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. Author manuscript; available in PMC: 2026 Jun 30.
Published in final edited form as: ORL Head Neck Nurs. 2026;44(1):51–65.

Redefining Nursing in Otorhinolaryngology-Head & Neck Care: Implications of the ICN’s 2025 Definitions for an Evolving Specialty

Vinciya Pandian 1,2,3, Sarah E Hughes 4, Michael J Brenner 5,6
PMCID: PMC13313049  NIHMSID: NIHMS2171816  PMID: 42375812

Abstract

Background

Otorhinolaryngology-head and neck (ORL-HN) nursing encompasses complex, multisystem care for conditions affecting hearing, olfaction, balance, breathing, sleep, swallowing, communication, appearance, and identity across the lifespan. In 2025, the International Council of Nurses (ICN) updated its definitions of nursing and a nurse to better reflect contemporary practice, emphasizing professional autonomy, cultural safety, health literacy, health equity, environmental stewardship, and interprofessional collaboration. These concepts are highly relevant to ORL-HN nursing, where care is technologically advanced, interdisciplinary, and deeply connected to quality of life.

Purpose

To synthesize and interpret the ICN’s 2025 definitions of nursing and a nurse through the lens of ORL-HN nursing practice and to examine their implications for clinical care, education, leadership, and equity across the continuum of care.

Methods

A narrative review was conducted drawing on international nursing, otorhinolaryngology, head and neck oncology, airway, hearing, and rehabilitation literature, alongside the ICN’s 2025 definition report. Key themes were identified and mapped to ORL-HN nursing roles across acute, perioperative, rehabilitative, survivorship, and community-based settings. Illustrative case scenarios were used to contextualize the application of core ICN principles in specialty practice.

Results

The ICN definitions affirm ORL-HN nurses as autonomous, accountable professionals who integrate scientific knowledge, ethical judgment, and culturally responsive communication. Across subspecialty areas, nurses operationalize these principles through airway vigilance, early complication detection, device-based rehabilitation, health literacy-responsive education, caregiver engagement, and coordination of interprofessional care. The framework also highlights nursing leadership in clinical pathways, simulation-based education, telehealth, survivorship programs, and global equity initiatives that reduce preventable harm and enhance person-centered outcomes.

Conclusions

The ICN’s 2025 definitions provide a timely and unifying framework that aligns closely with the realities of ORL-HN nursing. Applying this framework strengthens professional identity, clarifies nursing contributions within interprofessional teams, and offers guidance for advancing equitable, person-centered care, education, research, and policy in an evolving specialty.

Keywords: Otolaryngology, Head and Neck Neoplasms, Otorhinolaryngology Nursing, Nursing Role, Professional Autonomy, Interprofessional Relations, Patient-Centered Care, Health Literacy, Health Equity, Cultural Safety

INTRODUCTION

Otorhinolaryngology head and neck nursing engages the functions that make us human, including hearing, speaking, breathing, swallowing, and expressing emotion, all of which shape how people experience the world and connect with others. The International Council of Nurses updated its definitions in 2025 because earlier versions no longer reflected the realities of modern nursing, which now includes leadership, technological expertise, population health engagement, and practice across diverse clinical and community settings. A revised definition was needed to capture this expanded scope and to guide global workforce planning, education, and regulation. These updates are especially relevant to otorhinolaryngology head and neck nursing, where conditions from congenital disorders to oncology or acquired injury can affect communication, airway, and identity. Caring for patients across this diverse clinical terrain requires a holistic and transdisciplinary approach to care (Kagan, 2009; B. Sigler, 1994). The ICN’s 2025 definition affirms the nurse’s role in supporting dignity, equity, and whole-person well-being, principles central to caring for patients whose conditions influence quality of life and human connection.

Caring for patients with head and neck cancer, airway compromise, sinus disease or hearing loss involves recognizing how impaired ability to communicate, eat, breathe, or engage socially can disrupt human lives (Dempsey et al., 2016; B. A. Sigler, 1988). The complexity of this work requires more than technical proficiency and calls for holistic, psychosocially informed, and function focused care that addresses long term treatment effects and quality of life concerns (Brommelsiek et al., 2024; Renghea et al., 2022). It demands advanced assessment, cultural humility, interdisciplinary coordination, and sustained therapeutic presence across acute, ambulatory, operative, oncologic, rehabilitative, and community settings that are often organized within multidisciplinary programs and survivorship clinics (Brenner et al., 2020; Meister et al., 2021; Pandian et al., 2023; V. Pandian et al., 2012, 2020; Salahshurian & Moore, 2024; Vergara et al., 2024; Zaga et al., 2020)

The International Council of Nurses’ (ICN) 2025 updated definitions of “nursing” and “a nurse” offer a timely framework for these realities by articulating nursing’s scope, identity, and contribution to global health (White et al., 2025). By emphasizing equity, cultural safety, health literacy, environmental awareness, and shared accountability, the ICN definitions reflect contemporary expectations for nursing practice within complex specialties such as otorhinolaryngology-head and neck care (White et al., 2025). Nurses in this specialty integrate science, ethics, and collaboration in the care of patients whose conditions profoundly affect quality of life, consistent with descriptions of nurses as professionals who promote health, prevent illness, protect safety, alleviate suffering, and uphold dignity across the lifespan (Morozova & Sheina, 2024; Safavi et al., 2022). The renewed definitions also elevate nurses as autonomous professionals whose contributions extend beyond tasks to encompass system stewardship, compassion, advocacy, and policy influence, which aligns with contemporary analyses of the nursing role in complex cancer and survivorship care (White et al., 2025).

The updated definitions arrive at a moment when the specialty itself is evolving in response to advances in airway science, cochlear implantation, head and neck cancer therapies, minimally invasive sinus and skull base surgery, and deep learning that have reshaped care trajectories across the lifespan (Comini et al., 2025; Hosoya et al., 2024; Novi et al., 2025). Patients are living longer with more complex needs and with higher expectations for functional recovery, communication access, and shared decision making, particularly in survivorship contexts where physical, psychological, and social domains of health-related quality of life remain affected (Gianfredi et al., 2025; Perron et al., 2024).

As the scope of otorhinolaryngology-head and neck practice expands, the responsibility of nurses to lead in care coordination, education, safety, and innovation becomes increasingly visible in multidisciplinary clinics, survivorship programs, and quality improvement initiatives (Gianfredi et al., 2025). Taken together, the ICN’s 2025 definitions offer a unifying language that affirms the breadth of nursing practice, strengthens interdisciplinary partnerships, and provides direction for advancing equitable, person centered care across diverse settings (Moser, Freeman-Sanderson, et al., 2022; V. Pandian et al., 2016). The following sections examine how this framework can guide the future of otorhinolaryngology-head and neck nursing and amplify the specialty’s contributions across the continuum of care from acute interventions to long term survivorship and community support. The dimension of the ICN 2025 definitions of nursing and a nurse are depicted in Figure 1 (Table 1).

Figure 1.

Figure 1.

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Dimension of the ICN 2025 Definitions of Nursing and a Nurse

Table 1.

Alignment of ICN’s 2025 Definitions with Otorhinolaryngology-Head and Neck Nursing Practice

ICN 2025
Core Concept		 Definition and Intent Application in Otorhinolaryngology-Head and Neck Nursing Practice
Equity Ensuring fair access to high-quality care regardless of circumstance Address disparities in hearing technology access, cancer treatment, airway safety, interpreter services, and rural follow-up pathways
Cultural safety Providing care that is respectful, responsive, and free of discrimination Adapt communication approaches for diverse linguistic and cultural backgrounds, and consider cultural norms in postoperative and survivorship care
Health literacy Supporting comprehension and informed decision-making Use teach-back, visual aids, interpreters, and hands-on demonstration for hearing devices, wound care, stoma care, and postoperative recovery
Collaboration Working in partnership with patients, families, and interprofessional teams Coordinate care with surgeons, speech-language pathologists, audiologists, respiratory therapists, dietitians, oncology teams, and social workers
Ethical accountability Upholding integrity, person-centered care, and professional responsibility Advocate for equitable device coverage, patient privacy, shared decisionmaking, and safe transitions between hospital and home
Environmental stewardship Promoting environmental health and minimizing harm Support safe management of medical waste from stoma supplies and devices, and use telehealth to reduce travel burden
Professional autonomy Exercising independent judgment and evidence-based decision-making Perform autonomous assessments of airway stability, swallowing safety, hearing changes, vertigo, and postoperative complication risk
System integration Contributing to system-level safety, quality improvement, and policy Lead clinical pathways for airway, hearing, and oncology, participate in quality improvement projects, and support care transitions
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ICN 2025 DEFINITIONS AND THEIR RELEVANCE TO OTORHINOLARYNGOLOGY-HEAD AND NECK NURSING

Reframing Nursing Through Core Values

The ICN’s 2025 definitions of “nursing” and “a nurse” emerged from a global consultation process and represent one of the most substantive rearticulations of the profession in recent decades (White et al., 2025). Rather than simply updating language, the ICN reframed nursing around core values that include equity, cultural safety, health literacy, environmental stewardship, ethical accountability, and collaboration across settings (White et al., 2025). These concepts closely mirror the lived practice of otorhinolaryngology-head and neck nurses, whose clinical encounters routinely require navigating vulnerability, communication barriers, stigma, and complex health transitions in conditions such as head and neck cancer, airway compromise, and hearing loss (Kersen et al., 2024; Peng et al., 2024).

A Definition That Reflects Specialty Scope

The ICN defines nursing as a discipline grounded in scientific knowledge and ethical principles, committed to promoting health, preventing illness, and alleviating suffering across the lifespan (White et al., 2025). This framing aligns with otorhinolaryngology-head and neck care, where nurses guide communication and hearing rehabilitation across developmental stages, support safe breathing and airway management, advocate for nutrition and swallowing safety, safeguard sensory and vestibular well-being, and assist patients who are navigating conditions that may alter appearance, identity, or social engagement (Green, 2018; Rothrie et al., 2025). The breadth of these responsibilities underscores nursing as a relational, integrative, and evidence informed practice rather than one defined primarily by tasks or anatomical systems, consistent with contemporary descriptions of nursing as a safety critical, knowledge-based profession in oncology and survivorship contexts (Brenner et al., 2024; Brodsky et al., 2021; Searl et al., 2024).

Affirming the Nurse as an Autonomous, Accountable Professional

The ICN’s revised definition of a nurse highlights professional autonomy, clinical judgment, and accountability for coordinating culturally safe, person-centered care (Bhutta et al., 2008; Pursio et al., 2021). In otorhinolaryngology-head and neck settings, nurses operationalize these principles through independent assessment of airway stability, hearing changes, vertigo, and swallowing safety and through early recognition of complications such as bleeding, airway obstruction, surgical site infection, and aspiration in high risk surgical and airway populations (Crosbie et al., 2014; Grewal et al., 2022; Ninan et al., 2023). Nurses also apply culturally attuned communication strategies in linguistically diverse populations, particularly for individuals undergoing complex procedures such as free flap reconstruction, cochlear implantation, or endoscopic sinus surgery, where treatment pathways and self-management demands are extensive (Govindan et al., 2025). Leadership in preoperative education, survivorship navigation, and family counseling further reflects nurses as professionals who enhance health literacy, promote recovery, and uphold dignity across the illness trajectory. In this specialty, clinical autonomy is fundamental to safe care, and proactive nursing assessment in tracheostomy and airway teams has been associated with fewer emergencies and improved outcomes.

Equity, Cultural Safety, and Health Literacy as Core Elements

The updated ICN definitions explicitly call for equitable, culturally safe care that acknowledges the social determinants of health and access (Armache et al., 2024; Burks et al., 2024). Otorhinolaryngology-head and neck nursing can address global workforce needs (Petrucci et al., 2023). It intersects with documented disparities in communication access, language barriers, cancer survivorship, environmental exposures, pediatric developmental trajectories, and the needs of rural or low resource communities, as described in recent reviews of inequities across otolaryngology subspecialties and head and neck cancer care. Patients with communication impairments, whether from head and neck cancer, airway reconstruction, craniofacial differences, or severe hearing loss, are at heightened risk of being misunderstood, marginalized, or excluded from decisions about their care, with downstream effects on participation, psychosocial adjustment, and quality of life (Hughes, Brenner, Facione, et al., 2025). The ICN emphasis on health literacy reinforces nursing’s role in transforming information into shared understanding, particularly for patients facing complex postoperative care, lifelong device management, or stigmatizing conditions that require high levels of self-management and informed consent (Liddell et al., 2025). Studies across otorhinolaryngology and head and neck practice document variable and often inadequate health literacy and highlight the importance of tailored education strategies that match literacy levels, language preferences, and cultural contexts.

Collaboration as a Defining Feature

The ICN highlights collaboration as intrinsic to nursing identity and to the profession’s contribution to safe, effective health systems (Kagan, 2009; Wiederholt et al., 2007). This focus resonates in otorhinolaryngology-head and neck practice, where optimal outcomes depend on synergy among surgeons, nurses, speech language pathologists, respiratory therapists, audiologists, dietitians, social workers, and rehabilitation therapists, as well as engaged patients and families (Hazzard et al., 2021; Heineman et al., 2017; Reger & Kennedy, 2009). Team based approaches, including specialized tracheostomy and head and neck multidisciplinary teams, have been shown to improve airway safety, communication outcomes, surgical recovery, and patient satisfaction across the continuum of care (Figure 2). By situating nursing within global goals such as universal health coverage, cultural responsiveness, and system level advocacy, the ICN definitions reflect expanding responsibilities for otorhinolaryngology–head and neck nurses in survivorship programs, telehealth monitoring, device troubleshooting, caregiver education, and transition planning (Karam et al., 2018; Schmid et al., 2022). These definitions offer a professional identity that is forward looking and responsive to global inequities in hearing, airway, and head and neck cancer care, consistent with calls for multidisciplinary survivorship models, innovative communication technologies, and equity focused interventions.

Figure 2.

Figure 2.

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Depiction of the continuum of otorhinolaryngology which spans patient age, phase of care, and specialty.

Otorhinolaryngology nurses care for patients from young children to elderly adults, providing care in inpatient and outpatient settings, and across a wide range of subspecialty areas.

NURSING ACROSS THE OTORHINOLARYNGOLOGY-HEAD AND NECK CONTINUUM

The continuum of otorhinolaryngology nursing spans patient age, phase of care, and subspeciality areas; otorhinolaryngology nurses care for patients from young children to elderly adults, providing care in inpatient and outpatient settings, and across a wide range of subspecialty areas (Figure 1).

Otorhinolaryngology-head and neck nursing encompasses critical airway management, ambulatory procedures, oncology, device-based rehabilitation, and community based chronic disease support (Kagan, 2009). Across these environments, nurses embody the ICN description of the nurse as an autonomous, evidence informed, and culturally responsive professional who promotes health, alleviates suffering, and enhances health literacy across the lifespan (Hong et al., 2015). The specialty requires nurses to serve as a unifying presence for patients and families as they navigate complex, high risk, and emotionally significant care journeys from diagnosis through rehabilitation and survivorship (Weissbach et al., 2025).

Acute and Perioperative Care

In acute and perioperative settings, nurses perform vigilant assessment and rapid intervention for conditions that can deteriorate quickly after otorhinolaryngology and head and neck procedures (Li et al., 2024). This includes monitoring airway patency after thyroidectomy, parathyroidectomy, or neck dissection, where expanding hematoma can precipitate sudden obstruction, and assessing for bleeding and dehydration after tonsillectomy or skull base surgery (Ingram & Friedman, 2015; Turkdogan et al., 2022). Nurses also provide communication support and anticipatory guidance regarding recovery, which are consistently emphasized in perioperative head and neck cancer and free flap nursing literature.

Oncology and Reconstructive Care

Head and neck oncology nursing involves guiding patients through intensive treatment courses that may include surgery, microvascular free flap reconstruction, radiation, and systemic therapies (Greedy, 2022). Nurses prepare patients for major surgery, manage complex drains and grafts, and monitor for early signs of flap compromise, all of which are critical to preserving tissue viability and preventing life threatening complications (Chen et al., 2025). They coordinate swallowing and speech language rehabilitation and address psychosocial concerns related to appearance, voice, and identity, reflecting the documented functional and emotional impact of dysphagia, disfigurement, and communication changes in head and neck cancer (Patel et al., 2017).

Airway and Respiratory Care

Airway care is central to otorhinolaryngology-head and neck nursing, particularly in populations with tracheostomies, upper airway tumors, bilateral vocal fold immobility, or postoperative edema (A. T. Pandian et al., 2025; Zaga et al., 2025). Nurses maintain readiness for airway obstruction and bleeding, guide suctioning, humidification, and secretion management, and collaborate closely with speech language pathology, respiratory therapy, and surgical teams to improve safety and outcomes (Brenner & Pandian, 2024; Morris et al., 2025; Moser, Budhathoki, et al., 2025; A. T. Pandian et al., 2025; Peter et al., 2024; Vergara et al., 2024; Zaga et al., 2025). Structured family education programs on airway safety and emergency planning have been associated with fewer unplanned readmissions and better home management for tracheostomy and airway dependent patients (Foran et al., 2024; Moser, Budhathoki, et al., 2025).

Hearing, Vestibular, and Communication Disorders

In hearing, balance, and communication care, nurses assist patients with sensory disruption, dizziness, tinnitus, and adaptation to hearing devices across the lifespan. Key responsibilities include preoperative and postoperative teaching for cochlear implantation and bone conduction devices, counseling on communication strategies, and assessing safety risks in patients with acute vertigo or balance disturbances. These roles align with the ICN emphasis on preserving dignity, autonomy, and functional capacity when sensory and communication deficits threaten participation in work, school, and social life.

Pediatric Otorhinolaryngology Nursing

Pediatric otorhinolaryngology nurses address conditions that affect growth, development, communication, nutrition, sleep, and family routines, including chronic otitis media, airway anomalies, craniofacial differences, sleep disordered breathing, and tracheostomy care. Chronic otitis media and pediatric sleep disordered breathing are linked to behavioral problems, learning difficulties, and reduced quality of life, which underscores the importance of early identification and coordinated management. Nurses manage feeding challenges and recurrent infections, monitor developmental impacts, and prepare families for procedures such as hearing restoration or cleft related surgeries in collaboration with craniofacial and cochlear implant teams (Prezelski et al., 2025; Wagner et al., 2024).

Community and Home-Based Care

Beyond hospital discharge, otorhinolaryngology-head and neck nursing extends to homes, schools, workplaces, and long-term care settings, where nurses support sustained adaptation to chronic ear, nose, throat, and head and neck conditions (Table 2). Nurses troubleshoot hearing devices, promote medication adherence, provide wound and stoma care, reinforce rehabilitation plans, and coordinate services for medically complex patients in survivorship. Telehealth follow up and remote triage have improved access to specialty care and continuity during public health emergencies, and telemedicine for cochlear implant and tracheostomy populations demonstrates feasibility and high satisfaction.

Table 2.

The Otorhinolaryngology-Head and Neck Nursing Continuum Across Care Settings

Care Setting Primary Nursing Roles Key Examples of Responsibilities
Acute and perioperative care Assessment, airway vigilance, postoperative safety, communication support Monitor bleeding and airway patency after thyroidectomy, guide hydration and pain management, support communication with temporary voice changes
Oncology and reconstructive
care		 Surgical recovery, flap monitoring, symptom management, psychosocial support Manage drains and grafts, detect flap compromise, guide swallowing rehabilitation, address appearance-related concerns and survivorship needs
Airway and respiratory care Emergency readiness, secretion management, family training Guide suctioning and humidification, educate on airway safety, collaborate with speech-language pathology and respiratory therapy
Hearing, vestibular, communication Device education, counseling, safety assessment Teach cochlear implant care, troubleshoot hearing aids, counsel on tinnitus, assess fall risk for vestibular disorders
Pediatric ENT care Developmentally informed education, caregiver coaching, safety monitoring Prepare families for hearing restoration procedures, manage chronic otitis media, support feeding and airway needs in craniofacial conditions
Community and home care Long-term device support, chronic symptom management, telehealth monitoring Provide stoma and wound care, support home use of hearing devices, reinforce rehabilitation plans, coordinate with school nurses and community resources
Rehabilitation and survivorship Education, functional support, emotional care, interdisciplinary coordination Facilitate voice and swallowing rehabilitation, monitor late effects of cancer treatment, guide safe return to school, work, and social activities
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INTERPROFESSIONAL COLLABORATION AND THE ICN DEFINITIONS

Interprofessional Collaboration and Accountability

Otorhinolaryngology-head and neck care depends on cohesive, coordinated teamwork that spans surgery, oncology, rehabilitation, and survivorship. Patients often experience conditions that affect communication, airway protection, swallowing, sensory function, and appearance, which require contributions from multiple disciplines to support safe and effective care. These realities reinforce contemporary interpretations of the ICN definitions that describe nursing as a collaborative, relational, and system aware profession that shares accountability for person centered, culturally safe, and ethically grounded care.

Collaboration as a Driver of Safe and High-Quality Care

Interprofessional collaboration is essential to achieving optimal outcomes in airway, oncology, otology, rhinology, laryngology, and craniofacial care. Nurses work alongside surgeons, speech language pathologists, respiratory therapists, audiologists, dietitians, physical and occupational therapists, social workers, and care coordinators to deliver integrated plans of care, and multidisciplinary models in tracheostomy and airway care reduce adverse events, improve communication access, and support timely rehabilitation. In surgical oncology and complex reconstructive care, coordinated nursing collaboration with reconstructive surgeons, nutrition specialists, and psychosocial providers further supports wound management, swallow safety, and survivorship concerns.

The Nurse as System Integrator and Communication Bridge

Analyses of multidisciplinary cancer care highlight the nurse’s central role in coordinating complex pathways and ensuring information flow between specialties and across the patient journey. In acute care settings, nurses may be critical in early detection (Ahmed et al., 2024). In outpatient otorhinolaryngology–head and neck settings, nurses often serve as the communication bridge when patients have hearing loss, aphonia, dysphagia, or neurologic conditions that limit participation. By leading or facilitating care pathways, clinical huddles, postoperative education programs, and device training sessions, nurses identify barriers, coordinate timely referrals, and maintain continuity across acute, rehabilitative, and community-based care. Nurses in cooperation with other health professionals also play a vital role in opioid stewardship (Anne et al., 2021; Cramer et al., 2020, 2021, 2023; McCoul et al., 2021).

Shared Accountability and Ethical Practice

Contemporary discussions of the ICN definitions emphasize that nurses share accountability with other professionals for ethical, safe, and effective care across the continuum. Shared accountability is evident when teams anticipate and prevent airway emergencies, promote early mobilization, deliver consistent messages about swallowing and communication, and prepare patients and caregivers for transitions to home or community settings. Interprofessional teams also share responsibility for addressing disparities in access to hearing care, communication support, cancer treatment, and airway safety, and equitable access to multidisciplinary services and follow up has been linked to reduced complications and improved long-term outcomes.

CASE SCENARIO 1. ADULT HEAD AND NECK ONCOLOGY: COLLABORATIVE CARE AND HEALTH LITERACY

Mr. L is a 58-year-old man recovering from composite resection and free flap reconstruction for advanced oral cavity cancer who is experiencing appearance changes, aphonia, and feeding related anxiety, consistent with documented burdens of disfigurement, functional loss, and psychological distress in head and neck cancer. English is not his primary language, and his family feels overwhelmed by wound care, nutrition, and communication strategies, reflecting health literacy and caregiver challenges described in oncology literature. A head and neck nurse leads coordination by arranging interpreter supported teaching, using teach back to confirm understanding, performing daily flap assessments, and collaborating with reconstructive surgery, nutrition, and speech language pathology, practices that are associated with better adherence and multidisciplinary integration. Tailored instructions help the family manage tube feedings and stoma hygiene at home, which aligns with evidence linking caregiver preparation to fewer complications, reduced burden, and improved experience in head and neck cancer and tracheostomy care.

Empowering Patients and Families Through Health Literacy and Person-Centered Care

Otorhinolaryngology–head and neck conditions often affect hearing, speech, swallowing, breathing, facial expression, and balance, which are central to identity and social participation (Amin et al., 2025; Ward et al., 2018). These changes influence emotional well-being, relationships, employment, and quality of life for patients and families. Commentaries on the ICN definitions emphasize the nurse’s responsibility to enhance health literacy, foster culturally safe environments, and uphold dignity across the lifespan, which aligns closely with the aims of head and neck oncology and airway care (V. Pandian et al., 2022).

Health Literacy as a Foundation for Safety and Engagement

Health literacy is essential for safe care in otorhinolaryngology-head and neck practice, where patients must understand information related to airway protection, hearing device management, swallowing safety, postoperative wound care, and symptom monitoring during cancer treatment. Lower health literacy is associated with difficulty processing cancer related information, poorer quality of life, and suboptimal adherence, whereas structured, health literacy sensitive communication improves adherence and treatment completion. Nurses use clear language, visual aids, teach back, and culturally sensitive materials, especially for patients with hearing loss, language differences, voice disorders, or cognitive impairment, which supports informed participation in decisions and safer self-management.

Supporting Communication Access Across the Lifespan

Communication access is a pillar of empowerment and is associated with better psychosocial outcomes and participation in decision making for individuals with head and neck cancer and airway conditions. Nurses help patients use hearing devices, alternative communication strategies, and speech aids and partner with audiology and speech language pathology to optimize rehabilitation. In patients with hearing loss, tinnitus, or vestibular disorders, nurses counsel on safety, device troubleshooting, and strategies to maintain engagement in social, educational, and occupational environments. For those recovering from surgery or airway procedures, nurses collaborate to facilitate voice restoration and swallowing rehabilitation while protecting airway safety.

Family Engagement as a Cornerstone of Effective Care

Families provide practical and emotional support related to wound care, airway monitoring, nutrition, communication practices, device use, and symptom surveillance, and they often experience substantial psychological burden and role strain. Nurses build caregiver readiness through repeated explanations, skill demonstrations, and emotional support, which is associated with fewer preventable complications and better adjustment. Family engagement is especially important in pediatric populations, where parents must integrate medical instructions into daily routines related to feeding, sleep, school, and development.

CASE SCENARIO 2. PEDIATRIC ENT: FAMILY EMPOWERMENT IN HEARING AND AIRWAY CARE

Maya is a 6-year-old child with chronic otitis media, mild conductive hearing loss, and sleep disordered breathing whose caregivers recently immigrated and have limited English proficiency, a constellation that reflects known risks for delayed identification of hearing loss, barriers to specialty care, and school related stress. The pediatric otorhinolaryngology nurse acts as primary advocate and educator, arranging interpreter services, using visual aids, and providing hands on demonstrations to teach hearing device care and signs of worsening sleep apnea, strategies that reflect best practices for health literacy and engagement. She partners with the school nurse for classroom accommodations and coordinates care with audiology, sleep medicine, and otolaryngology to create a unified plan that fits the family’s constraints, which mirrors integrative models associated with higher satisfaction and adherence. With nursing support, Maya’s family reports increased confidence, improved school engagement, and better adherence to follow up, consistent with evidence linking caregiver empowerment to improved quality of life, reduced distress, and better clinical trajectories.

Addressing Emotional Well-being and Psychosocial Needs

Changes in hearing, voice, breathing, appearance, or swallowing can trigger anxiety, social withdrawal, stigma, depression, and fear of recurrence, while caregivers experience distress and fear about the future. Nurses often provide the first line of emotional support, normalize reactions, and facilitate referrals to counseling, support groups, and survivorship programs, and psychosocial support has been shown to improve adaptation and reduce burden (Brenner et al., 2021; V. Pandian et al., 2021). Person centered and culturally safe care that respects values, preferences, and goals is associated with better satisfaction and adherence in head and neck cancer and tracheostomy populations and is a core pathway to improved outcomes (Jamal et al., 2023).

LEADERSHIP, INNOVATION, AND GLOBAL EQUITY IN OTORHINOLARYNGOLOGY-HEAD AND NECK NURSING

The ICN’s renewed definition of nursing has been interpreted as a call for nurses to act as leaders, innovators, and advocates who shape health systems and advance justice in care delivery (Bedwell et al., 2019; Brenner et al., 2020; McGrath, Wallace, et al., 2020). These expectations resonate with otorhinolaryngology-head and neck nursing, where nurses drive practice improvements, coordinate interdisciplinary initiatives, and address inequities that affect access to hearing, communication, airway safety, and cancer care. Leadership in this specialty extends from bedside practice to institutional, national, and global arenas (Jung et al., 2023; Ninan et al., 2023).

Nursing Leadership in Complex Systems

Otorhinolaryngology-head and neck care increasingly relies on clinical pathways, coordinated recovery programs, shared decision making frameworks, and collaborative care models for complex surgical, oncologic, and airway populations (Moser, Peeler, et al., 2022b; V. Pandian, Atkins, et al., 2023; V. Pandian, Ghazi, et al., 2023). Nurses often lead within these structures by standardizing postoperative education, coordinating follow up, facilitating multidisciplinary rounds, and overseeing discharge teaching for patients recovering from laryngectomy, tracheostomy, and major head and neck reconstruction. Nursing contributions to tracheostomy safety bundles, emergency algorithms, and pathway-based approaches have reduced complications and improved out-comes, and similar leadership in survivorship programs supports symptom monitoring, psychosocial care, and rehabilitation planning (Ward et al., 2023).

Innovation Across Airway, Hearing, Communication, and Oncology Care

Innovation in this specialty spans clinical pathways, simulation, digital tools, and survivorship models (Moser, Kim, et al., 2025). Nurse led tracheostomy and airway pathways have been associated with fewer adverse events, shorter time to communication, and improved family preparedness. Simulation based training improves competence in suctioning, tube changes, and emergency response for interprofessional staff and reduces error in airway care. Digital and algorithm supported models, including nurse led survivorship platforms and decision support tools, demonstrate feasibility in coordinating complex cancer follow up and improving access to supportive care. In head and neck oncology, nurse led survivorship interventions and structured radiotherapy education have been associated with better caregiver resilience, reduced distress, and improved quality of life.

Advancing Global Equity in ENT and Head and Neck Care

Equity is a central concern in otorhinolaryngology-head and neck practice, where disparities in access to hearing screening, otologic surgery, communication rehabilitation, and cancer treatment are well documented in the United States and abroad (Hughes, Brenner, Facione, et al., 2025; Hughes, Brenner, Pandian, et al., 2025). Studies from low- and middle-income settings show that limited infrastructure, shortages of specialized personnel, and financial barriers restrict access to safe airway management and post-surgical rehabilitation, placing disproportionate burden on families and local health workers. Within these environments, nurses often serve as primary providers of airway monitoring, hearing education, and rehabilitation support and adapt teaching materials to local resources and cultural contexts. Nurse led initiatives in community-based hearing education, structured caregiver training for tracheostomy and airway management, and early detection of head and neck cancers have improved referral timeliness and access to basic services (Patterson et al., 2025; Tsai Do et al., 2024).

Research, Scholarship, and System Change

Nurses strengthen otorhinolaryngology-head and neck care through research and scholarship that inform evidence-based practice and policy. Nurse led or nurse collaborative studies have advanced knowledge regarding tracheostomy team effectiveness, pressure injury prevention, communication outcomes, family experience, and interprofessional performance (Balakrishnan et al., 2021; Moser, Budhathoki, et al., 2025; Moser, Peeler, et al., 2022a, 2022b). Quality improvement initiatives have documented reductions in tracheostomy related emergencies and management amid pandemic crises, enhanced communication access, and improved satisfaction when structured pathways are sustained with nursing leadership. In head and neck oncology, clinical and longitudinal studies demonstrate that nurse led survivorship programs, decision aids, and psychosocial interventions reduce caregiver burden, mitigate fear of recurrence, and improve quality of life (Berges et al., 2021; McGrath, Brenner, et al., 2020; V. Pandian et al., 2020; Zaga et al., 2020). Advocacy for early access to hearing technologies, timely cancer referrals, equitable coverage, interpreter services, and comprehensive post discharge resources further illustrates nursing’s role in system change and health justice.

PRACTICAL IMPLICATIONS ACROSS STAKEHOLDERS

Recent editorials on the updated ICN definitions describe them as a unified framework that can guide practice, education, policy, and collaboration across health systems by centering equity, cultural safety, and system stewardship (Balakrishnan et al., 2021; Jamal et al., 2023). Because otorhinolaryngology and head and neck conditions intersect with communication, airway safety, hearing, swallowing, sensory function, and identity, coordinated actions from multiple stakeholders are required to address clinical complexity and psychosocial burden (Figure 3).

Figure 3.

Figure 3.

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Stakeholder engagement in interprofessional otorhinolaryngology – head and neck cancer care

Implications for Clinical Nurses

For clinical nurses, current scholarship reinforces autonomy, critical thinking, and health literacy promotion as core responsibilities in complex care. In otorhinolaryngology and head and neck settings, this translates into early identification and management of airway, hearing, swallowing, and wound complications, as well as culturally and linguistically tailored education and discharge planning (Figure 4). Nurses coordinate rehabilitation and follow up services with speech language pathology, audiology, nutrition, and survivorship programs, which improves safety, comprehension, and continuity across settings.

Figure 4.

Figure 4.

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Practice Pearls for Otorhinolaryngology Head and Neck Nurses

Implications for Interprofessional Team Members

Strong interprofessional partnerships are foundational for high quality airway, oncology, otology, rhinology, and laryngology care. Teams that include surgeons, nurses, speech language pathologists, respiratory therapists, audiologists, dietitians, social workers, and rehabilitation specialists can use modern nursing frameworks to clarify shared accountability and develop consistent, culturally informed communication strategies for tracheostomy, laryngectomy, and head and neck oncology populations. Joint training programs and care pathways have been associated with improved airway safety, timely rehabilitation, enhanced communication access, and better postoperative recovery.

Implications for Administrators and Health System Leaders

Health system leaders can use contemporary analyses of nursing’s evolving role to design structures that support interdisciplinary teamwork, shared governance, and specialized pathways such as airway safety committees, tracheostomy teams, and head and neck cancer programs. Ensuring access to interpreter services, culturally appropriate materials, and health literacy resources is critical for diverse populations and aligns with evidence that communication support improves outcomes. Investment in simulation-based training for airway emergencies, hearing device management, and postoperative education, as well as support for nurse led quality improvement and research, contributes to better safety metrics, fewer adverse events, and higher satisfaction.

Implications for Educators and Academic Institutions

Educators can draw on emergent scholarship on nursing definitions and professional identity to strengthen curricula in otorhinolaryngology and head and neck nursing. Key priorities include teaching culturally responsive communication to address health literacy and stigma, integrating simulation scenarios focused on airway vigilance, hearing device management, dizziness assessment, and wound care, and preparing learners for interprofessional teamwork and equity focused practice. These strategies ensure future nurses are ready to contribute to safe, person centered, and collaborative care systems.

Implications for Patients, Families, and Caregivers

Studies in head and neck cancer and tracheostomy care highlight the central role of patients and families in managing complex regimens, device care, and long-term recovery. Caregivers benefit from clear, culturally and linguistically relevant education that is reinforced over time and matched to health literacy levels, and hands on training in airway, hearing, communication, swallowing, and surgical care tasks supports confidence and successful transitions to home and community settings. When patients and families feel empowered and informed, outcomes improve and complications decrease across high acuity and chronic otorhinolaryngology conditions.

Implications for Global and Community Health Stakeholders

The 2025 ICN definition represents a shift toward valuing human rights, relationality and care, planetary health, and transformative leadership (Cleofas, 2025). At global and community levels, nursing and otorhinolaryngology literature underscore the need to address disparities in hearing care, cancer treatment, communication rehabilitation, and airway management, particularly in low resource and rural settings (Faucett et al., 2022; Graboyes et al., 2020; Truesdale et al., 2021). Community health programs, public health agencies, and international networks can use these frameworks to expand screening, education, and early detection efforts and to deliver contextually appropriate caregiver training that reduces preventable complications for patients living far from tertiary centers. Supporting nurse led innovations that address resource limitations and strengthening advocacy for underserved populations are consistent with global calls for equitable and sustainable otorhinolaryngology and head and neck care and position nurses as key partners in advancing global surgery and communication health agendas.

CONCLUSION

The 2025 ICN definitions provide a forward-looking framework that affirms the breadth, complexity, and societal importance of otorhinolaryngology–head and neck nursing. By emphasizing autonomy, equity, cultural safety, health literacy, and interprofessional collaboration, the definitions align closely with the realities of caring for patients whose conditions affect communication, airway safety, sensory function, identity, and well-being across the lifespan. Across acute care, rehabilitation, survivorship, and community settings, nurses serve as system integrators, educators, advocates, and innovators who reduce preventable harm and support meaningful recovery for patients and families. Applying the ICN framework can strengthen professional identity, enhance interdisciplinary partnerships, and guide education, quality improvement, research, and policy efforts that address persistent disparities in hearing, communication, airway, and head and neck cancer care. As the specialty continues to evolve, these definitions offer a shared language that supports high-quality, person-centered, and equitable care and underscores the essential contributions of otorhinolaryngology-head and neck nurses to global health.

Funding

This work was supported by the National Institutes of Health (NIH) R25 grant (5R25DC020262-02) awarded through the Michigan Otolaryngology Research Education (MORE) program. The funding source had no role in the design of the review, manuscript preparation, or the decision to submit the manuscript for publication.

Footnotes

Ethics Statement

This manuscript is a narrative review and did not involve human participants, animals, or identifiable private information. As such, institutional review board approval and informed consent were not required.

Conflicts of Interest

The authors declare no conflicts of interest.

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