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To propose an ethical decision-making framework for artificial intelligence (AI) involvement in person-centred fundamental care, organised around the relational dependency of care activities and grounded in the Fundamentals of Care Framework and the Caring Life Course Theory.
Discursive paper integrating care ethics, the Fundamentals of Care Framework, the Caring Life Course Theory, person-centred care theory and technology ethics scholarship.
Peer-reviewed literature (primarily 2006–2026, plus seminal earlier care-ethics works) from nursing, bioethics, technology ethics and health informatics was searched across CINAHL Complete, PubMed, PsycINFO and Scopus. Policy documents from the World Health Organisation (WHO), the International Council of Nurses (ICN) and the European Union (EU) were also reviewed.
The Relational Care–Artificial Intelligence Alignment (RCAA) framework operates within the three established dimensions of the Fundamentals of Care Framework (relationship, integration of care and context) and classifies fundamental care activities by relational dependency into three zones: Zone 1 (high dependency), where AI serves as background support; Zone 2 (moderate dependency), where collaborative human–AI partnership is appropriate; and Zone 3 (low dependency), where autonomous AI operation under human oversight is acceptable. Five ethical principles guide zone placement: relational autonomy, non-maleficence of depersonalisation, universal access to person-centred fundamental care, transparency and explicability and proportionality. Each is grounded in established care ethics, bioethics or AI governance traditions. Establishing the nurse–patient relationship and eliciting patient preferences sit at the entry point of the framework.
The framework offers a structured approach for determining where AI can participate in fundamental care while preserving the relational essence of nursing. It is offered as a heuristic to facilitate discussion and action across clinical, educational and policy settings.
The framework can inform institutional AI adoption policies, guide nursing curricula and support regulatory standards for technology deployment in care.
What problem did the study address? The absence of a systematic ethical framework, anchored in established person-centred fundamental care theory, for determining appropriate boundaries of artificial intelligence involvement in fundamental nursing care. What were the main findings? A relational dependency-based classification, situated within the Fundamentals of Care Framework, can guide artificial intelligence involvement through three zones of human–machine collaboration while preserving patient choice and the centrality of the nurse–patient relationship. Where and on whom will the research have an impact? Nurses, healthcare organisations, policymakers and technology developers working through artificial intelligence integration into person-centred care.
This study did not include patient or public involvement in its design, conduct or reporting. We acknowledge this as a limitation and discuss it explicitly in the Strengths and Limitations section.
To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual.
Systematic review and meta-analysis.
Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined.
A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025.
A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence.
This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships.
These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
The research protocol was registered with PROSPERO (CRD420251027354).
To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based healthcare.
A two-round Delphi survey was carried out from April to June 2023.
Consensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence-Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions.
Sixteen national and three international experts were involved in the first-round Delphi survey and 17 experts participated in the second-round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence-generation, evidence-synthesis, evidence-transfer and evidence-implementation. In round-one, the instrument was revised from 77 to 61 items. In round-two, the instrument was further revised to have 57 items under the four dimensions in the final version.
The Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally.
Systematic assessment of nurses and other health professionals' competencies in different phases of evidence-based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence-based practice and better care process and outcomes.
This study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes.
This study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies.
No patient or public contribution.
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