Nurses Redefine Vulnerability: From Label to Lifeline in Patient Care

Vulnerability is one of the most frequently invoked words in healthcare, yet it has long functioned more as a slogan than a scientific concept. In a sweeping analysis published in BMC Nursing, researchers Miriam Läpple of the University of Koblenz and Martina Hasseler of Ostfalia University of Applied Sciences set out to give the term disciplinary precision. Drawing on a principle-based concept analysis originally proposed by Penrod and Hupcey, the pair systematically searched three bibliographic databases, screened 1,169 records, and distilled 49 studies published between 1983 and 2024 into a coherent framework. Their verdict: vulnerability in nursing science is only partially mature, a construct whose theoretical promise outpaces its current definitional and operational rigor.

The stakes of this ambiguity are not academic. Etymologically, vulnerability derives from the Latin “vulnus,” meaning wound, and in everyday clinical discourse it has hardened into a sorting mechanism. People living with dementia, older adults, children, and persons with disabilities are routinely designated as “vulnerable groups,” triggering targeted protective measures such as infection controls during pandemics or safeguarding protocols against violence. But these categorizations are often social or expert attributions, shaped by epidemiologists, politicians, and institutional priorities rather than by the people so labeled. The authors note that it remains unknown whether affected individuals would describe themselves as vulnerable at all, which is why they deliberately use the phrase “so-called vulnerable groups” throughout their analysis.

This gap between categorial attribution and professional nursing practice matters because the discipline’s mandate has expanded. The International Council of Nurses now defines nursing as requiring people-centred, compassionate clinical and social care, alongside advancing public and population health and fostering safe and sustainable environments. Nurses in primary healthcare are called to lead, educate, research, advocate, and shape policy to improve health outcomes. To plan, justify, carry out, and evaluate interventions that acknowledge the social determinants of health, the discipline needs a theoretically grounded understanding of vulnerability rather than a loose label. Without one, the authors warn, nursing risks merely reproducing existing categorizations and failing to address the causes and relations underlying health inequity.

The methodological machinery behind the study is itself instructive. Principle-based concept analysis privileges empirical and theoretical publications over colloquial or media sources, aiming to synthesize the best available scientific knowledge into a working definition. The researchers searched MEDLINE via PubMed, CINAHL, and LIVIVO, a German life sciences index that includes gray literature. Notably, they avoided controlled vocabulary for vulnerability itself: the CINAHL major heading reflects susceptibility, and the MEDLINE descriptor is “Vulnerable Populations,” both deemed too restrictive for capturing the broader concept. Instead, they searched “vulnerability” as an all-text term combined with methodological keywords such as “concept” and “phenomenon.” Backward citation searching using the citationchaser tool supplemented the primary retrieval, and deduplication combined manual checks with the Rayyan application.

From the 49 included studies, 48 journal articles and one edited volume spanning ten countries, three diverging epistemological perspectives emerged. The first understands vulnerability as a universal human condition arising from inherent exposure to potential harm. Authors in this tradition underscore human fragility and mortality, existential uncertainty, and relational dependence that makes vulnerability mutual. This “emic” perspective, rooted in anthropological and philosophical approaches, is linked to lived experience and varies with self-perception of challenges. Crucially, it permits growth: openness to experience can be positive even when accompanied by stress, anxiety, or threats to autonomy.

The second perspective is risk-oriented and individual. Here vulnerability means impaired self-protection or an increased likelihood of harm, associated with susceptibility, frailty, and what Derek Sellman termed “more-than-ordinary” vulnerability. This “etic” view anchors in group-level demographics or situational exposures, designating children, older adults, people with mental health issues or disabilities, and socioeconomically disadvantaged groups as vulnerable. Nichiata and colleagues summarize it as addressing alterations from biological or psychological normalcy, often within a biomedical context where individuals are deemed vulnerable based on their constitution.

The third perspective builds on both, framing vulnerability as a multifactorial state shaped by social determinants of health. Authors describe it as the capacity to decide or act within risky situations, determined by individual, familial, cultural, social, political, biological, and economic factors. Interrelations are identified along individual axes such as resources for safe behaviors, social axes including access to care, information, and rights, and programmatic or institutional axes covering prevention, promotion, and care. Exposure to harm and coping capacity depend heavily on these factors, and individuals are not deemed responsible when structural conditions limit self-care opportunities. Vulnerability thus serves as an indicator of social inequality and health inequity, defined by rights entitlement, participation, and economic policy.

Each perspective carries distinct methodological implications, which the analysis evaluates through the pragmatic principle. The universal-condition view relies on qualitative and phenomenological methods to capture how individuals experience and appraise potentially vulnerable events; Havi Carel’s phenomenological approach emphasizes the lived body, and Barbara Schrems draws on Kipnis’s model of cognitive, juridical, deferential, medical, allocational, and infrastructural vulnerability patterns for participatory assessment. The risk-oriented view favors quantitative measures, with scales and assessment tools evaluating vulnerability in older adults through self-report or proxy assessment, and risk factors spanning age, gender, socioeconomic status, race, education, substance use, and early pregnancy. The social-determinants view examines health literacy, self-esteem, coping skills, economic instability, unemployment, and institutional factors such as stable funding for welfare services and human rights initiatives.

The linguistic and logical principles expose the concept’s fault lines. Vulnerability carries dual connotations: positive in the human-condition sense, where it is associated with growth and resilience, and negative in the biomedical sense of heightened risk. The term is frequently conflated with risk, susceptibility, and frailty, though researchers argue these are distinct: risk concerns individual susceptibility to adverse outcomes, whereas vulnerability encompasses quality of life. Frailty is characterized variously as a state or precursor of vulnerability, and concepts such as marginalization, stigma, and oppression exhibit logical interrelationships with it, since designating people as vulnerable often signifies powerlessness that can lead to stigmatization. Resilience serves as the opposing construct, emphasizing coping strategies and available resources. The analysis concludes that vulnerability is logically related to these surrounding concepts yet lacks clear delimitation in current nursing discourse.

Synthesizing the three perspectives, the authors propose a preliminary definition: vulnerability in nursing science represents an inherent human condition whose manifestation is shaped by individual, programmatic, environmental, institutional, and sociocultural dimensions, with life circumstances reflected in the dynamic interplay of subjective and objective factors directly or indirectly modulating it for better or worse. Their conceptual model places the individual dimension at the center, links it to social determinants including water, sanitation, housing, healthcare, education, and employment, and situates institutional and programmatic state-level factors at the periphery, where politics, culture, and the prevailing health paradigm shape moral values, legislative frameworks, and economic trajectories. Regional patterns are evident: Brazilian studies emphasize the public-health perspective, North American and European studies tend toward biomedical risk framing, and European contributions additionally engage research ethics and subjective perspectives.

Across the four principles, the verdict is partial maturity. Epistemologically, each perspective demonstrates maturity within its domain, but the integrative model remains exploratory and lacks empirical validation. Pragmatically, no assessment tool currently incorporates the integrative concept, and the qualitative, self-assessed approach to perceived embodied vulnerability remains largely unexplored. Linguistically, usage is inconsistent, and the demarcation from susceptibility, frailty, and risk is blurred. Logically, terminological inconsistency constrains any claim of full maturity. The authors also acknowledge limitations: the analysis excluded adjacent disciplines such as sociology, philosophy, and ethics unless explicitly discussed within nursing; the framework does not address ontology, axiology, or ethics; and the search may have missed relevant gray literature. They further situate the work within feminist epistemology debates, noting that classifying concepts as mature or immature risks overlooking standpoint perspectives and power relations, and that perspectives from nursing ethics and caring science need integration in future work.

The implications reach well beyond terminology. The authors argue that the dominance of the individualistic perspective in nursing reflects the discipline’s embedding in neoliberal discourses that frame health as a matter of personal responsibility rather than structural determinants. A nuanced conceptualization of vulnerability, by contrast, may serve as a critical lens for questioning how social and healthcare systems recognize, accommodate, and address vulnerability in its multifaceted forms. Because individuals have limited scope for health-related decision-making under structural arrangements that neglect barriers to resources and access, the discipline is called to operate across multiple levels: applying health-promotion theories at the individual level, engaging with social determinants at the structural level, and guiding policies and institutions at the programmatic level. Established connections between sense of coherence and health literacy suggest a plausible pathway: investing in health promotion and health literacy is key to reducing individual vulnerability. The next steps are demanding but concrete: developing discriminant definitions vis-à-vis related constructs, advancing valid operational measures, and testing the concept empirically across settings to support assessment, intervention design, and system-level strategies for health promotion, disease prevention, and more equitable healthcare models.

Subject of Research: Vulnerability in nursing science: a principle-based concept analysis

Article Title: Vulnerability in nursing science: a principle-based concept analysis

Article References: Läpple, M., & Hasseler, M. (2026). Vulnerability in nursing science: a principle-based concept analysis. BMC Nursing, 25(1), Article 989. https://doi.org/10.1186/s12912-026-05523-w

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05523-w

Keywords: nursing, vulnerability, concept analysis, social determinants of health, health equity, BMC Nursing, nursing science, health policy, science, principle-based, concept, analysis