Integrating self-leadership and caring in primary nursing: a theory-building scoping review

Background Primary nursing emphasizes continuity, accountability, and individualized care; however, its implementation in contemporary healthcare settings remains conceptually fragmented. Existing literature often examines structural, cognitive-behavioral, and relational-ethical dimensions of nursing practice in isolation, limiting understanding of how these elements may interact. This review aimed to synthesize the literature and develop a preliminary conceptual framework integrating self-leadership and caring within primary nursing. Methods A scoping review was conducted in accordance with PRISMA-ScR guidance. Four databases (Scopus, PubMed, CINAHL, and Web of Science) were searched, supplemented by manual searching and backward and forward citation tracking. Eligible publications made a substantive contribution to at least one focal domain: primary nursing, self-leadership and related concepts, or caring and related relational-ethical concepts. Data were charted and thematically synthesized to identify patterns, conceptual relationships, and evidence gaps. Results Fifteen publications were included: five conceptual/theoretical papers, four qualitative studies, two quantitative cross-sectional studies, one quasi-experimental study, and three reviews. The synthesis identified five themes: primary nursing as a structural foundation of accountable practice; self-leadership as a cognitive-behavioral dimension of autonomous practice; clinical decision-making as an operational expression of practice; caring as a relational-ethical dimension; and fragmentation across domains. Higher-order synthesis positioned relational accountability as a candidate integrative mechanism linking structural responsibility, self-regulated autonomy, and relational engagement. This proposed mechanism was not empirically established by the included literature. Conclusion This review proposes a preliminary conceptual framework integrating structural, cognitive-behavioral, and relational-ethical dimensions of nursing practice. The framework organizes potentially related constructs and generates propositions for empirical investigation. Its proposed relationships and outcomes require validation across diverse healthcare contexts. Clinical trial number Not applicable.