Humanizing Digitalnursing Practice: Preserving Caring Values in the Era of Technology-driven Healthcare: A Scoping Review

Humanizing Digitalnursing Practice: Preserving Caring Values in the Era of Technology-driven Healthcare: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Humanizing Digitalnursing Practice: Preserving Caring Values in the Era of Technology-driven Healthcare: A Scoping Review Ida Ayu Kade Sri Widiastuti, Moses Glorino Rumambo Pandin, Yuni Sufyanti Arief This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7935522/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The digital transformation of healthcare has reshaped how nurses deliver care and express human compassion. Technologies such as Electronic Health Records (EHR), telehealth, and artificial intelligence (AI) enhance efficiency yet challenge the preservation of human touch within therapeutic relationships. Objective The aim of this study was to map empirical evidence on how digital technology influences, reshapes, and preserves the values of caring and human touch in nursing practice. Method This scoping review, guided by Arksey and O’Malley’s framework and PRISMA-ScR, synthesized. Result 16 empirical studies published between 2020 and 2025. Thematic analysis using the Population Concept Context (PCC) framework identified four themes: (1) transformation of caring and technological competence; (2) adaptive strategies and digital empathy; (3) emotional and ethical challenges in virtual care; and (4) human-centered design and organizational support. Conclusion Integration of Watson’s, Swanson’s, and Barnard’s theories revealed that caring in the digital era evolves into technological caring or digital compassion a synthesis of empathy, ethical reflection, and technological proficiency. Humanizing digital nursing requires balancing system efficiency with relational integrity. Further experimental and cross-cultural research is needed to explore the effects of technology on caring behavior and nurses’ emotional well-being, particularly in Global contexts. Nursing digital caring nursing empathy nursing technology humanized care caring theory Figures Figure 1 INTRODUCTION Digital transformation has become one of the most profound changes in global healthcare systems. Technologies such as Electronic Health Records (EHR), telehealth, artificial intelligence (AI), and robotic nursing systems have revolutionized nursing practice, enhancing efficiency while simultaneously challenging the very essence of caring as the core of the profession (Ahn et al., 2024 ). The value of caring, once expressed through human touch and therapeutic presence, has shifted in meaning as interactions increasingly move into digital spaces. Several studies indicate that digitalization does not diminish the meaning of caring but rather transforms it into a new form that emphasizes emotional presence and technological competence (Subramanya et al., 2024 ; Rouleau et al., 2024 ; Vennik et al., 2023 ). Nurses now demonstrate caring presence through reflective communication, therapeutic tone of voice, and digital empathy (Luetke Lanfer et al., 2024 ; Glenn et al., 2025 ). The ability to navigate systems such as telemonitoring, mHealth, and EHR reflects the manifestation of technological competence as caring practice (Coors et al., 2025 ; Ahn et al., 2024 ; Addotey-Delove et al., 2022 ). Nevertheless, digital transformation introduces comlex emotional and ethical tensions, including moral distress, administrative overload, and the erosion of perceived human closeness in nurse-patient relationships (Kang et al., 2023 ; Liao et al., 2023 ; Piras et al., 2025 ). Existing remains predominantly descriptive and qualitative, limiting the empirical understanding of how technology influences human touch and caring behaviors (De Leeuw et al., 2020 ; Laukvik et al., 2024 ). To brigde this gap, this scoping review synthesizes empirical evidence through the theoretical integration of Watson’s Theory of Human Caring, Swanson’s Caring Theory, and Barnard’s Parent Child Interaction Theory. This framework enables a deeper exploration of digital caring and technological compassion, emphasizing the humanization of technology in contemporary nursing practice. METHOD This studi employed a scoping review design guided by the methodological framework of Arksey & O’Malley ( 2005 ), further refined by (Levac et al. ( 2010 ), and aligned with the Joanna Briggs Institute (JBI) manual dan PRISMA-ScR reporting guidelines (Tricco et al., 2018 ). The objective was to map empirical evidance on how digital technologies influence, reshape, and sustain the values of caring human touch in nursing practice. The review adopted the Population Concept Context (PCC) framework dengan population: nurses and patients engaging through digital platform; Concept: the values of caring, empathy, and compassion within digital nursing contexts; Context: technology based healthcare settings such as telehealth, telenursing, Electronic Health Records (EHR), mobile health (mHealth), and AI or robotics assisted systems. The central research question was: How do nurses preserve the values of caring and human touch within technology driven healthcare systems? Two subquestions were formulated: (1) What strategies, competencies, or system designs support humanizing digital nursing practice? (2) What challenges do nurses face in maintaining caring values amid digitalization? A comprehensive literature search was conducted across four majordatabase: PubMed/MEDLINE, Scopus, CINAHL (EBSCO), and ScienceDirect for publications between 2020 and 2025. The following search terms were used in various combinations: (“nursing”) AND (“telehealth” OR “telenursing” OR “EHR” OR “mHealth” OR “robot*” OR “digital” OR “artificial intelligence”) AND (“caring” OR “empathy” OR “compassion” OR “human touch” OR “patient-centered”). Inclusion criteria comprised empirical studies (qualitative, quantitative, or mixed methods) examining aspects of caring, empathy, or human touch in digital nursing practice, with nurses as the primary participants. Exclusion criteria included conceptual papers, opinion articles, editorials, study protocols, non-English publications, or studies without empirical data. The article selection process followed the PRISMA ScR flow, which involved identification, screening, eligibility assessment, and inclusion of the final 16 empirical studies used for synthesis. Data Analysis and Thematic Synthesis Data were analyzed using an inductive thematic analysis approach following the steps proposed by Braun & Clarke ( 2006 ). The analytical process consisted of five key phases: Familiarization with the data, through repeated reading of the extracted data to gain a comprehensive understanding; Coding, involving the identification of recurring patterns related to caring, empathy, and technological adaptation; Theme development, by grouping similar codes into broader thematic categories; Theme review and refinement, through comparing and validating themes across study designs and contexts; and Interpretation, which involved linking the emergent themes to relevant nursing theories to provide deeper conceptual insights. RESULT Table 1 Data Analysis Results NO Authors (year) Country Title Objectives and Focus ofStudy Design Setting / Sample Technology Studied Key Findings Related to Caring/ Human Touch Implications / Practical Relevancei Limitations 1 De Leeuw et al. ( 2020 ) Belanda Identification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging To identify factors influencing the adoption of health information technology among nurses who are digitally lagging behind Qualitative– in depth interviews 10 hospital nurses Health Information Technology (EHR) Nurses experienced stress due to limited digital skills; peer support and individualized training enhanced confidence and caring behavior. Individualized digital training programs enhance nurses’ adaptation to technology without diminishing the value of human touch. Small sample size from a single hospital limits generalizability 2 Addotey-Delove et al. ( 2022 ) Ghana A Healthcare Workers’ mHealth Adoption Instrument for the Developing World To develop and validate an instrument to measure healthcare workers’ adoption of mobile health (mHealth) technologies. Cross-sectional design with Confirmatory Faktor Analysis (CFA) & Structural Equation Modeling (SEM) 104 nurses & midwives mHealth (MoTECH app) Adoption factors were linked to technical support and perceived usefulness; caring improved when technology was user friendly. The instrument supports the implementation of mHealth solutions that facilitate more humanized nurse–patient interactions. Conducted in a single district; findings require validation in other contexts. 3 Lanfer et al. (2022) Jerman Understanding Trust Determinants in a Live Chat Service on Familial Cancer To explore determinants of trust formation in online chat services for familial cancer counseling. Qualitative triangulation design Counselors, physicians, and community participants Live Chat Service (digital counseling) Human touch emerged through the presence of real medical professionals rather than automated chatbots. Chat-based services sustain caring relationships through authentic human interaction. Did not assess long-term outcomes or sustained behavioral changes. 4 Kang et al. ( 2023 ) Korea Selatan & Jepang Nurses’ Perception Towards Care Robots and Their Work Experience with Socially Assistive Technology During COVID-19 To examine nurses’ perceptions of care robots and their work experiences with assistive technologies during the COVID-19 pandemic. Descriptive qualitative design 18 community nurses Care robots (Silbot, Hyodol, Aria speaker) Robots facilitated contact-free interaction among older adults, yet human interaction remained irreplaceable. The integration of technology and human empathy maintains the quality and depth of caring practices. Limited to the Korean context and specific technological applications.. 5 Liao et al. ( 2023 ) Taiwan Enhancing Nurse–Robot Engagement: Two-Wave Survey Study To analyze the impact of perceived usefulness and burden of care robots on nurses’ engagement and interaction. Longitudinal quantitative design 331 surgical nurses Assistive robots (AI-based) The perceived benefits of robots increased engagement, while technical burdens reduced comfort and emotional connection. Robots should function as supportive tools rather than substitutes for nurses’ empathy. Single-hospital study without patient outcome evaluation. 6 Vennik et al. ( 2023 ) Inggris Patient Perceptions of Empathy in Primary Care Telephone Consultations To investigate patients’ perceptions of empathy during telephone-based primary care consultations Mixed methods design 359 patients (30 interviewed) Teleconsultation (telephone) Empathy could be transmitted through active verbal cues and a warm tone of voice. Verbal communication training is essential for maintaining warmth and emotional connection in virtual care. Conducted in the UK with older adult participants only. 7 Chouchene Douma et al. ( 2024 ) Tunisia Impact of Implementing Electronic Nursing Records on Quality and Safety Indicators in Care To assess the impact of implementing electronic nursing records (ENRs) on quality and safety indicators in clinical care. Descriptive quantitative design Nurses from a university hospital Electronic Nursing Records (ENR) Digitalization improved efficiency but required training to sustain caring values. EHR systems can enhance safety and consistency while preserving elements of human touch. Single-context study employing a purely quantitative approach. 8 El-Gazar et al. ( 2024 ) Mesir & Arab Saudi Are Nurses and Patients Willing to Work with Service Robots in Healthcare? A Mixed-Methods Study To examine the readiness and attitudes of nurses and patients toward the use of service robots in healthcare. Mixed-methods design 220 nurses & 120 patients Service robots Nurses and patients accepted robots for routine tasks, but emotional caring must remain human-driven.. Highlights the need to balance technological efficiency with meaningful human relationships.. Findings are context-bound to Egyptian/Saudi cultural settings. 9 Lütke Lanfer et al. (2024) Jerman Digital Clinical Empathy in a Live Chat: Multiple Findings from a Formative Qualitative Study To explore how digital empathy is expressed within live chat–based cancer counseling interactions. Qualitative design (Focus Group Discussions and usability testing) Concelor & cancer patients Live Chat Service Digital empathy emerged through tone of language and message personalization. Digital empathy communication guidelines are needed to ensure the continued presence of caring in virtual interactions.. Did not evaluate clinical or health outcomes.. 10 Laukvik et al. ( 2024 ) Norwegia Utilizing Nursing Standards in Electronic Health Records: A Descriptive Qualitative Study To describe nurses’ experiences in utilizing nursing standards within electronic health record documentation. Descriptive qualitative design 15 nurses Electronic Nursing Records (EHR + ICNP) Standardization improved consistency but reduced the depth of empathic narrative. EHR design should allow space for nurses’ empathic expression and reflective practice. Small-scale study without measurement of patient-centered outcomes. 11 Rouleau et al. ( 2024 ) Kanada Providing Compassionate Care in a Virtual Context: Qualitative Exploration of Canadian Primary Care Nurses’ Experiences To explore nurses’ experiences in providing compassionate care in virtual primary care settings. Exploratory qualitative design 18 primary nurses Telehealth / virtual care Nurses adapted empathy through tone modulation and emotional validation. Virtual communication training is crucial for sustaining therapeutic nurse–patient relationships. Conducted solely within the Canadian healthcare setting.. 12 Subramanya et al. ( 2024 ) United State Empathetic Communication in Telemedicine: A Pilot Study To evaluate differences in perceived empathy between face-to-face and telemedicine consultations Quantitative pilot study 8 clinicians & 34 patients Telemedicine (video) Empathy did not differ significantly; caring presence was maintained in virtual interactions. Telemedicine can preserve empathy when communicative behaviors are intentionally maintained. Limited by a small and non-representative sample. 13 Yuan et al. ( 2024 ) Tiongkok & Jepang Intervention Effects of Telenursing Based on M-O-A Model in Empty-Nest Older Adults with Chronic Diseases To test the effectiveness of telenursing interventions based on the Motivation–Opportunity–Ability (M-O-A) model among older adults with chronic illnesses. Randomized Controlled Trial (RCT) 78 older adults with cronic ilInesses Telenursing Improved quality of life and communication; caring values were preserved. Telenursing is effective in providing emotional support for socially isolated older adults. Short study duration and limited contextual diversity.. 14 Coors et al. (2024) Jerman Cost-Effectiveness of a Nurse-Led Transitional Care Model for CVD (Cardiolotse Study) To evaluate the cost-effectiveness and care coordination of nurse-led transitional care models in cardiovascular disease management. Health economic analysis (based on RCT data) 2550 patients with cardiovascular diseases Nurse-led transitional care Nurse navigators enhanced continuity of care and patients’ sense of being cared for. Nurse-led coordination promotes human connection and continuity of care in digital systems. Focused primarily on economic aspects, lacking exploration of empathy dimensions. 15 Glenn et al. (2024) United State A Nurse-Led Approach to Testing and Adapting a Telehealth Guide for e-Empathy in Goals of Care Conversations To design and test a telehealth guide that enhances e-empathy in goals-of-care discussions with patients suffering from chronic kidney disease (CKD). Qualitative design (Guideline development) Nurses and Black patients with cronic kidney disease Telehealth (e-empathy guide) Empathy was conveyed through emotional acknowledgment and virtual validation. Practical guidelines assist nurses in preserving human touch within online care environments Small-scale pilot not yet tested on a larger population. 16 Piras et al. (2024) Italia Nurses’ Experience with Telecare: A Qualitative Analysis of Perceptions and Implications for Caring and the Nursing Profession To explore nurses’ experiences in telecare practice and its implications for caring values and professional identity. Descriptive qualitative design 20 nurses Telecare Telecare enabled remote support but raised concerns about losing human warmth and emotional connection. Digital training should emphasize empathic communication to prevent technology from eroding caring values.mengikis caring. Italian-specific context; findings may be influenced by subjective interpretations Thematic Analysis Results The thematic analysis revealed four major themes that capture the dynamic interplay between humanity and digitalization in nursing practice: (1) Transformation of Caring and Technological Competence, (2) Adaptive Strategies and Digital Empathy, (3) Emotional and Ethical Challenges of Caring in the Virtual Era, and (4) Human Centered Design and Organizational Support. These themes collectively illustrate how nurses negotiate the balance between technological efficiency and humanistic values in digital care. The following table presents the identified themes along with their supporting studies. Table 2 Thematic Analysis Results Main Themes Brief Description of Themes Focus of Caring Values Supporting Studies 1. Transformation of Caring and Technological Competence This theme illustrates the evolving meaning of caring in the digital age—from physical touch to reflective and empathic presence mediated through technology. Caring now encompasses the nurse’s ability to engage with technology in a humane and ethical manner. Mastery of digital systems such as telenursing, electronic health records (EHR), and mHealth represents a new form of professional caring competence that ensures safety, continuity, and quality of care. - Caring as digital emotional presence (digital presence) - Technology as an extension of professional responsibility and clinical empathy. Subramanya et al. ( 2024 ); Rouleau et al. ( 2024 ); Vennik et al. ( 2023 ); Coors et al. (2024); Addotey-Delove et al. ( 2022 ); Chouchene Douma et al. ( 2024 ); Laukvik et al. ( 2024 ) 2.Adaptive Strategies and Digital Empathy This theme highlights nurses’ adaptive capacity to preserve the human touch through technology-mediated communication. Caring is expressed through a gentle tone of voice, reflective language, digital empathy (e-empathy) , and sensitivity to patients’ emotional cues during virtual interactions. Training in digital empathy and the design of interactive communication platforms help sustain emotional connection and therapeutic presence in digital care environments. - Virtual empathic communication. - Digital empathic as a relational bridge. - Behavioral adaptation of caring in online environments. Lütke Lanfer et al. (2024); Glenn et al. (2024); Yuan et al. ( 2024 ); De Leeuw et al. ( 2020 ); Lanfer et al. (2022). 3.Emotional Challenges and Ethical Dimensions of Caring in the Virtual Era This theme explores the emotional and moral dimensions of nursing practice in a digitized healthcare system. Nurses face dilemmas between system efficiency and human connection, as well as emotional strain caused by the loss of physical contact and increasing administrative demands. Ethical reflection, emotional supervision, and value-driven digital training are essential to prevent depersonalization and maintain the moral integrity of caring practice. - Moral distress and empathic fatique (emotional labour). - Ethical refleksi in digital caring contexts. - Balancing efficiency and humanity. Piras et al. (2024); Kang et al. ( 2023 ); Liao et al. ( 2023 ); De Leeuw et al. ( 2020 ). . 4.Human-Centered Design and Organizational Support for Humanizing Digital Care This theme emphasizes the importance of system design and organizational culture that place human values at the core of digital transformation. User-centered systems, empathetic workflows, and ethical digital training enable nurses to demonstrate compassion within technology-mediated environments. Organizational support and human-centered policies form the foundation for sustaining humanizing digital nursing practice , ensuring that technological innovation continues to serve the essence of humanity in care. - Human-centered design and ethical policy development. - Organizational support for nurses’ emotional well-being. - Integration of empathy-supportive systems. Laukvik et al. ( 2024 ); Lanfer et al. (2022); El-Gazar et al. ( 2024 ). The following section offers a comprehensive interpretation of the results: Thema 1. Transformation of Caring and Technological Competence Digitalization has redefined the meaning of caring, shifting it from physical touch to digital emotional presence. Nurses now express empathy through reflective communication and therapeutic voice rather than direct physical interaction (Booth et al., 2021 ; Subramanya et al., 2024 ; Rouleau et al., 2024 ). Patients still perceive compassion when nurses demonstrate personal attention and genuine engagement (Vennik et al., 2023 ). Mastery of technologies such as telemonitoring, mHealth, and Electronic Health Records (EHR) represents a form of technological caring competence, emphasizing that empathy and professionalism can coexist with digital innovation (Coors et al., 2025 ; Douma et al., 2024 ; Laukvik et al., 2024 ; Ahn et al., 2024 ; Addotey-Delove et al., 2022 ). Thema 2. Adaptive Strategies and Digital Empathy Nurses develop adaptive strategies to preserve the human touch through empathetic virtual communication. Soft vocal tones, eye contact via camera, and reflective language help convey warmth and presence in digital spaces. Telehealth and telenursing practices foster a sense of being cared for and reduce patient loneliness (Yuan et al., 2024 ). Digital empathy training and personalized communication systems strengthen the nurse–patient connection (Luetke Lanfer et al., 2024 ; Glenn et al., 2025 ; De Leeuw et al., 2020 ; Lanfer et al., 2023 ). In this context, caring is embodied through words, tone, and empathetic responses manifesting as a digital form of human presence. Thema 3. Emotional and Ethical Challenges of Caring in the Virtual Era While digitalization enhances efficiency, it also introduces emotional burdens and ethical dilemmas. Nurses experience moral distress due to system-driven interactions and increasing administrative demands (Piras et al., 2025 ; Liao et al., 2023 ). Those with low digital confidence often feel isolated and disconnected from the meaning of caring (De Leeuw et al., 2020 ), while the absence of ethical reflection risks depersonalizing patients. However, when technology is viewed as an assistive rather than a substitutive tool, nurses are able to maintain balance between efficiency and human connection (Kang et al., 2023 ). Thema 4. Human-Centered Design and Organizational Support for Humanizing Digital Care The preservation of caring values largely depends on human-centered system design and organizational support. Empathic EHR systems and digital communication platforms strengthen therapeutic relationships (Laukvik et al., 2024 ; Lanfer et al., 2023 ). The acceptance of service robots improves when supported by ethical and human-oriented organizational cultures (El-Gazar et al., 2024 ). Managerial intiatives such as workflow redesign and digital empathy training create opportunities for nurse to remain emotionally present. Ultimately, humanizing digital nursing can only be realized when systems, designs, and policies prioritize human values. These findings reveal that caring is no longer confined to physical interactions but extends into emotional dimensions expressed through digital environments, laying the foundation for the discussion that follows: DISCUSSION The digital transformation of nursing has redefined the paradigm of caring, shifting it from physical touch to an emotionally mediated presence through technology. Recent studies highlight that nurses now convey empathic presence through reflective communication, timely responsiveness, and the ability to foster a sense of safety in virtual interactions (Subramanya et al., 2024 ; Rouleau et al., 2024 ; Within this new landscape, technological competence is no longer a merely technical requirement but a vital dimension of professional caring that safeguards continuity, safety, and patient comfort. (Coors et al., 2025 ; Addotey-Delove et al., 2022 ; Douma et al., 2024 ). This aligns with Watson’s Theory of Human Caring, which emphasizes the transpersonal caring relationship and caring presence as expressions of human compassion qualities that can transcend physical space through mindful and intentional digital communication. Therefore, caring in the digital era should not be seen as the erosion of humanism but as its transformation into reflective empathy and spiritual connection expressed through technology. From the lens of Swanson’s Caring Theory, nurses demonstrate adaptive strategies to sustain the human touch through technologically mediated empathy. Digital empathy or e-empathy is manifested through therapeutic tone, reflective dialogue, and sensitivity to patients’ emotional expressions during virtual encounters (Luetke Lanfer et al., 2022; Glenn et al., 2022); Yuan et al., 2022); De Leeuw et al., 2020 ; Lanfer et al., 2023 ). Through the processes of “ knowing , being with , and doing for” , nurses sustain human connection even across digital interfaces (Swanson, 1991 ). Training in digital empathy and the design of interactive communication platforms further enhance nurses’ ability to establish emotional presence online. These findings reaffirm that technology, when used intentionally and mindfully, does not replace caring, it extends its reach into new forms of relational presence. Nevertheles, the digitalization of care introduces new ethical tensions and emotional burdens. Nurses increasingly report moral distress arising from reduced face to face contact, administrative overload, and the pressure to sustain performative empathy within virtual systems (Piras et al., 2025 ; Kang et al., 2023 ; Liao et al., 2023 ). Drawing on Barnard’s Parent–Child Interaction Theory, the nurse-patient relationship in digital contexts mirrors the attunement process found in parent-child interactions, requiring heightened emotional sensitivity and intuitive responsiveness (Barnard, 2019 ). As technology blurs physical boundaries, nurse capacity to “sense” and “respond” to patients affective needs remains the essence of digital caring. To preserve the sensitivity, structured ethical reflection, emotional supervision, and organizational policies that balance digital efficiency with moral and human values are essential. Moreover, the sustainability of humanistic care in digital environments depends on human-centered system design and organizational support. Evidence suggests that emotionally responsive EHR systems, ethical digital policies, and empathy-oriented training enable nurses to maintain compassionate therapeutic relationships despite technological pressures (Laukvik et al., 2024 ; Lanfer et al., 2023 ; El-Gazar et al., 2024 ). Responsive system design that accommodates emotional needs, digital ethics policies, and empathy training grounded in technological contexts are key pillars for preserving compassion in digital workplaces. These principles resonate with Watson’s and Swanson’s concept of a caring–healing environment, where nurses’ emotional well-being is integral to care quality. Caring in the digital age thus requires balance between technological rationality and human spirituality, between efficiency and empathy. This review also highlights a gap: most existing studies remain descriptive and qualitative, limiting empirical understanding of the relationship between advanced technologies (e.g., AI, robotics) and caring behaviors (De Leeuw et al., 2020 ; Liao et al., 2023 ; Kang et al., 2023 ; El-Gazar et al., 2024 ). Many focus on nurses’ perceptions and experiences rather than measuring causal links between technology use and caring outcomes (Addotey-Delove et al., 2022 ; (Laukvik et al., 2024 ). Future research should employ experimental and longitudinal designs to assess the impact of technology on therapeutic interactions, patient satisfaction, and nurses’ emotional well-being(Coors et al., 2025 ; Yuan et al., 2024 ). Moreover, the integration of Watson’s, Swanson’s, and Barnard’s frameworks warrants further development to articulate a comprehensive and cross-cultural model of digital caring, particularly in the Global, where sociocultural norms and healthcare infrastructure differ substantially (Rouleau et al., 2024 ; Vennik et al., 2023 ). In essence, the emerging paradigm of technological caring or digital compassion embodies the future of nursing: a convergence of emotional sensitivity, relational ethics, and technological proficiency within a unified, human-centered framework. This synthesis underscores that while technology may redefine the medium of care, the essence of nursing empathy, intentionality, and human connection remains timeless. Implication These findings emphasize that in nursing practice, it is essential to balance technological efficiency with human values through digital empathy and ethical reflection. Healthcare institutions should promote human-centered digital care policies and training to preserve therapeutic relationships within increasingly automated systems. In nursing education, the integration of digital literacy, technology ethics, and empathic communication should be strengthened to prepare future nurses to humanize technology in their professional roles. Furthermore, nursing research needs to empirically examine the impact of technology on caring behaviors and develop intervention models that protect nurses’ emotional well-being in the digital era Limitations This review was limited to 16 English-language empirical studies (2020–2025 ) , most of which employed qualitative designs, thus constraining generalizability. The heterogeneity of technologies examined, ranging from telehealth to AI and robotic systems, also limits the universality of conclusions. Nevertheless, these limitations highlight the need for multidisciplinary and cross-cultural collaborations to deepen the understanding of humanizing digital nursing practices across diverse healthcare contexts. Conclusion Nursing in the digital era faces a profound challenge: sustaining the essence of humanity amid technological advancement. Digitalization has transformed the expression of caring from physical touch to digital emotional presence, mediated by empathy, reflection, and technological competence. Through the integration of Watson’s Human Caring Theory, Swanson’s Caring Theory, and Barnard’s Parent Child Interaction Theory, caring emerges as a dynamic human relationship capable of adapting to evolving media without losing its spiritual core. Humanizing digital nursing requires a balance between system efficiency and relational integrity. Technology should not replace human touch but rather extend the reach of compassion through what can be described as technological caring or digital compassion. When technology is used reflectively, empathetically, and ethically, nurses become bridges between digital progress and humanity ensuring that the future of nursing remains rooted in compassion, presence, and respect for human dignity. Declarations Funding Source There is no funding source. Conflict of Interest Declaration There is no conflict of interest. References Addotey-Delove M, Scott RE, Mars M (2022) A healthcare workers’ mHealth adoption instrument for the developing world. BMC Health Serv Res 22(1):1–10. https://doi.org/10.1186/s12913-022-08592-0 Ahn S, Lee CJ, Bae I (2024) Patients’ Use of Electronic Health Records Facilitates Patient-Centered Communication: Findings From the 2017 Health Information National Trends Survey. 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Patient Education and Counseling , 113 (November 2022), 107748. https://doi.org/10.1016/j.pec.2023.107748 Yuan Y, Hou P, Wang S, Kitayama A, Yanagihara K, Liang J (2024) Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial. Front Public Health 12(May):1–14. https://doi.org/10.3389/fpubh.2024.1239445 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7935522","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":534188170,"identity":"a7cfc463-dd5f-4f8b-9e4d-4657446bb11d","order_by":0,"name":"Ida Ayu Kade Sri 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17:26:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":909435,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7935522/v1/4d443a51-78be-47ed-b9ae-9bfa70cd1884.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eHumanizing Digitalnursing Practice: Preserving Caring Values in the Era of Technology-driven Healthcare: A Scoping Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDigital transformation has become one of the most profound changes in global healthcare systems. Technologies such as Electronic Health Records (EHR), telehealth, artificial intelligence (AI), and robotic nursing systems have revolutionized nursing practice, enhancing efficiency while simultaneously challenging the very essence of caring as the core of the profession (Ahn et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The value of caring, once expressed through human touch and therapeutic presence, has shifted in meaning as interactions increasingly move into digital spaces.\u003c/p\u003e\u003cp\u003eSeveral studies indicate that digitalization does not diminish the meaning of caring but rather transforms it into a new form that emphasizes emotional presence and technological competence (Subramanya et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rouleau et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Vennik et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Nurses now demonstrate caring presence through reflective communication, therapeutic tone of voice, and digital empathy (Luetke Lanfer et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Glenn et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The ability to navigate systems such as telemonitoring, mHealth, and EHR reflects the manifestation of technological competence as caring practice (Coors et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Ahn et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Addotey-Delove et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNevertheless, digital transformation introduces comlex emotional and ethical tensions, including moral distress, administrative overload, and the erosion of perceived human closeness in nurse-patient relationships (Kang et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Liao et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Piras et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Existing remains predominantly descriptive and qualitative, limiting the empirical understanding of how technology influences human touch and caring behaviors (De Leeuw et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Laukvik et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). To brigde this gap, this scoping review synthesizes empirical evidence through the theoretical integration of Watson\u0026rsquo;s Theory of Human Caring, Swanson\u0026rsquo;s Caring Theory, and Barnard\u0026rsquo;s Parent Child Interaction Theory. This framework enables a deeper exploration of digital caring and technological compassion, emphasizing the humanization of technology in contemporary nursing practice.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eThis studi employed a scoping review design guided by the methodological framework of Arksey \u0026amp; O\u0026rsquo;Malley (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2005\u003c/span\u003e), further refined by (Levac et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), and aligned with the Joanna Briggs Institute (JBI) manual dan PRISMA-ScR reporting guidelines (Tricco et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The objective was to map empirical evidance on how digital technologies influence, reshape, and sustain the values of caring human touch in nursing practice. The review adopted the Population Concept Context (PCC) framework dengan population: nurses and patients engaging through digital platform; Concept: the values of caring, empathy, and compassion within digital nursing contexts; Context: technology based healthcare settings such as telehealth, telenursing, Electronic Health Records (EHR), mobile health (mHealth), and AI or robotics assisted systems.\u003c/p\u003e\u003cp\u003eThe central research question was: How do nurses preserve the values of caring and human touch within technology driven healthcare systems? Two subquestions were formulated:\u003c/p\u003e\u003cp\u003e(1) What strategies, competencies, or system designs support humanizing digital nursing practice?\u003c/p\u003e\u003cp\u003e(2) What challenges do nurses face in maintaining caring values amid digitalization?\u003c/p\u003e\u003cp\u003eA comprehensive literature search was conducted across four majordatabase: PubMed/MEDLINE, Scopus, CINAHL (EBSCO), and ScienceDirect for publications between 2020 and 2025. The following search terms were used in various combinations: (\u0026ldquo;nursing\u0026rdquo;) AND (\u0026ldquo;telehealth\u0026rdquo; OR \u0026ldquo;telenursing\u0026rdquo; OR \u0026ldquo;EHR\u0026rdquo; OR \u0026ldquo;mHealth\u0026rdquo; OR \u0026ldquo;robot*\u0026rdquo; OR \u0026ldquo;digital\u0026rdquo; OR \u0026ldquo;artificial intelligence\u0026rdquo;) AND (\u0026ldquo;caring\u0026rdquo; OR \u0026ldquo;empathy\u0026rdquo; OR \u0026ldquo;compassion\u0026rdquo; OR \u0026ldquo;human touch\u0026rdquo; OR \u0026ldquo;patient-centered\u0026rdquo;).\u003c/p\u003e\u003cp\u003eInclusion criteria comprised empirical studies (qualitative, quantitative, or mixed methods) examining aspects of caring, empathy, or human touch in digital nursing practice, with nurses as the primary participants. Exclusion criteria included conceptual papers, opinion articles, editorials, study protocols, non-English publications, or studies without empirical data. The article selection process followed the PRISMA ScR flow, which involved identification, screening, eligibility assessment, and inclusion of the final 16 empirical studies used for synthesis.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis and Thematic Synthesis\u003c/h2\u003e\u003cp\u003eData were analyzed using an inductive thematic analysis approach following the steps proposed by Braun \u0026amp; Clarke (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The analytical process consisted of five key phases:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFamiliarization with the data, through repeated reading of the extracted data to gain a comprehensive understanding;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCoding, involving the identification of recurring patterns related to caring, empathy, and technological adaptation;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTheme development, by grouping similar codes into broader thematic categories;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTheme review and refinement, through comparing and validating themes across study designs and contexts; and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eInterpretation, which involved linking the emergent themes to relevant nursing theories to provide deeper conceptual insights.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULT","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eData Analysis Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuthors (year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObjectives and Focus ofStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDesign\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSetting / Sample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTechnology Studied\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eKey Findings Related to Caring/ Human Touch\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eImplications / Practical Relevancei\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDe Leeuw et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBelanda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIdentification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo identify factors influencing the adoption of health information technology among nurses who are digitally lagging behind\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQualitative\u0026ndash; in depth interviews\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10 hospital nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHealth Information Technology (EHR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNurses experienced stress due to limited digital skills; peer support and individualized training enhanced confidence and caring behavior.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIndividualized digital training programs enhance nurses\u0026rsquo; adaptation to technology without diminishing the value of human touch.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSmall sample size from a single hospital limits generalizability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAddotey-Delove et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGhana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA Healthcare Workers\u0026rsquo; mHealth Adoption Instrument for the Developing World\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo develop and validate an instrument to measure healthcare workers\u0026rsquo; adoption of mobile health (mHealth) technologies.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCross-sectional design with Confirmatory Faktor Analysis (CFA) \u0026amp; Structural Equation Modeling (SEM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e104 nurses \u0026amp; midwives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003emHealth (MoTECH app)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAdoption factors were linked to technical support and perceived usefulness; caring improved when technology was user friendly.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eThe instrument supports the implementation of mHealth solutions that facilitate more humanized nurse\u0026ndash;patient interactions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eConducted in a single district; findings require validation in other contexts.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLanfer et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJerman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnderstanding Trust Determinants in a Live Chat Service on Familial Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore determinants of trust formation in online chat services for familial cancer counseling.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQualitative triangulation design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCounselors, physicians, and community participants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eLive Chat Service (digital counseling)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHuman touch emerged through the presence of real medical professionals rather than automated chatbots.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eChat-based services sustain caring relationships through authentic human interaction.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eDid not assess long-term outcomes or sustained behavioral changes.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKang et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKorea Selatan \u0026amp; Jepang\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses\u0026rsquo; Perception Towards Care Robots and Their Work Experience with Socially Assistive Technology During COVID-19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo examine nurses\u0026rsquo; perceptions of care robots and their work experiences with assistive technologies during the COVID-19 pandemic.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDescriptive qualitative design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 community nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCare robots (Silbot, Hyodol, Aria speaker)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRobots facilitated contact-free interaction among older adults, yet human interaction remained irreplaceable.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eThe integration of technology and human empathy maintains the quality and depth of caring practices.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eLimited to the Korean context and specific technological applications..\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiao et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTaiwan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEnhancing Nurse\u0026ndash;Robot Engagement: Two-Wave Survey Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo analyze the impact of perceived usefulness and burden of care robots on nurses\u0026rsquo; engagement and interaction.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLongitudinal quantitative design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e331 surgical nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAssistive robots (AI-based)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eThe perceived benefits of robots increased engagement, while technical burdens reduced comfort and emotional connection.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eRobots should function as supportive tools rather than substitutes for nurses\u0026rsquo; empathy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSingle-hospital study without patient outcome evaluation.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVennik et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInggris\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePatient Perceptions of Empathy in Primary Care Telephone Consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo investigate patients\u0026rsquo; perceptions of empathy during telephone-based primary care consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMixed methods design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e359 patients (30 interviewed)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTeleconsultation (telephone)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eEmpathy could be transmitted through active verbal cues and a warm tone of voice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eVerbal communication training is essential for maintaining warmth and emotional connection in virtual care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eConducted in the UK with older adult participants only.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChouchene Douma et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTunisia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImpact of Implementing Electronic Nursing Records on Quality and Safety Indicators in Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo assess the impact of implementing electronic nursing records (ENRs) on quality and safety indicators in clinical care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDescriptive quantitative design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNurses from a university hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eElectronic Nursing Records (ENR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eDigitalization improved efficiency but required training to sustain caring values.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eEHR systems can enhance safety and consistency while preserving elements of human touch.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSingle-context study employing a purely quantitative approach.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEl-Gazar et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMesir \u0026amp; Arab Saudi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAre Nurses and Patients Willing to Work with Service Robots in Healthcare? A Mixed-Methods Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo examine the readiness and attitudes of nurses and patients toward the use of service robots in healthcare.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMixed-methods design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e220 nurses \u0026amp; 120 patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eService robots\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNurses and patients accepted robots for routine tasks, but emotional caring must remain human-driven..\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHighlights the need to balance technological efficiency with meaningful human relationships..\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eFindings are context-bound to Egyptian/Saudi cultural settings.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eL\u0026uuml;tke Lanfer et al. (2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJerman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDigital Clinical Empathy in a Live Chat: Multiple Findings from a Formative Qualitative Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore how digital empathy is expressed within live chat\u0026ndash;based cancer counseling interactions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQualitative design (Focus Group Discussions and usability testing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eConcelor \u0026amp; cancer patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eLive Chat Service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eDigital empathy emerged through tone of language and message personalization.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eDigital empathy communication guidelines are needed to ensure the continued presence of caring in virtual interactions..\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eDid not evaluate clinical or health outcomes..\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLaukvik et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNorwegia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUtilizing Nursing Standards in Electronic Health Records: A Descriptive Qualitative Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo describe nurses\u0026rsquo; experiences in utilizing nursing standards within electronic health record documentation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDescriptive qualitative design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eElectronic Nursing Records (EHR\u0026thinsp;+\u0026thinsp;ICNP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStandardization improved consistency but reduced the depth of empathic narrative.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eEHR design should allow space for nurses\u0026rsquo; empathic expression and reflective practice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSmall-scale study without measurement of patient-centered outcomes.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRouleau et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKanada\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eProviding Compassionate Care in a Virtual Context: Qualitative Exploration of Canadian Primary Care Nurses\u0026rsquo; Experiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore nurses\u0026rsquo; experiences in providing compassionate care in virtual primary care settings.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eExploratory qualitative design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 primary nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTelehealth / virtual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNurses adapted empathy through tone modulation and emotional validation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eVirtual communication training is crucial for sustaining therapeutic nurse\u0026ndash;patient relationships.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eConducted solely within the Canadian healthcare setting..\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubramanya et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnited State\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEmpathetic Communication in Telemedicine: A Pilot Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo evaluate differences in perceived empathy between face-to-face and telemedicine consultations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQuantitative pilot study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 clinicians \u0026amp; 34 patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTelemedicine (video)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eEmpathy did not differ significantly; caring presence was maintained in virtual interactions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTelemedicine can preserve empathy when communicative behaviors are intentionally maintained.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eLimited by a small and non-representative sample.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYuan et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTiongkok \u0026amp; Jepang\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntervention Effects of Telenursing Based on M-O-A Model in Empty-Nest Older Adults with Chronic Diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo test the effectiveness of telenursing interventions based on the Motivation\u0026ndash;Opportunity\u0026ndash;Ability (M-O-A) model among older adults with chronic illnesses.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRandomized Controlled Trial (RCT)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e78 older adults with cronic ilInesses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTelenursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eImproved quality of life and communication; caring values were preserved.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTelenursing is effective in providing emotional support for socially isolated older adults.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eShort study duration and limited contextual diversity..\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoors et al. (2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJerman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCost-Effectiveness of a Nurse-Led Transitional Care Model for CVD (Cardiolotse Study)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo evaluate the cost-effectiveness and care coordination of nurse-led transitional care models in cardiovascular disease management.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHealth economic analysis (based on RCT data)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2550 patients with cardiovascular diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNurse-led transitional care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNurse navigators enhanced continuity of care and patients\u0026rsquo; sense of being cared for.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNurse-led coordination promotes human connection and continuity of care in digital systems.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eFocused primarily on economic aspects, lacking exploration of empathy dimensions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGlenn et al. (2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnited State\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eA Nurse-Led Approach to Testing and Adapting a Telehealth Guide for e-Empathy in Goals of Care Conversations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo design and test a telehealth guide that enhances e-empathy in goals-of-care discussions with patients suffering from chronic kidney disease (CKD).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQualitative design (Guideline development)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNurses and Black patients with cronic kidney disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTelehealth (e-empathy guide)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eEmpathy was conveyed through emotional acknowledgment and virtual validation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003ePractical guidelines assist nurses in preserving human touch within online care environments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSmall-scale pilot not yet tested on a larger population.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePiras et al. (2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eItalia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses\u0026rsquo; Experience with Telecare: A Qualitative Analysis of Perceptions and Implications for Caring and the Nursing Profession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo explore nurses\u0026rsquo; experiences in telecare practice and its implications for caring values and professional identity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDescriptive qualitative design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20 nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTelecare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTelecare enabled remote support but raised concerns about losing human warmth and emotional connection.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eDigital training should emphasize empathic communication to prevent technology from eroding caring values.mengikis caring.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eItalian-specific context; findings may be influenced by subjective interpretations\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eThematic Analysis Results\u003c/h3\u003e\n\u003cp\u003eThe thematic analysis revealed four major themes that capture the dynamic interplay between humanity and digitalization in nursing practice:\u003c/p\u003e\u003cp\u003e(1) Transformation of Caring and Technological Competence,\u003c/p\u003e\u003cp\u003e(2) Adaptive Strategies and Digital Empathy,\u003c/p\u003e\u003cp\u003e(3) Emotional and Ethical Challenges of Caring in the Virtual Era, and\u003c/p\u003e\u003cp\u003e(4) Human Centered Design and Organizational Support.\u003c/p\u003e\u003cp\u003eThese themes collectively illustrate how nurses negotiate the balance between technological efficiency and humanistic values in digital care. The following table presents the identified themes along with their supporting studies.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThematic Analysis Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrief Description of Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFocus of Caring Values\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSupporting Studies\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Transformation of Caring and Technological Competence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThis theme illustrates the evolving meaning of caring in the digital age\u0026mdash;from physical touch to reflective and empathic presence mediated through technology. Caring now encompasses the nurse\u0026rsquo;s ability to engage with technology in a humane and ethical manner. Mastery of digital systems such as telenursing, electronic health records (EHR), and mHealth represents a new form of \u003cem\u003eprofessional caring competence\u003c/em\u003e that ensures safety, continuity, and quality of care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Caring as digital emotional presence (digital presence)\u003c/p\u003e \u003cp\u003e- Technology as an extension of professional responsibility and clinical empathy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSubramanya et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); Rouleau et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); Vennik et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); Coors et al. (2024); Addotey-Delove et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); Chouchene Douma et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); Laukvik et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.Adaptive Strategies and Digital Empathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThis theme highlights nurses\u0026rsquo; adaptive capacity to preserve the \u003cem\u003ehuman touch\u003c/em\u003e through technology-mediated communication. Caring is expressed through a gentle tone of voice, reflective language, \u003cem\u003edigital empathy (e-empathy)\u003c/em\u003e, and sensitivity to patients\u0026rsquo; emotional cues during virtual interactions. Training in digital empathy and the design of interactive communication platforms help sustain emotional connection and therapeutic presence in digital care environments.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Virtual empathic communication.\u003c/p\u003e\u003cp\u003e- Digital empathic as a relational bridge.\u003c/p\u003e\u003cp\u003e- Behavioral adaptation of caring in online environments.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eL\u0026uuml;tke Lanfer et al. (2024); Glenn et al. (2024); Yuan et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); De Leeuw et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); Lanfer et al. (2022).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.Emotional Challenges and Ethical Dimensions of Caring in the Virtual Era\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThis theme explores the emotional and moral dimensions of nursing practice in a digitized healthcare system. Nurses face dilemmas between system efficiency and human connection, as well as emotional strain caused by the loss of physical contact and increasing administrative demands. Ethical reflection, emotional supervision, and value-driven digital training are essential to prevent depersonalization and maintain the moral integrity of caring practice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Moral distress and empathic fatique (emotional labour).\u003c/p\u003e\u003cp\u003e- Ethical refleksi in digital caring contexts.\u003c/p\u003e\u003cp\u003e- Balancing efficiency and humanity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePiras et al. (2024); Kang et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); Liao et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e); De Leeuw et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). .\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.Human-Centered Design and Organizational Support for Humanizing Digital Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThis theme emphasizes the importance of system design and organizational culture that place human values at the core of digital transformation. User-centered systems, empathetic workflows, and ethical digital training enable nurses to demonstrate compassion within technology-mediated environments. Organizational support and human-centered policies form the foundation for sustaining \u003cem\u003ehumanizing digital nursing practice\u003c/em\u003e, ensuring that technological innovation continues to serve the essence of humanity in care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Human-centered design and ethical policy development. \u003c/p\u003e\u003cp\u003e- Organizational support for nurses\u0026rsquo; emotional well-being.\u003c/p\u003e\u003cp\u003e- Integration of empathy-supportive systems.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLaukvik et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); Lanfer et al. (2022); El-Gazar et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe following section offers a comprehensive interpretation of the results:\u003c/p\u003e\u003cp\u003eThema 1. Transformation of Caring and Technological Competence\u003c/p\u003e\u003cp\u003eDigitalization has redefined the meaning of caring, shifting it from physical touch to digital emotional presence. Nurses now express empathy through reflective communication and therapeutic voice rather than direct physical interaction (Booth et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Subramanya et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rouleau et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Patients still perceive compassion when nurses demonstrate personal attention and genuine engagement (Vennik et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Mastery of technologies such as telemonitoring, mHealth, and Electronic Health Records (EHR) represents a form of technological caring competence, emphasizing that empathy and professionalism can coexist with digital innovation (Coors et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Douma et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Laukvik et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ahn et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Addotey-Delove et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThema 2. Adaptive Strategies and Digital Empathy\u003c/p\u003e\u003cp\u003eNurses develop adaptive strategies to preserve the human touch through empathetic virtual communication. Soft vocal tones, eye contact via camera, and reflective language help convey warmth and presence in digital spaces. Telehealth and telenursing practices foster a sense of being cared for and reduce patient loneliness (Yuan et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Digital empathy training and personalized communication systems strengthen the nurse\u0026ndash;patient connection (Luetke Lanfer et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Glenn et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; De Leeuw et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lanfer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In this context, caring is embodied through words, tone, and empathetic responses manifesting as a digital form of human presence.\u003c/p\u003e\u003cp\u003eThema 3. Emotional and Ethical Challenges of Caring in the Virtual Era\u003c/p\u003e\u003cp\u003eWhile digitalization enhances efficiency, it also introduces emotional burdens and ethical dilemmas. Nurses experience moral distress due to system-driven interactions and increasing administrative demands (Piras et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Liao et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Those with low digital confidence often feel isolated and disconnected from the meaning of caring (De Leeuw et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), while the absence of ethical reflection risks depersonalizing patients. However, when technology is viewed as an assistive rather than a substitutive tool, nurses are able to maintain balance between efficiency and human connection (Kang et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThema 4. Human-Centered Design and Organizational Support for Humanizing Digital Care\u003c/p\u003e\u003cp\u003eThe preservation of caring values largely depends on human-centered system design and organizational support. Empathic EHR systems and digital communication platforms strengthen therapeutic relationships (Laukvik et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lanfer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The acceptance of service robots improves when supported by ethical and human-oriented organizational cultures (El-Gazar et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Managerial intiatives such as workflow redesign and digital empathy training create opportunities for nurse to remain emotionally present. Ultimately, humanizing digital nursing can only be realized when systems, designs, and policies prioritize human values. These findings reveal that caring is no longer confined to physical interactions but extends into emotional dimensions expressed through digital environments, laying the foundation for the discussion that follows:\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe digital transformation of nursing has redefined the paradigm of caring, shifting it from physical touch to an emotionally mediated presence through technology. Recent studies highlight that nurses now convey empathic presence through reflective communication, timely responsiveness, and the ability to foster a sense of safety in virtual interactions (Subramanya et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rouleau et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Within this new landscape, technological competence is no longer a merely technical requirement but a vital dimension of professional caring that safeguards continuity, safety, and patient comfort. (Coors et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Addotey-Delove et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Douma et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This aligns with Watson\u0026rsquo;s Theory of Human Caring, which emphasizes the transpersonal caring relationship and caring presence as expressions of human compassion qualities that can transcend physical space through mindful and intentional digital communication. Therefore, caring in the digital era should not be seen as the erosion of humanism but as its transformation into reflective empathy and spiritual connection expressed through technology.\u003c/p\u003e\u003cp\u003eFrom the lens of Swanson\u0026rsquo;s Caring Theory, nurses demonstrate adaptive strategies to sustain the \u003cem\u003ehuman touch\u003c/em\u003e through technologically mediated empathy. Digital empathy or \u003cem\u003ee-empathy\u003c/em\u003e is manifested through therapeutic tone, reflective dialogue, and sensitivity to patients\u0026rsquo; emotional expressions during virtual encounters (Luetke Lanfer et al., 2022; Glenn et al., 2022); Yuan et al., 2022); De Leeuw et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lanfer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Through the processes of \u0026ldquo;\u003cem\u003eknowing\u003c/em\u003e, \u003cem\u003ebeing with\u003c/em\u003e, and \u003cem\u003edoing for\u0026rdquo;\u003c/em\u003e, nurses sustain human connection even across digital interfaces (Swanson, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). Training in digital empathy and the design of interactive communication platforms further enhance nurses\u0026rsquo; ability to establish emotional presence online. These findings reaffirm that technology, when used intentionally and mindfully, does not replace caring, it extends its reach into new forms of relational presence.\u003c/p\u003e\u003cp\u003eNevertheles, the digitalization of care introduces new ethical tensions and emotional burdens. Nurses increasingly report moral distress arising from reduced face to face contact, administrative overload, and the pressure to sustain performative empathy within virtual systems (Piras et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kang et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Liao et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Drawing on Barnard\u0026rsquo;s Parent\u0026ndash;Child Interaction Theory, the nurse-patient relationship in digital contexts mirrors the attunement process found in parent-child interactions, requiring heightened emotional sensitivity and intuitive responsiveness (Barnard, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). As technology blurs physical boundaries, nurse capacity to \u0026ldquo;sense\u0026rdquo; and \u0026ldquo;respond\u0026rdquo; to patients affective needs remains the essence of digital caring. To preserve the sensitivity, structured ethical reflection, emotional supervision, and organizational policies that balance digital efficiency with moral and human values are essential.\u003c/p\u003e\u003cp\u003eMoreover, the sustainability of humanistic care in digital environments depends on human-centered system design and organizational support. Evidence suggests that emotionally responsive EHR systems, ethical digital policies, and empathy-oriented training enable nurses to maintain compassionate therapeutic relationships despite technological pressures (Laukvik et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lanfer et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; El-Gazar et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Responsive system design that accommodates emotional needs, digital ethics policies, and empathy training grounded in technological contexts are key pillars for preserving compassion in digital workplaces. These principles resonate with Watson\u0026rsquo;s and Swanson\u0026rsquo;s concept of a caring\u0026ndash;healing environment, where nurses\u0026rsquo; emotional well-being is integral to care quality. Caring in the digital age thus requires balance between technological rationality and human spirituality, between efficiency and empathy.\u003c/p\u003e\u003cp\u003eThis review also highlights a gap: most existing studies remain descriptive and qualitative, limiting empirical understanding of the relationship between advanced technologies (e.g., AI, robotics) and caring behaviors (De Leeuw et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Liao et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Kang et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; El-Gazar et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Many focus on nurses\u0026rsquo; perceptions and experiences rather than measuring causal links between technology use and caring outcomes (Addotey-Delove et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; (Laukvik et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Future research should employ experimental and longitudinal designs to assess the impact of technology on therapeutic interactions, patient satisfaction, and nurses\u0026rsquo; emotional well-being(Coors et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Yuan et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Moreover, the integration of Watson\u0026rsquo;s, Swanson\u0026rsquo;s, and Barnard\u0026rsquo;s frameworks warrants further development to articulate a comprehensive and cross-cultural model of digital caring, particularly in the Global, where sociocultural norms and healthcare infrastructure differ substantially (Rouleau et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Vennik et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In essence, the emerging paradigm of technological caring or digital compassion embodies the future of nursing: a convergence of emotional sensitivity, relational ethics, and technological proficiency within a unified, human-centered framework. This synthesis underscores that while technology may redefine the medium of care, the essence of nursing empathy, intentionality, and human connection remains timeless.\u003c/p\u003e\n\u003ch3\u003eImplication\u003c/h3\u003e\n\u003cp\u003eThese findings emphasize that in nursing practice, it is essential to balance technological efficiency with human values through digital empathy and ethical reflection. Healthcare institutions should promote human-centered digital care policies and training to preserve therapeutic relationships within increasingly automated systems. In nursing education, the integration of digital literacy, technology ethics, and empathic communication should be strengthened to prepare future nurses to humanize technology in their professional roles. Furthermore, nursing research needs to empirically examine the impact of technology on caring behaviors and develop intervention models that protect nurses\u0026rsquo; emotional well-being in the digital era\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis review was limited to 16 English-language empirical studies (2020\u0026ndash;2025\u003cb\u003e)\u003c/b\u003e, most of which employed qualitative designs, thus constraining generalizability. The heterogeneity of technologies examined, ranging from telehealth to AI and robotic systems, also limits the universality of conclusions. Nevertheless, these limitations highlight the need for multidisciplinary and cross-cultural collaborations to deepen the understanding of humanizing digital nursing practices across diverse healthcare contexts.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNursing in the digital era faces a profound challenge: sustaining the essence of humanity amid technological advancement. Digitalization has transformed the expression of caring from physical touch to digital emotional presence, mediated by empathy, reflection, and technological competence. Through the integration of Watson\u0026rsquo;s Human Caring Theory, Swanson\u0026rsquo;s Caring Theory, and Barnard\u0026rsquo;s Parent Child Interaction Theory, caring emerges as a dynamic human relationship capable of adapting to evolving media without losing its spiritual core. Humanizing digital nursing requires a balance between system efficiency and relational integrity. Technology should not replace human touch but rather extend the reach of compassion through what can be described as technological caring or digital compassion. When technology is used reflectively, empathetically, and ethically, nurses become bridges between digital progress and humanity ensuring that the future of nursing remains rooted in compassion, presence, and respect for human dignity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no funding source.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Conflict of Interest Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAddotey-Delove M, Scott RE, Mars M (2022) A healthcare workers\u0026rsquo; mHealth adoption instrument for the developing world. 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Front Public Health 12(May):1\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2024.1239445\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2024.1239445\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"digital caring, nursing empathy, nursing technology, humanized care, caring theory","lastPublishedDoi":"10.21203/rs.3.rs-7935522/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7935522/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe digital transformation of healthcare has reshaped how nurses deliver care and express human compassion. Technologies such as Electronic Health Records (EHR), telehealth, and artificial intelligence (AI) enhance efficiency yet challenge the preservation of human touch within therapeutic relationships.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe aim of this study was to map empirical evidence on how digital technology influences, reshapes, and preserves the values of caring and human touch in nursing practice.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThis scoping review, guided by Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework and PRISMA-ScR, synthesized.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003e16 empirical studies published between 2020 and 2025. Thematic analysis using the Population Concept Context (PCC) framework identified four themes: (1) transformation of caring and technological competence; (2) adaptive strategies and digital empathy; (3) emotional and ethical challenges in virtual care; and (4) human-centered design and organizational support.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIntegration of Watson\u0026rsquo;s, Swanson\u0026rsquo;s, and Barnard\u0026rsquo;s theories revealed that caring in the digital era evolves into technological caring or digital compassion a synthesis of empathy, ethical reflection, and technological proficiency. Humanizing digital nursing requires balancing system efficiency with relational integrity. Further experimental and cross-cultural research is needed to explore the effects of technology on caring behavior and nurses\u0026rsquo; emotional well-being, particularly in Global contexts.\u003c/p\u003e","manuscriptTitle":"Humanizing Digitalnursing Practice: Preserving Caring Values in the Era of Technology-driven Healthcare: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 11:35:52","doi":"10.21203/rs.3.rs-7935522/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35ce7148-3193-4e24-af7c-1fc3c4fcfc03","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56854770,"name":"Nursing"}],"tags":[],"updatedAt":"2025-10-27T11:35:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-27 11:35:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7935522","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7935522","identity":"rs-7935522","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}