Vulnerability in nursing science: a principle-based concept analysis.

Abstract

Background: The term "vulnerability" is widely used across disciplines and variably defined within nursing, reflecting differing theoretical and methodological assumptions. This ambiguity hinders coherent application in research and practice. A broad understanding of vulnerability in healthcare is susceptibility to risks and/or illnesses, implying the need for special protection or treatment.

Methods: To clarify the concept of vulnerability in nursing, its disciplinary meanings were synthesized and its maturity was evaluated by using a principle-based concept analysis according to Penrod and Hupcey (2005), which was conducted on nursing literature. Databases MEDLINE via PubMed, CINAHL and LIVIVO were systematically searched with defined keywords, and citation searching. Of 1,169 records identified, 49 studies (1983-2024) were included. The evidence was evaluated using the principles of principle-based concept analysis: epistemological adequacy, pragmatic utility, linguistic clarity, and logical coherence.

Results: Three diverging perspectives were identified: (1) vulnerability as a universal human condition; (2) vulnerability as an individual, risk-oriented notion; and (3) vulnerability as a multifactorial state influenced by social determinants of health. Each perspective shapes nursing's approach to individuals in its own way, focusing on different methodologies. The three perspectives have been combined into an integrative concept for nursing. It addresses the individual, community, and healthcare policy levels. The multidimensionality of vulnerability is suitable to support the notion of nursing care for the individual with a view to the social determinants of health. An assessment of the concept across the principles indicates that it is partially mature and requires further theoretical and empirical development.

Conclusions: The analysis provides an integrative concept of vulnerability for nursing science which can serve as a foundation for its disciplinary use and thematic relevance. Further work should develop discriminant definitions vis-à-vis related constructs, advance valid operational measures, and test the concept empirically across settings to support assessment, intervention design, and system-level health policy, health-promotion, and disease prevention strategies.

Trial registration: Not applicable.