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Self‐Leadership and Caring as Enacted Professional Practice: Reconceptualizing Autonomous Clinical Decision‐Making in Nursing

Year: 2026

Type: article

Abstract: Prevailing accounts of autonomy in nursing continue to emphasize structural authority, role‐based permission, or legal scope of practice, offering limited insights into how nurses exercise judgment amid clinical complexity, moral uncertainty, and relational demands. This conceptual integrative review therefore seeks to reposition self‐leadership and caring as foundational practices through which autonomy is enacted in everyday nursing work. Drawing on self‐leadership theory articulated by Manz and Neck, alongside Jean Watson’s theory of human caring and Kristen Swanson’s theory of caring, this paper adopts a reflective and analytical synthesis to examine how intrapersonal agency, moral–relational orientation, and caring‐based clinical action contribute to autonomous clinical decision‐making in nursing practice. Rather than treating leadership and caring as parallel or equivalent domains, the analysis integrates these perspectives as complementary dimensions to reconceptualize autonomous clinical decision‐making as a multidimensional professional practice encompassing cognitive, moral, relational, and behavioral dimensions. The paper advances the integrated self‐leadership and caring model of autonomous clinical decision‐making (ISLC‐ACDM), which conceptualizes autonomy as an emergent and relationally enacted professional capacity shaped through the interaction of self‐leadership as an intrapersonal resource, caring orientation as a moral‐relational foundation, and caring praxis as the enactment of clinical judgment. By reframing autonomy as something nurses enact within clinical practice rather than merely possess or are granted, the model offers a more contextually grounded understanding of nursing practice in complex healthcare environments. This reconceptualization provides a theoretically grounded framework to inform future research, nursing education, leadership development, and professional policy, supporting a more nuanced understanding of autonomous clinical decision‐making as an ethically grounded and relationally situated professional practice.

Source: Nursing Forum

DOI: 10.1155/nuf/2212561

Authors: Mahmud Ady Yuwanto, Iyus Yosep, Iqbal Pramukti, Ati Surya Mediawati

Institutions: Universitas dr. Soebandi, Padjadjaran University

Language: English

Topic: Nursing education and management

Subfield: Research and Theory

Field: Nursing

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $840