Nursing students see community nurses as mothers, shields and even air

Ask a nursing student to finish the sentence “A community nurse is like…” and the answers are far more revealing than any standard job description. A new study from China has done exactly that, collecting 216 metaphorical completions from undergraduate nursing students and sorting them into a taxonomy of how the next generation of nurses actually imagines community-based care. The results, published in BMC Nursing, show students reaching for images of mothers, shields, bridges, lighthouses and even air — everyday concepts that carry surprisingly precise information about how they understand one of the least visible but most consequential roles in modern health systems.

The research team, led by Yayun Song and Pu Lin of Hubei Polytechnic University together with Jia Qu of Tongji Hospital at Huazhong University of Science and Technology, designed a descriptive qualitative study with a deceptively simple instrument. In June 2025, students from three cohorts at a single university in central China were given a fill-in-the-blank prompt: “A community nurse is like ______ because ______.” Each response consisted of two parts — an image and a justification — and the pair together formed the unit of analysis. This structure matters methodologically, because the metaphor alone can be ambiguous; it is the stated reason that anchors the interpretation and allows researchers to code responses reliably rather than reading meanings into them.

The analytical machinery behind the study combined two complementary approaches. The researchers used inductive qualitative content analysis, meaning that categories emerged from the data itself rather than being imposed from a pre-existing framework. At the same time, they adopted conceptual metaphor theory as a sensitizing lens — the idea, originating in cognitive linguistics, that metaphors are not decorative flourishes but cognitive tools through which people understand abstract or unfamiliar domains in terms of concrete, embodied experience. A community nurse is an abstract professional role; a mother, a shield or a breath of air are immediately graspable. The gap between the two is precisely where the students’ mental models live.

To guard against the subjectivity that plagues qualitative coding, the team built in two verification steps. First, intercoder agreement was formally assessed on 65 responses that were independently categorized, providing a quantitative check on whether different coders assigned the same responses to the same categories. Second, in a member-checking procedure, 22 participants reviewed the category their own response had been assigned to along with the category’s description, confirming or challenging the researchers’ interpretation. The study was approved by the Institutional Review Board of Hubei Polytechnic University in May 2025 and conducted in accordance with the Declaration of Helsinki, with written informed consent obtained from all participants before data collection.

Out of this process emerged six descriptive categories, and their relative sizes tell a story about what dominates students’ imaginations. The largest group, accounting for 31.0 percent of responses, was Nurturer/Caregiver — the metaphorical territory of mothers, warmth and sustenance. Students in this category framed community nursing as relational, emotionally close care, the kind of work that feeds and sustains people rather than merely treating them. The second-largest category, at 23.6 percent, was Guardian/Defender, capturing images of protection: the nurse as a shield standing between residents and illness, harm or vulnerability. Together, these two categories account for more than half of all responses, suggesting that students conceive of community nursing first and foremost through intimacy and protection rather than through technical procedure.

The remaining categories sketch a more organizationally sophisticated picture. Connector/Coordinator, at 16.2 percent, captured the nurse as a bridge or link — someone who joins residents to resources, services and the wider health system. Guide/Educator, at 13.4 percent, emphasized teaching, health promotion and lighting the way for people to manage their own health. Versatile/Multi-role Professional, at 10.2 percent, reflected an awareness that community nursing demands adaptability, with students describing the nurse as a multi-tool or an all-rounder who must shift between roles as circumstances demand. The final 5.6 percent fell into Other Role Representations, a residual category covering responses focused on specific tasks, working style or perceived professional value rather than a coherent relational image.

What makes these findings more than a curiosity is what the metaphors reveal about the reasoning behind them. The authors note that students represented community nursing through three interlocking dimensions: relationships with residents, the organization of care, and the sheer variety of responsibilities the role entails. A student who writes “a community nurse is like a mother because she cares for residents with warmth and patience” is not just being sentimental — she is encoding a theory of care that privileges continuity, emotional labor and long-term relationship over episodic intervention. A student who chooses “air” — something omnipresent, essential and often unnoticed — is making a subtler claim about how community nursing functions as invisible infrastructure for population health.

There is also a diagnostic dimension to the technique. Metaphor elicitation, as the authors point out, can help educators explore students’ understanding of community nursing and open discussions about the reasoning and responsibilities involved in practice. If a cohort overwhelmingly produces nurturer images while underrepresenting coordination or education, that imbalance is a signal — perhaps of curricular gaps, perhaps of limited clinical exposure to the full breadth of community roles. Conversely, the prominence of Connector/Coordinator and Versatile/Multi-role Professional categories in this sample suggests that at least some students already grasp that community nursing is less about bedside tasks and more about orchestrating care across households, clinics and social services. For educators designing placements and role-modeling opportunities, the metaphor inventory functions as a low-cost, high-yield window into professional identity formation before it hardens.

The study’s setting adds context to its interpretation. Community nursing in China sits within a health system under pressure from an aging population, chronic disease burden and policy pushes toward tiered, community-first care — making the pipeline of students who choose community roles a matter of national health strategy. How students conceptualize the role influences whether they see it as a career destination or a professional backwater. The metaphors collected here — overwhelmingly positive, relational and protective — suggest an idealized but genuinely engaged view, one that educators could either nurture or, if left unexamined, allow to collide with the bureaucratic and logistical realities of practice. The authors are careful not to overclaim: this was a single university, three cohorts, and a one-prompt instrument, and the findings are descriptive rather than predictive.

Methodologically, the paper is a compact demonstration of how a qualitative prompt can be made rigorous. The SRQR standards for reporting qualitative research frame the write-up; the inductive coding with a sensitizing theory, the quantified intercoder agreement, and the member checking with participants collectively address the classic objections to metaphor research — that categories are arbitrary and interpretations are projections. The funding acknowledgments, spanning Hubei provincial teaching reform projects and a national medical education research program, signal institutional interest in the pedagogical payoff of this line of work. For a field where professional identity is known to shape retention, job satisfaction and quality of care, a two-blank sentence may turn out to be one of the cheapest diagnostic instruments available. The next step, implicitly, is longitudinal: tracking whether the students who wrote “shield” and “air” as undergraduates become the community nurses who embody those images — or discover that the reality demands a metaphor no one thought to write down.

Subject of Research: Metaphorical perceptions of the community nursing role among undergraduate nursing students

Article Title: ‘Mother, shield, or air’: undergraduate nursing students’ metaphorical constructions of the community nursing role

Article References: Song, Y., Lin, P., & Qu, J. (2026). ‘Mother, shield, or air’: undergraduate nursing students’ metaphorical constructions of the community nursing role. BMC Nursing. https://doi.org/10.1186/s12912-026-05494-y

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05494-y

Keywords: community nursing, nursing education, nursing students, metaphor elicitation, professional role perception, qualitative content analysis, conceptual metaphor theory, nursing research, China, professional identity, Mother, shield