Vulnerability Within A Nursing Clinical Practice. A Qualitative Review

TL;DR

This paper reviews how vulnerability affects both patients and nurses in clinical practice, shaped by personal, relational, and societal factors.

Contribution

The study provides a qualitative synthesis of vulnerability in nursing from both patient and nurse perspectives.

Findings

Vulnerability in patients is linked to loss of bodily autonomy and lack of holistic care.

Nurses experience vulnerability due to emotional strain and ethical tensions in their work.

Vulnerability can foster ethical sensitivity and stronger nurse-patient relationships.

Abstract

Vulnerability is a fundamental human condition shaped by existential interdependence and social structures. In nursing, it is experienced by both patients and nurses, influenced by care relationships, institutional norms, and ethical responsibilities. This review explores how the phenomenon of vulnerability is reflected in the research literature on nursing clinical practice, from both patient and nurse perspectives.

A qualitative literature search of eight bibliographic databases (inception to 13 May 2025) identified 29 papers, assessed using the Critical Appraisal Skills Programme Qualitative Checklist (CASP-QC). Data were analysed through qualitative content analysis inspired by Graneheim, Lundman and Lindgren.

Socioeconomic and sociopolitical conditions shape vulnerability by influencing care needs and perceptions of healthcare and nursing. Physical changes that compromise bodily autonomy expose patients to undignified care, as loss of control over one's body can lead to embarrassment, shame, and diminished dignity. A lack of holistic care increases patient vulnerability when professionals fail to recognise patients as unique individuals. Nurses’ vulnerability is portrayed as a significant burden, shaped by personal suffering, grief, and contextual work factors. This suffering may result in emotional distancing from patients when nurses lack the courage to engage.

Vulnerability is multifaceted, shaped by personal, relational, and sociopolitical conditions. Patients often experience vulnerability through lack of recognition of individuality and dignity, while nurses face emotional strain, knowledge gaps, ethical tensions and limited support. Vulnerability can also be viewed as a strength, fostering ethical sensitivity, moral courage and deeper nurse–patient relationships.

Figures

PRISMA flowchart (Page et al., 2021).

Full text

Introduction

Vulnerability is a fundamental human condition shaped by existential interdependence and social structures. Within nursing, vulnerability is experienced by both patients and nurses, influenced by care relationships, institutional norms, and ethical responsibilities. For the nursing profession, the phenomenon of vulnerability has a profound impact on the delivery of care and the treatment of patients. This review explores how the phenomenon of vulnerability is reflected in the research literature on nursing clinical practice, from both patient and nurse perspectives. It is informed by the ethical framework of ethics of proximity articulated in the works of Løgstrup and Martinsen, as well as Butler's perspectives on ethics and cohabitation.

Background

Vulnerability is a universal phenomenon; we are all vulnerable and experience it in different ways and contexts. It can be understood in a personal context, influenced by social resources, oppression and growth, or as primarily related to health and disease (Havrilla, 2017). Mergen and Akpinar (2021) approach the phenomenon from a bioethical perspective, distinguishing between ontological grounds, which address the existential meaning of the term and circumstantial grounds, which relate to individual and social structures. Sanchini et al. (2022), in exploring vulnerability in elderly care, identified two perspectives: universal vulnerability – an ontological condition representing basic human vulnerability – and situational vulnerability, which arises from unfair social, political and economic conditions.

Inspired by Løgstrup's view of human life as one of interdependence, Martinsen (2003, 2012) argues that human beings are interconnected and dependent on one another, particularly on caring for and from others. Martinsen (2006) explains that vulnerability is a fundamental prerequisite for all life, and that our inherent vulnerability brings with it an ethical responsibility to respond to the vulnerability of others (Martinsen, 2006, 2012). Similarly, the American philosopher Judith Butler (2012) views vulnerability as universal, existential and relational. Drawing on a phenomenological perspective, Butler emphasises that the lives of others are not our own, yet are connected to ours in the sense that, from the beginning, our lives depend on a world of others, constituted in and by a social world. In contrast to Løgstrup and Martinsen, Butler's perspective in a nursing context offers insight into how our shared vulnerability affects life on both individual and social levels (Hillestad et al., 2024).

According to Sellman (2005), nursing often frames patients as vulnerable, assuming they are more susceptible to harm – either because they cannot protect themselves or because they are exposed to greater risks. Delmar (2006) stated that life phenomena constitute a fundamental condition in our search for content and meaning. Delmar (2019) further explains that some phenomena are ethical in a relational sense; some are existentially life-limiting, while others are existentially life-facilitating, such as life courage. Human vulnerability overlaps with these life phenomena, encompassing both ethical and life-limiting aspects. Engaging with patients’ life phenomena by listening to their stories requires an existential approach rather than an exclusively technological or biomedical one (Delmar, 2019).

Hillestad et al.'s (2024) review shows that nurses’ organisation of daily work and their interaction with marginalised patients can exacerbate patients’ vulnerability. This vulnerability arises not only from nurses’ norms and values but also from the structure of the institutional healthcare system. The review also highlights nurses’ own vulnerability in relation to working conditions, societal recognition and professional socialisation during nursing education.

The application of the concept of vulnerability in bioethical literature and nursing research has been questioned when used to describe the care of vulnerable individuals (Havrilla, 2017; Mergen & Akpınar, 2021; Sanchini et al., 2022). Wrigley (2015) criticises the concept as being too vague, overly broad or too narrowly defined. This review does not aim to analyse the concept itself but rather to examine the phenomenon it seeks to capture, a distinction worth noting. To the best of our knowledge, no qualitative review has synthesised the phenomenon of vulnerability in nursing clinical practice from both patient and nurse perspectives.

Aim

This review aimed to explore how the phenomenon of vulnerability is reflected in the research literature on nursing clinical practice, from both patient and nurse perspectives.

Methods

Study Design

This qualitative review was developed according to updated PRISMA guidelines (Page et al., 2021). We also used the ENTREQ-guideline to ensure scientific rigour and transparency (Tong et al., 2012).

Search Methods

In May 2025, two authors (Lauritzen and Schneider) conducted a literature search to identify studies using various research designs, such as qualitative and mixed methods studies, when qualitative data could be separated. The search strategy and terms were developed and agreed upon by all authors. The search was peer reviewed by two academic librarians and published in the Open Science Framework (OSF) Research Data Archive (Schneider et al., 2024).

Search Strategy/Identifying Relevant Studies

The inclusion and exclusion criteria and search terms were guided by the SPIDER framework (Sample, Phenomenon of Interest, Design, Evaluation and Research type) (Cooke et al., 2012). No limits were set on year of publication (Table 1).

A comprehensive search across eight appropriate and relevant databases was conducted. CINAHL was included due to its comprehensive coverage of nursing, as the main focus of this review. MEDLINE and Embase were also selected as they are the next most relevant databases for nursing literature (Gusenbauer, 2022).

A two-step search strategy was used. First, we did a limited search of CINAHL and MEDLINE. This revealed that ‘vulnerability’ and ‘nursing’ produced a vast number of irrelevant results. Vulnerability is often used as a peripherally term in abstracts – only slightly or not at all representing the study's main focus.

A second search was therefore conducted where precision was prioritized, targeting only the title field, in order to retrieve studies with a main focus on vulnerability in nursing. We searched for two SPIDER elements – ‘Vulnerability’ AND ‘Nurs*’ (truncated) across all selected databases. The databases searched from inception to 13 May 2025 were: CINAHL (EBSCO), MEDLINE (EBSCO), AMED (EBSCO), Academic Search Premier (EBSCO), APA PsycINFO (EBSCO), Scopus, Embase and Idunn (Schneider et al., 2024).

Selection of Studies

The PRISMA flowchart (Figure 1) showed that a total of 482 potentially relevant papers were identified. All identified studies were transferred to the reference management software Zotero, where 286 duplicates were removed. The titles and abstracts of the remaining 196 studies were screened in the review management software Rayyan (Qatar Computing Research Institute) by three authors (Marchen, Kvande, Hillestad) using the a priori inclusion and exclusion criteria outlined in the SPIDER framework (Cooke et al., 2012). After abstract evaluation, 156 irrelevant papers were excluded.

PRISMA flowchart (Page et al., 2021).

A full-text review of the remaining 40 papers was then conducted by the same three authors. After reading the papers, these authors discussed disagreements until a consensus was reached, and 29 papers met the inclusion criteria and were deemed eligible for the review. All included papers were independently assessed for quality using the CASP-QC (?Table 2). Quality assessments were discussed among all authors until consensus was reached, after which the 29 papers were confirmed for inclusion (Table 3).

Table 1.: Inclusion and Exclusion Criteria SPIDER Framework (Cooke et al., 2012).

Table 2.: Critical Appraisal Skills Programme (CASP).

Table 3.: The Descriptive Characteristics of the Articles (n = 29).

Analysis

The articles were analysed using qualitative content analysis inspired by Graneheim, Lundman and Lindgren (Graneheim & Lundman, 2004; Graneheim et al., 2017; Lindgren et al., 2020). First, all articles were read to gain a comprehensive understanding of the whole. The next step was to identify meaning units relevant to the study's aim. These meaning units were extracted and labelled with codes. Based on similarities and differences, the codes were grouped, re-contextualised and abstracted into categories. The categories were then grouped into four themes (Graneheim et al., 2017; Lindgren et al., 2020).

Three of the authors (Marchen, Kvande, Hillestad) conducted the initial analysis, which included reading the articles and developing codes. Data extraction was handled in Microsoft Word. They also grouped and reconstructed these codes into categories. The remaining authors reviewed the categories and themes to ensure consistency and took part in further analysis, in which sub-themes and themes were identified. Consensus was reached through dialogue within the research team, and the process continued until no further insights emerged. This approach was undertaken to strengthen the transparency and trustworthiness of the findings (Graneheim & Lundman, 2004; Graneheim et al., 2017).

Results

The findings were organised into four themes: (a) socioeconomic and sociopolitical conditions shaping vulnerability; (b) vulnerability and the body; (c) vulnerability arising from nurse–patient interactions; and (d) nurses’ vulnerability in encounters with patients. Of the 29 articles reviewed, 26 interpret vulnerability primarily as fragility, encompassing socioeconomic disadvantage, social marginalisation, psychological insecurity, organisational pressures, and violations of dignity (Angel et al., 2020; Bombonatti et al., 2021; Brandão et al., 2016; Chenitz, 1989; Dalton et al., 2021; dos Santos & Gomes, 2013; Ferreira et al., 2013; Geuens et al., 2021; Heaslip & Board, 2012; Heydarikhayat et al., 2024; Høy et al., 2016; Hudon et al., 2023; Kim et al., 2017; Liaschenko, 1997; Liu & Chiang, 2017; Malone, 2000; Melissa dos Reis Pinto et al., 2015; Morrissette, 1986; Nobis & Sandén, 2008; Nugent et al., 2022; Rydeman & Törnkvist, 2006; Silva et al., 2015; Vatne, 2017; Villamin et al., 2025; Wallerstedt et al., 2011; Zarth et al., 2024). The remaining three articles interpret vulnerability as a strength (Sarvimäki et al., 2017; Stenbock-Hult & Sarvimäki, 2011; Thorup et al., 2012). These studies emphasise acknowledging nurses’ own vulnerability, transforming challenging situations into inner strength, and viewing vulnerability as a foundation for ethical formation, requiring courage to act, stay and speak out.

Overall, most studies interpret vulnerability as fragility linked to disadvantage and marginalisation, while a minority regard it as a resource for ethical growth and resilience.

Socioeconomic and Sociopolitical Conditions Shaping Vulnerability

Socioeconomic and sociopolitical conditions shape vulnerability by influencing care needs and perceptions of healthcare and nursing. Disadvantages often intersect among people experiencing homelessness, low educational attainment, poverty, or financial hardship (Bombonatti et al., 2021; Brandão et al., 2016; Heydarikhayat et al., 2024; Høy et al., 2016; Hudon et al., 2023; Liaschenko, 1997; Melissa dos Reis Pinto et al., 2015; Rydeman & Törnkvist, 2006; Silva et al., 2015; Villamin et al., 2025; Zarth et al., 2024). Pregnant women in vulnerable circumstances frequently lack decision-making power, social support, and access to care, while young adults with limited education face heightened risks of STDs, HIV and AIDS. These conditions delay or prevent access to healthcare, increasing unintended pregnancies, STDs, exposure to drug trafficking, and reducing life expectancy (Hudon et al., 2023; Melissa dos Reis Pinto et al., 2015; Silva et al., 2015; Zarth et al., 2024). Homeless individuals often confront substance abuse, trafficking, and violence, perpetuating cycles of marginalisation and inadequate care for themselves and their children (Bombonatti et al., 2021). Older adults encounter particular vulnerabilities when entering nursing homes or other care facilities, where dignity, autonomy, and social engagement may diminish. Hospital discharge is another critical juncture, where systemic weaknesses, limited ethical consideration, and insufficient patient involvement can lead to increased dependence and neglect of individuality (Høy et al., 2016; Rydeman & Törnkvist, 2006).

Systemic shortcomings in mental healthcare, such as under-resourced services, inadequate training, poverty, violence, and social exclusion, further exacerbate vulnerability; fragmented care, excessive bureaucracy, and commodification of services are of particular concern to frontline nurses (Brandão et al., 2016; Liaschenko, 1997). During the COVID-19 pandemic, nursing leadership faced added challenges including staff depletion, societal distrust in healthcare organisations, fragile operational performance, and widening inequalities (Heydarikhayat et al., 2024). Migrant nurses in Australia reported vulnerability linked to financial strain and limited social networks following migration, contributing to loneliness despite efforts to adapt (Villamin et al., 2025). Overall, socioeconomic and systemic conditions create layered vulnerabilities that intersect with institutional shortcomings, reinforcing cycles of disadvantage and limiting access to dignified care.

Vulnerability and the Body

Physical changes that compromise bodily autonomy can expose patients to undignified care, as loss of control over one's body may lead to embarrassment, shame, and diminished dignity. Dependence on others intensifies these risks, as seen among men with disabilities whose reliance on carers can threaten self-esteem and engender helplessness (Høy et al., 2016; Nobis & Sandén, 2008; Rydeman & Törnkvist, 2006).

In reproductive care, vulnerability is shaped by the dual-patient configuration of mother and foetus, uncertainty around birth, and anxiety. Where trusting relationships with nurses are present, women are more able to acknowledge vulnerability, accept risks, and disclose issues such as substance use, uncertain paternity, or abuse (Dalton et al., 2021). More broadly, adolescent sexual health risks are influenced by gender norms that shape sexual behaviours and produce disparities in exposure to STD and AIDS, highlighting how socio-cultural expectations interact with bodily vulnerability and the need for gender-responsive, trust-based care (Silva et al., 2015). Bodily vulnerability emerges when autonomy is compromised, with trust and relational care acting as key mediators in preserving dignity and reducing harm.

Vulnerability Arising from Nurse–Patient Interactions

A lack of holistic care increases patient vulnerability when professionals fail to recognise patients as unique individuals (Heaslip & Board, 2012; Høy et al., 2016; Rydeman & Törnkvist, 2006). Nursing home residents often felt overlooked when nurses prioritised tasks over personal engagement. From the resident's perspective, dignity entails being recognised and supported as an active member of society (Høy et al., 2016). Transitions from hospital to other care settings often felt isolated and dependent, shaped by overly medicalised care (Rydeman & Törnkvist, 2006).Vulnerability is further compounded by knowledge gaps as limited professional understanding can lead to diagnostic delays and treatment challenges, illustrated by the experiences of patients with sickle cell disease and their families (Ferreira et al., 2013).

Nurses in dementia care may find disease progression distressing, leading them to focus on clinical rather than emotional care to avoid attachment (Heaslip & Board, 2012). Similarly, dos Santos and Gomes (2013) found that caring for patients with HIV/AIDS could provoke insecurity, mechanised routines, reduced self-esteem, and lower quality of care.

Vulnerability in nurse–patient interactions often stems from insufficient holistic care and knowledge gaps, with emotional distancing and task prioritisation undermining dignity and trust.

Nurses’ Vulnerability in Encounters with Patients

Several studies portray nurses’ vulnerability as a significant burden, shaped by personal suffering, grief, and contextual work factors. Such suffering may create emotional distance from patients when the courage to engage is lacking (Thorup et al., 2012); loss and grief are associated with vicarious trauma and persistent anxiety, even in the absence of direct personal involvement (Nugent et al., 2022), while unresolved grief can erode self-esteem and compromise mental health, thereby increasing vulnerability (Liu & Chiang, 2017).

Vulnerability is associated with burnout (Geuens et al., 2021) and is heightened under the pressures of caring for older adults (Stenbock-Hult & Sarvimäki, 2011). Knowledge gaps and professional uncertainty further contribute (Angel et al., 2020; dos Santos & Gomes, 2013), though vulnerability can be mitigated through interaction with patients, relatives, colleagues, and managers (Angel et al., 2020), and by specialised knowledge in domains such as HIV/AIDS (dos Santos & Gomes, 2013). Working alone or with terminally ill patients heightens vulnerability as nurses confront their own mortality (Heaslip & Board, 2012; Wallerstedt et al., 2011), and limited bereavement support and insufficient collegial backing can hinder the processing of loss, intensifying stress (Geuens et al., 2021; Nugent et al., 2022). Ethically, the nurse's body serves as an “ethical thermometer” (Angel et al., 2020); psychiatric nurses mediate family distress while simultaneously supporting therapists (Morrissette, 1986); and vulnerability is linked to ethical formation, with courage emerging as a critical resource for helping patients face suffering and sustaining a commitment to care (Thorup et al., 2012). This courage arises from a deepened awareness of vulnerability in others (Malone, 2000). Overall, nurses’ vulnerability reflects emotional strain, ethical challenges, and knowledge gaps, while courage and collegial support remain essential for maintaining high-quality care.

Discussion

This review explored how the phenomenon of vulnerability is reflected in the research literature on nursing clinical practice, from both patient and nurse perspectives. A dual perspective emerges, underscoring the complexity of the phenomenon. Most studies portray vulnerability as fragility; fewer show it as strength, emphasising courage.

Vulnerability as fragility includes socioeconomic disadvantage, marginalisation, psychological insecurity, and individual vulnerability overlooked in organisational contexts (Bombonatti et al., 2021; Geuens et al., 2021; Hudon et al., 2023; Morrissette, 1986). This aligns with Butler's (Butler & Berbec, 2017) concept of precarity, which describes conditions where certain populations suffer disproportionately from failing social and economic support networks.

Vulnerability as strength highlights courage and the recognition of one's vulnerability. It involves transforming challenges into inner strength and viewing vulnerability as a basis for ethical formation, with courage to act, stay and speak out (Sarvimäki et al., 2017; Stenbock-Hult & Sarvimäki, 2011; Thorup et al., 2012). Delmar (2024) discusses professional courage as essential for nurses, given the complexity and unpredictability of clinical practice. Courage is not the absence of fear but the ability to act wisely and rightly despite it. It means being present with patient suffering, challenging personal biases, tolerating rejection, trusting decisions, and prioritising professional judgement. Delmar (2024) further describes courage as an active urge to act and engage in life, fostering meaning and promoting life.

Our study found that vulnerability manifests across social groups, including those who are homeless, undereducated, or impoverished, often facing intersecting challenges (Bombonatti et al., 2021; Hudon et al., 2023; Melissa dos Reis Pinto et al., 2015; Silva et al., 2015; Zarth et al., 2024). Social, economic, and institutional factors intertwine, shaping care needs, perceptions of healthcare, and attitudes toward nurses (Bombonatti et al., 2021; Brandão et al., 2016; Heydarikhayat et al., 2024; Høy et al., 2016; Hudon et al., 2023; Liaschenko, 1997; Melissa dos Reis Pinto et al., 2015; Rydeman & Törnkvist, 2006; Silva et al., 2015; Villamin et al., 2025; Zarth et al., 2024). Sanchini et al. (2022) identified both universal and situational vulnerability in elderly care and proposed three responses: understanding vulnerability, providing care, and intervening through socio-political measures. This is supported by Havrilla (2017) who found that vulnerability involves both individual and societal factors, influenced by social resources, oppression and health. Hillestad et al. (2024) found that healthcare structures and nurses’ work organisation can exacerbate patient vulnerability. This observation is consistent with that of Butler (2004) who explained that systemic inequalities shape nursing care, calling for practices that challenge norms and prioritise dignity.

Older adults face vulnerabilities when moving to care facilities, where dignity, autonomy, and social participation are often compromised. Discharge from hospital can heighten vulnerability when systemic weaknesses and limited patient involvement foster dependence and erode individuality (Høy et al., 2016; Rydeman & Törnkvist, 2006). Lévinas (1969) frames face-to-face encounters as ethically charged, wherein exposure to the other discloses vulnerability and imposes a responsibility to respond. This aligns with our findings and resonates with Martinsen's emphasis on the challenge of sustaining cultures that acknowledge and ethically safeguard existential vulnerability (Martinsen, 2006).

Our study found that systemic shortcomings in mental health care, and excessive bureaucracy, increase vulnerability and compromise care quality. The COVID-19 pandemic further exposed weaknesses through nurse depletion, societal distrust, organisational fragility, and widening inequalities (Brandão et al., 2016; Heydarikhayat et al., 2024; Liaschenko, 1997). Hillestad et al. (2024), highlight nurses’ vulnerability in relation to working conditions, and professional socialisation during their nursing education. Similarly, Stokes-Parish et al. (2023) found that critical care nurses rejected labels such as ‘heroes’ and ‘angels’ calling for improved role representation, recognition, and safe working conditions.

Vulnerability to undignified care arises from physical changes that compromise bodily autonomy, leading to embarrassment, shame, and a diminished sense of dignity. Dependence on others heightens the risk of undignified care (Høy et al., 2016; Nobis & Sandén, 2008; Rydeman & Törnkvist, 2006). Martinsen (2006) refers to the biblical story of the Good Samaritan as a fundamental narrative in care ethics, illustrating lifès vulnerability and our dependence on one another. According to Løgstrup (1997), one never interacts with another person without some degree of control; we constitute one another's world and destiny. Martinsen emphasises that being a caring nurse is a way of being, characterised by sensitivity to human vulnerability and a commitment to alleviating suffering while safeguarding dignity and worth. This aligns with our findings and those of Høy et al. (2016), who observed that nursing home residents often felt overlooked when nurses prioritised routine tasks over personal interaction. From the residents` perspective, dignity involves being acknowledged and supported as active members of society. Delmar (2019) adds that the asymmetrical nurse–patient relationship can either expand or constrain life-conductive possibilities. To expand these possibilities, nurses must recognise their role in inherent power relations. When nurses reject their own vulnerability and keep a protective distance, care becomes paternalistic, fostering passivity and undermining person-centred practice, potentially limiting or destroying the patient's life-conductive possibilities.

Our study found that a lack of holistic perspective and failure to acknowledge patients as unique individuals contribute to vulnerability (Heaslip & Board, 2012; Høy et al., 2016; Rydeman & Törnkvist, 2006). Patients felt overlooked and devalued when nurses prioritised medical tasks over holistic needs, often leaving them isolated, exposed, and dependent (Høy et al., 2016; Rydeman & Törnkvist, 2006). These findings resonate with Martinsen's (2006) rephrasing of Løgstrup's assertion that one always holds something of another person's life in one's gaze, and through that gaze, also in one's power. An objective attitude from healthcare professionals may deepen patientś sense of isolation. This aligns with Eriksson's (2002, 2006) theory of the suffering human being, which emphasises that nurses can either promote healing and comfort or, conversely, intensify suffering and vulnerability. Caring suffering arises when nurses fail to meet patients’ needs for respect, dignity and compassionate care.

An important aspect of our findings concerns dignity in care. Maintaining dignity involves treating patients as human beings, recognising who they are, and supporting their efforts to belong and participate as integrated members of society (Høy et al., 2016; Rydeman & Törnkvist, 2006). This reflects Martinsen's (2006) assertion that, in encountering a wounded person, one should look with the ‘eye of the heart’, a participatory, attentive gaze that allows the other to emerge as significant. The ethical demand arises when one remains open and receptive, striving to understand what is at stake. Through perception and understanding, this becomes a fundamental experience of protecting and caring for life.

Lévinas (1969) discusses the ethics of human encounters, emphasising vulnerability as central to face-to-face relationships. Such encounters expose us to otherś needs and demands, revealing our inherent vulnerability and ethical responsibility to respond. Inspired by Lévinas, Butler (2004, 2005, 2012) emphasises that face-to-face encounters are foundational to our interdependence within collective and political social structures. Encountering the face of the other and grasping its meaning serves as a powerful reminder of both the otheŕs vulnerability and humanity, and of the vulnerability of life itself. For vulnerability to become a productive force, Butler argues, it must be articulated, recognised and acknowledged. Our findings suggest that nurseś vulnerability is not merely an individual trait but a relational and ethical condition shaping encounters. When the courage to engage with suffering is lacking, emotional distance may arise, leaving patients at risk of feeling unseen, a vulnerability further intensified by grief, burnout, and professional uncertainty, and limited collegial support (Angel et al., 2020; dos Santos & Gomes, 2013; Geuens et al., 2021; Liu & Chiang, 2017; Nugent et al., 2022; Stenbock-Hult & Sarvimäki, 2011; Thorup et al., 2012). Yet vulnerability can also be ethically formative. When nurses recognise vulnerability in others, courage emerges as a vital resource for continuing care and responding meaningfully to patients’ appeals (Malone, 2000; Thorup et al., 2012). This aligns with Martinsen’s view that, in clinical contexts, nurses who are sensitive and attentive become receptive, touched and moved to respond to patients’ appeals and needs. Sensitivity involves presence and engagement, allowing nurses to listen, attend to, and care for patients. Conversely, when nurses are not attentively and vulnerably present, often due to the fast pace of the healthcare system, patients may be left exposed and may withdraw from receiving support (Martinsen, 2012).

Implications for Nursing Education and Practice

The results show that, in nursing education, curricula should integrate vulnerability as a core concept, not only as a patient characteristic but as an ethical and relational dimension of care. Vulnerability may serve as a source of strength and ethical formation, preparing nurses for reflective practice. Nursing education should also address systemic conditions, such as the social determinants of health and institutional structures that shape vulnerability, thereby equipping nurses to advocate for equity and dignity in care.

In clinical practice, nurses should adopt approaches that view vulnerability as a dynamic and relational phenomenon, fostering dignity and resilience while addressing systemic inequalities that perpetuate disadvantage. This calls for attentiveness, presence, and professional courage to uphold person-centred care under constraint, supported by work environments that allow time for relational care and prevent distancing attitudes and paternalistic practices.

The results also show that, at the policy level, policies influence organisational cultures in ways that shape values, norms, and the possibility of holistic care and ethical responsiveness, recognizing that vulnerability is inherent to human life and central to the nurse-patient relationship.

Strengths and Limitations

A key strength of this qualitative review is its systematic and critical approach adopted throughout the review process, including the use of the PRISMA framework, the ENTREQ-guideline, and the SPIDER tool to guide inclusion criteria tailored for qualitative research.

Qualitative content analysis enabled an in-depth synthesis of complex and nuanced perspectives on vulnerability in clinical nursing practice. The inclusion of diverse clinical nursing contexts and populations enriched the understanding of how vulnerability manifests across different situations, individuals, and illness experiences. However, the review also encountered certain limitations. The number of well-indexed qualitative studies explicitly addressing vulnerability in clinical nursing practice was limited. This may reflect a broader underrepresentation of phenomenological and ethically grounded perspectives in current nursing research databases. The relatively small number of included studies may be partially a result of the restrictive search strategy rather than a true lack of existing research. The findings indicate that vulnerability as a phenomenon is relevant within clinical nursing practice, both in terms of patient experiences and the emotional and professional dimensions of nursing.

Future research should explore vulnerability from relational, ethical, and organisational perspectives to support and strengthen clinical practice and political relevance.

Conclusion

Vulnerability is a multifaceted phenomenon that affects both patients and nurses, shaped by personal, relational and sociopolitical conditions. It is often perceived as fragility, emerging in contexts of socioeconomic hardship, illness, dependency and organisational neglect. For patients, vulnerability may arise from a lack of recognition of individuality and dignity; for nurses, it can stem from emotional distress, knowledge gaps, ethical tensions and inadequate support.

Vulnerability can also be understood as a strength, fostering ethical sensitivity, moral courage and deeper nurse–patient relationships. Holistic, person-centred and ethically conscious care is essential – recognising patients as unique human beings and viewing nurses’ vulnerability not as weakness but as a source of ethical reflection and relational depth. In nursing, vulnerability should be regarded as a dynamic, relational phenomenon that demands attentiveness, courage, and ethical responsiveness to human suffering and interdependence.