memes were selected from popular hashtags and nursing meme accounts with more than 2500 followers. Memes were included if they followed traditional meme format and content‐centered discourses of gender, race, and other aspects of power and oppression within nursing and healthcare systems. Our analysis employed a qualitative descriptive design within an overarching critical social theoretical framework. We identified that nursing memes reproduced stigmatizing and discriminatory narratives of patients and perpetuated harmful notions of “who” nurses are and “what” nurses do, while also drawing attention to systemic challenges facing the profession. Memes therefore serve as a valuable artifact for communicating contemporary cultural narratives about nursing and nursing work. Generating and distributing memes to raise awareness of systemic pressures may serve as a valuable social strategy toward advocating for systemic shifts in nursing and healthcare to address persistent challenges.

With the growing complexity of hospital care, patient safety has become even more critical. This study explores the development and exchange of situation awareness of clinical hospital ward nurses engaged in interdisciplinary and distributed teamwork. A focused ethnographic study was conducted and involved shadowing 10 hospital ward nurses, semi‐structured interviews, group reflections and patient record screenings. In‐depth analysis of three representative clinical cases using state‐space diagrams and a critical decision method was performed. The results show that development and exchange of situational awareness is often not reciprocal, timely or complete, with insufficient information available before decisions are made, which can compromise patient safety. Factors in communication, coordination and learning climate were identified as influential. We argue that the complexity of nurses' work in which sensitivity, alertness and control over key nodes in the healthcare network is required to achieve assimilation and accommodation in situational awareness among involved healthcare professionals. Although challenging, we see opportunities to improve situational awareness transactions through nurses' leadership behaviour. Analysing interdisciplinary and distributed collaboration from the perspective of an information network provides insight into improving situational awareness transactions, the key role nurses play in them, and further promoting patient safety.

Operational failures in hospitals, such as communication breakdowns and equipment malfunctions, challenge nurses by disrupting patient care, workflow, and clinical processes. These failures are primarily addressed with short‐term solutions, rather than comprehensive, long‐term strategies. This study investigates the impact of operational failures on patients and examines whether nurses alter their problem‐solving behavior in response to the perceived direct impact on patients. A qualitative, exploratory study was conducted in 23 wards across five Belgian hospitals. Data were collected through in‐depth semi‐structured interviews with 26 nurses and a group discussion with ward managers (n = 6). Findings reveal that barriers such as nurses' limited awareness regarding the broader impact of operational failures on patients, poor communication, and excessive workloads hinder problem‐solving efforts. However, when operational failures result in patient harm, nurses are more likely to take corrective action to prevent recurrence. Enablers to enhance problem‐solving behaviors include using narrative medicine to highlight patient safety risks, improvements to communication frameworks, the streamlining of reporting systems, and the allocation of adequate time and resources to address underlying issues. Furthermore, a proactive approach, grounded in Safety‐II principles, emphasizes nurses' flexibility and adaptability, recognizing their indispensable role in learning from successful outcomes and making real‐time adjustments to strengthen resilience within healthcare systems.

Conflicts can arise when a medical team declares a patient brain dead, especially in Lebanon, where families may be reluctant to accept the diagnosis for religious or cultural reasons. Families sometimes withhold consent for organ donation until they can reconcile their beliefs with their concerns. This manuscript examines these challenges through the eyes of an ICU nurse, who described what happened when a 22‐year‐old woman was declared brain dead. The nurse explains how she helped the patient's family overcome their objections to organ donation despite some nurses exacerbating the situation by arguing with the family about the patient's care. I use Stein's theory of empathy and Castoriadis' concepts of radical imagination and social imagery to interpret the conflict that emerged due to Lebanese law, which permits families to veto organ donation and prohibits the withdrawal of life support unless requested by the patient's next of kin or legally authorized representative. The case study highlights the importance of trust, compassion, and kindness in helping families resolve organ donation conflicts. ICU nurses who earn families' trust can help them make informed decisions about organ donation without compromising their religious and cultural beliefs. This approach improves outcomes for waitlisted organ recipients. Resolving conflicts requires nurses to stay true to their values and accept responsibility. While the case study focuses on Lebanon, creative nursing practices have the potential to address brain death and after‐death care disputes in other jurisdictions.

Studies into the experiences of Black nurses in Canada's healthcare system provide policymakers with a deeper understanding into designing policies and practice guidelines to best support equity and diversity. With male nurses making up 9% of the nursing population in Canada, there remains a paucity of studies into their experiences and significantly less for Black male nurses (BMNs). The World Health Organization's call for more nurses means an increase in Internationally Educated and Canadian‐born BMNs who will experience sociocultural stereotypes and biases that underpin nursing practices. BMNs are left to navigate intersections of race and gender power relations within nursing. Remaining invisible and voiceless within nursing literature, and discriminated against in the workplace culture, this study uses an exploratory qualitative approach to understand the experiences of six BMNs working in the Greater Toronto Area and the strategies they use to navigate the intersections of race and gender that sustain the negative stereotypes and tropes of the Black man. The findings disclose the need for policymakers, nursing administrators, and organizations to co‐create policies that support dynamically tailored mentorship programs and practice guidelines when dismantling anti‐Black racism and promote inclusivity and a sense of belonging.

While understanding of what nurses do is most commonly framed as using clinical decision‐making in completing a range of tasks to meet the care needs of patients, other perspectives show nurses as experiential carers and/or utilising a body of professional knowledge to do this. Taking data from an ethnographic study framed in Bourdieu's theory of practice, this paper aims to extend understanding of how nurses in acute care accomplish nursing‐in‐practice by utilising reconnaissance, a conceptualisation of nursing practice knowledges, as a vocabulary to further analyse these data. In this new way of thinking about what nurses do, nursing‐as‐it‐happens is shown to be not about nurses making decisions as such, but about how nurses use contextualised knowledge to activate practices that respond to what needs to be done for patient care in the context of each practice situation. Focusing attention on what nurses accomplish in their daily practices‐of‐work reveals nurse agency as working with and for the patient. This enables recognition of how nurses working with multiple patients on a shift can make adjustments to their practices in light of unfolding situations and, when necessary, bring each of those patients as persons to the centre of their practice.

This review aimed to map the existing research and methodologies used and identify themes of power distance in healthcare. A systematic search for original studies was conducted in May 2023 in accordance with the Joanna Briggs Institute's guidelines for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews were used for reporting. A total of 30 studies were included, and all were published between 2004 and 2022. Power distance as a moderator was evident in the research, influencing the relation between other variables. Three distinct themes of power distance in healthcare were identified: interpersonal, intrapersonal and cultural aspects of power distance. These themes illustrate the multilevel effects of power distance in healthcare. Based on current evidence, power distance is an impactful phenomenon in healthcare. Power distance has diverse direct and indirect impacts and is a valuable framework for describing healthcare's complex social inequalities. Power distance was directly linked with hierarchy and associated with a lack of collegiality. Awareness and understanding of power distance are valuable for healthcare leadership and research, aiding in the comprehension of employee outcomes, expectations and subtle cultural differences, though further research on power distance in healthcare is needed.

Healthcare workplaces mirror broader societal inequities, embedding racialized power dynamics that shape professional relationships, communication, and collaboration. While systemic racism in healthcare is well‐documented, little research captures how these dynamics unfold in real‐time. This study employs a 2‐year qualitative participant‐observation approach in a medium‐sized acute care hospital to examine racialized workplace interactions among nursing professionals, offering a context‐rich understanding of how systemic exclusion operates daily. Unlike studies relying on self‐reported experiences, this approach minimizes recall bias and uncovers the subtle mechanisms that sustain inequities—non‐verbal exclusion, coded language, racialized delegation of tasks, and strategic adaptation by Black staff. Findings reveal disparities in respect distribution, inequitable workload assignments, and help‐giving patterns that reinforce in‐group favoritism and out‐group marginalization. Black professionals faced exclusion, heightened scrutiny, and dismissive communication, leading to workplace stress and high attrition. By applying Social Identity Theory to hierarchical healthcare environments, this study illustrates how professional hierarchies intersect with race to perpetuate exclusionary dynamics. Addressing these patterns requires structural interventions that foster equity, accountability, and inclusive leadership to disrupt systemic barriers and create collaborative workplaces that support professional growth and patient care outcomes.

Artificial intelligence (AI) is revolutionizing nursing by enhancing decision‐making, patient monitoring, and efficiency. Machine learning, natural language processing (NLP), and predictive analytics claim to improve safety and automate tasks. However, a structured analysis of AI applications is necessary to ensure their effective implementation in nursing practice. This umbrella review aimed to synthesize existing systematic reviews on AI applications in nursing care, providing a comprehensive analysis of its benefits, challenges, and ethical implications. By consolidating findings from multiple sources, this review seeks to offer evidence‐based insights to guide the effective and responsible integration of AI in nursing practice. A systematic umbrella review approach was employed following PRISMA guidelines. Multiple databases, including PubMed, CINAHL, Scopus, Web of Science, and IEEE Xplore, were searched for review articles published between 2015 and 2024. Findings were synthesized thematically to identify key trends, benefits, limitations, and research gaps. This review synthesized 13 studies, emphasizing AI's impact on clinical decision support, patient monitoring, nursing education, and workflow optimization. AI enhances early disease detection, minimizes diagnostic errors, and automates documentation, improving efficiency. However, data privacy risks, biases, ethical concerns, and limited AI literacy hinder integration. AI presents significant opportunities for improving nursing care, yet its successful implementation requires addressing ethical, legal, and practical challenges. Adequate AI training, robust data governance frameworks, and policies ensuring responsible AI use are essential for its integration into nursing practice. Future research should explore long‐term AI impact, training models for nurses, and strategies to balance AI‐driven efficiency with human‐centered care.

Recent discourse emphasizes the need to integrate social and structural determinants of health—such as poverty, violence, houselessness, and discrimination—into mental health care service design and delivery. This study investigates how psychiatric‐mental health nurse practitioners (PMHNPs) navigate the conflicting demands of an efficiently organized clinic and the realities of patients experiencing chronic mental illness along with structural adversity. Using an institutional ethnographic approach, this research focused on the everyday work practices of nine PMHNPs in outpatient community mental health clinics in a major American city. The findings revealed disjunctures within two powerful discourses related to patient access to care that circulate in mental health settings: (1) “every door is an open door,” and (2) “meeting people where they are.” PMHNPs believe in the values promoted by the rhetoric while also being required to work outside institutional structures to meet real patient needs. By illustrating how the institutional coordination expected to improve health systems overlooks PMHNPs' expert knowledge, we highlight how addressing the “structural determinants of health” in clinical care for people with serious mental illnesses remains an ideological aspiration. We call for a reevaluation of mental health care practices and systemic transformation through the informed, ground‐level interventions of PMHNPs.

The need for nurses to be political is as great as ever, however, nursing has a complicated relationship with politics and political action. This paper examines the impact of a sequential simulation learning activity that sought to transform students' values and attitudes towards political action in addressing Planetary Health issues. Adult and adult mental health nursing students from two British universities participated in the Political Action Sequential Simulation which had three scenarios related to either water or air pollution. Scenario one was clinical, while scenarios two and three were community‐ and policy‐based, respectively. We used a pre‐post design to gauge attitudes and values both before and after the intervention. Outcomes measures included Nurse Professional Value Scale‐3, Political Efficacy – Short Scale, Perceived Political Self‐Efficacy Scale – Short Form, Social Justice Scale and Internal Environmental Locus of Control scale. Of the 256 students who undertook the activity, 75 completed both pre and post‐measures. Significant shifts across all scales except the social justice scale were found, meaning that students' attitudes towards political action, their beliefs in their ability to take political action, and in particular, action related to the environment shifted significantly after the sequential simulation. We discuss these results in the context of the broader literature, reflect on some of the reasons why these shifts occurred and consider the implications for nursing education and practice.

This study examines the sociolegal construction of the family, its impact on informal caregiving, and the implications for family nursing. Nurses were among the first healthcare workers to recognize the family as a crucial site of growth, development, and recovery from illness. Despite widespread endorsement of family‐centered principles, actual practice often falls short of ideals, and there is limited empirical evidence supporting the effectiveness of family‐based interventions. Through analysis of historical, legal, and sociological sources, this study argues that nursing has not reckoned with the family's transformation from a public entity into a private repository of dependency care. The findings suggest that family nursing would benefit from greater attention to the legal, gendered, and economic dimensions of the family.

To develop more effective and equitable approaches, we propose reframing self-care and self-management as interconnected processes operating across multiple levels simultaneously: micro level: individual needs, behaviours and capabilities; meso level: social networks, community resources and healthcare providers; and macro level: health systems, policies and structural influences. This perspective highlights the socially situated, relational and evolving nature of self-care and self-management, emphasising that interpersonal relationships and system-level structures must be considered by nurses and healthcare teams when supporting patients and carers. Although acknowledging the biopsychosocial dimensions of chronic disease care is by no means new (Corbin and Strauss 1985; Thorne 1993), our approach explicitly integrates self-care philosophy, rooted (mostly) in nursing discourse, with the more biomedically dominated self-management approach. Both must be situated within a broader social system and community framework to be effective.

Relational practice is the basis for human connection and is linked to enhanced healthcare experiences and involvement with healthcare services. Although the nurse‐patient relationship is typically built around behavioural communication skills, relational practice requires developing awareness, connectedness and responsiveness to others. The task‐oriented ways of working have eroded these attributes. This study explored how Indigenous values and practices can transform relational practice in a publicly funded acute hospital in Aotearoa, New Zealand. Kaupapa Māori (Māori philosophy and practice) and grounded theory were used to generate and analyse data from interviews with Māori staff and consumers. Three culturally informed processes culminated in the culturally grounded theory of achieving a culture of whanaungatanga (belonging and inclusion): tikanga mahi (work ethic), whakawhanaungatanga (developing kinships) and manaakitanga (cultural and social responsibility). The study highlights the necessity of developing and maintaining relationships and creating an environment that enables relational practice. Findings show that developing a sound work ethic supported by solid and committed leadership and espousing Māori values is the catalyst for change. Applying an Indigenous mentoring model like the tuakana‐teina (leader–learner) model may create an environment supporting organisational culture change.

The growing demand for research that is culturally sensitive and contextually relevant is leading to a greater acceptance of indigenous paradigms. Despite this, African philosophy, with its rich cultural and ethical dimensions, is still developing as a field. This paper delves into the philosophical concepts of Ubuntu, Ukama and Consciencism, exploring the ontology, epistemology, axiology and methodology of indigenous African philosophy. It highlights the importance of relationships, community, interconnectedness and a holistic understanding of human existence and experiences. Indigenous African philosophy presents itself as an alternative framework for addressing health and social issues through co‐creation, active participation and empowerment. Ontologically, it focuses on relativism and individuals defined by their social and relational contexts. Epistemologically, it values the social construction of knowledge, which should be shared for the benefit of others. Relational ethics are central to African axiology. Together, the ontological, epistemological and axiological basis of African philosophy form a unique paradigm that emphasize community and examine phenomena in both physical and spiritual contexts to achieve a comprehensive understanding.