Beyond Technification: Ontological and Hermeneutic Foundations of Nursing Care

ABSTRACT

In this article, we examine the ontological, hermeneutic, and temporal dimensions of nursing care to explore how contemporary nursing practice and professional identity may be understood beyond exclusively technical accounts of care. Drawing primarily on Heidegger's ontology and Gadamer's philosophical hermeneutics, and engaging with concepts such as liminality, temporality, vulnerability, and self‐care, the article develops a theoretical framework for understanding nursing as a relational, interpretive, and ethically situated practice. Particular attention is given to the role of understanding, dialogue, and the fusion of horizons (Horizontverschmelzung) in clinical encounters, highlighting how caring involves not only technical competence and scientific knowledge but also the interpretation of patients’ lived experiences within specific historical, cultural, and biographical contexts. From this perspective, care emerges as a practice through which professional knowledge, ethical responsibility, and responsiveness to vulnerability are continuously negotiated and enacted. We argue that ontological and hermeneutic approaches enrich contemporary understandings of nursing by illuminating dimensions of care that cannot be fully captured through procedural, managerial, or productivity‐oriented frameworks alone. This perspective contributes to ongoing debates concerning nursing identity, autonomy, clinical decision‐making, and the humanization of healthcare, while reaffirming the importance of integrating scientific rigor, technical excellence, and interpretive understanding within professional nursing practice.

1. Care at the Threshold: Limit, Liminality, and Temporality in Nursing Practice

Contemporary nursing practice has benefited substantially from scientific development, technological innovation, and the consolidation of evidence‐based and protocol‐informed approaches to care. These advances have contributed to patient safety, clinical effectiveness, the standardization of interventions, and the professionalization of nursing. At the same time, nursing scholarship has continued to examine the tensions that may arise when organizational, procedural, and productivity‐oriented models inadequately account for the relational, experiential, and ethical dimensions of care (Caza and Creary 2016; Ewertsson et al. 2017; González‐Aguilar et al. 2018; Hwu and Pai 2025). In this context, professional nursing identity is shaped through an ongoing negotiation between scientific and technical competence, institutional demands, lived experience, and the meanings that nurses and patients attribute to caring practices (Mateo‐Martínez et al. 2021; Knop et al. 2024).

Among the philosophical perspectives that contribute to this discussion, Gadamer's philosophical hermeneutics offers a particularly fruitful framework for understanding nursing care as a practice of situated interpretation. From this perspective, caring involves not only the application of clinical knowledge and the skillful performance of interventions, but also engagement with the patient's history, language, values, concerns, and lived experience. Understanding develops dialogically as the professional's horizon of knowledge encounters the patient's historically situated world, without presupposing complete or transparent access to the other (Gadamer 2004). This hermeneutic orientation is consistent with interpretive approaches in nursing that emphasize embodiment, experience, professional judgment, and the relational constitution of caring practice (Benner 1994; Spichiger et al. 2005; Baart and Timmerman 2024; Healy 2024).

This interpretive understanding becomes especially relevant in situations of severe illness, chronicity, dependency, intense suffering, and proximity to death, in which patients may inhabit transitional or liminal spaces between health and illness, autonomy and dependence, and continuity and disruption of identity. Care is often enacted at what Oñate (2001) describes as the “limiting limit”: a point at which technical‐scientific knowledge remains indispensable but does not by itself account for the full meaning of the patient's vulnerability and experience. Turner's (1969) concept of liminality further illuminates these transitional states, in which established identities and categories may become unstable. By accompanying patients across such thresholds, nurses combine technically competent intervention with interpretation, presence, and attention to the meanings through which illness is experienced (Giorgi 1994; Mateo‐Martínez et al. 2021; Kaehne 2022; Zhao et al. 2024; Monge‐Moreno 2025a).

In this article, we examine how ontological, hermeneutic, and temporal perspectives can illuminate dimensions of nursing care that exclusively technical accounts may insufficiently articulate. We do not oppose philosophical reflection to scientific evidence, technological competence, clinical guidelines, or organizational requirements, all of which remain essential to responsible nursing practice. Rather, drawing primarily on Gadamer's philosophical hermeneutics and engaging selectively with Heidegger's ontology, the notions of limit and liminality, and different dimensions of temporality, we argue that nursing care is a technically competent, relational, interpretive, and ethically situated practice. This framework also provides a basis for examining how professional identity is continually formed through encounters with vulnerability, uncertainty, and the patient's singular experience.

The question of time is equally central to this understanding of care. The Greek tradition offers a plurality of temporal notions—Chronos, Kairos, Aion, and Aidion—that allow nursing practice to be understood beyond purely chronological and productive conceptions of time (Pereira et al. 2024). Chronos, linear and quantifiable time, organizes shifts, schedules, protocols, and institutional routines, and therefore remains indispensable to the functioning of healthcare systems. However, when Chronos becomes the sole framework through which care is organized and evaluated, important dimensions of the patient's experience may become less visible, and nursing practice may risk being understood primarily in procedural terms. By contrast, Kairos refers to the opportune moment, the qualitative instant in which an intervention—or a presence—acquires its fullest meaning (Miller et al. 2022). In nursing practice, Kairos appears when the professional knows when to intervene, when to remain silent, when to hold a hand, or when to allow the other to take charge of their own process (Babapour et al. 2022; Schaepkens and Coccia 2022). In this sense, temporal sensitivity may be understood as part of the art of nursing, insofar as nurses continually navigate between organizational time and the lived temporalities of patients, responding to different temporal horizons within the same caring encounter.

Aion, in turn, can be understood as the patient's existential time, particularly visible in situations of severe illness or end‐of‐life care, where time is no longer experienced in hours or days but as a biographical whole charged with meaning (Janes et al. 2021). Finally, Aidion refers to a suspended or almost immobile temporality, present in contexts of prolonged suffering or palliative care, where time seems to thicken or lose its usual structure (Hiong 2022; Pearce 2022).

Attending to these different temporal dimensions allows nursing care to be understood as a practice that extends beyond technical efficiency and is embedded within complex human experiences marked by finitude, waiting, urgency, uncertainty, and possibility. Within this framework, care may be approached as a form of “the unavailable”: a dimension of clinical practice that exerts a profound influence on the caring encounter while resisting complete capture through the logics of productivity, measurement, or standardization. This dimension becomes especially visible in experiences of liminality and vulnerability, where technical competence remains indispensable but acquires its fullest meaning within broader relational, ethical, and interpretive dimensions of care. From this perspective, temporality does not merely constitute the context in which care occurs; it becomes one of the ways through which the meaning of care is disclosed and enacted.

2. Ontology and Hermeneutics of Care: Being‐With, Giving Time, and Accompanying Vulnerability

If the previous section situated care at the threshold—within experiences of limit, liminality, and temporal disruption—the present section examines more closely its ontological and hermeneutic foundations. The aim is no longer merely to describe care as a practice that unfolds in critical moments of human existence, but to clarify the conditions under which nurses encounter, interpret, and respond to another person's experience of illness, dependency, suffering, or vulnerability. This shift requires distinguishing between the ontological conditions of shared human existence and the hermeneutic processes through which understanding becomes possible within particular clinical encounters.

From Heidegger's perspective, care (Sorge) is not one activity among others, but a fundamental determination of Dasein and an originary structure of being‐in‐the‐world (Heidegger 2006). Within this framework, Heidegger's notion of Mitsein should not be understood primarily as a description of a specific interpersonal relationship, such as the nurse–patient encounter. Rather, it refers to the ontological condition of always already existing with others in a shared world structured by language, practices, social meanings, and historical contexts (Heidegger 2006). This shared condition provides an important background for understanding why nursing care never takes place in isolation, but always unfolds within wider relational, cultural, and institutional horizons (Benner 1994; Askheim et al. 2024; Stocco et al. 2026).

However, inhabiting a shared world does not guarantee immediate or transparent access to another person's experience. Clinical encounters may be marked by differences in language, culture, biography, values, and ways of interpreting illness, which complicate any assumption of direct understanding. Nursing care therefore requires more than ontological coexistence: it involves a situated interpretive effort through which the professional seeks to understand what the patient's condition means within a particular life history and horizon of experience. This distinction creates the transition from Heidegger's ontology of shared existence to Gadamer's philosophical hermeneutics, which offers a more precise framework for examining dialogue, historicity, interpretation, and understanding within the caring encounter (Gadamer 2004; Benner 1994; Spichiger et al. 2005).

Heidegger further distinguishes two forms of Fürsorge (solicitude or care for the other): one that “leaps in” and takes over for the other, and another that “leaps ahead” and helps the other to become themselves (Heidegger 2006). In the first case, care may become intrusive, assuming control of the situation and diminishing the other's capacity to participate in decision‐making, thereby risking paternalism. In the second, care becomes a liberating practice oriented toward supporting the other's possibilities for self‐determination, even under conditions of profound vulnerability. Here, care is not understood as domination or substitution, but as accompaniment directed toward enabling the person's own agency.

This distinction is particularly valuable for nursing practice because it highlights that the ethical quality of care depends not only on what is done, but also on how professional knowledge and intervention are enacted in relation to the patient's autonomy. Technical competence remains indispensable to good nursing care; indeed, without it, nurses would be unable to promote health, relieve suffering, or respond appropriately to vulnerability. However, within a Heideggerian perspective, technical intervention acquires its fullest significance when it supports rather than replaces the patient's own possibilities for understanding, participation, and self‐determination (Benner 1994; Spichiger et al. 2005).

This ontological understanding of care finds an important complement in Gadamer's philosophical hermeneutics. For Gadamer, understanding is not the application of a method to an object, but an event that takes place through dialogue and participation in a historically situated process of interpretation (Gadamer 2004). Central to this perspective is the notion of the fusion of horizons, through which different perspectives encounter one another without being reduced to a single point of view. In clinical practice, this means that understanding emerges through the encounter between professional knowledge, clinical judgment, and the patient's lived experience of illness, vulnerability, and care.

As Gadamer argues, understanding and interpretation are inseparable dimensions of the hermeneutic process (Gadamer 2004). From this perspective, every act of nursing care is also an interpretive act. Nurses do not simply perform interventions; they continually interpret symptoms, narratives, silences, emotions, gestures, and forms of expression within a particular biographical, cultural, and relational context. The patient is therefore not approached merely as a clinical case or as a set of physiological parameters, but as a person whose experience acquires meaning within a unique life history and horizon of understanding (Morse 2018; Shankar et al. 2025). Gadamer's notion of Anwendung (application) is especially relevant to nursing practice. In philosophical hermeneutics, understanding, interpretation, and application do not constitute separate or successive stages; rather, they form a unified process through which meaning becomes concrete within a particular situation (Gadamer 2004). Transposed to nursing practice, this means that clinical understanding becomes effective through situated judgment: nurses interpret scientific evidence, technical knowledge, patients’ narratives, and the particular circumstances of care to determine how best to respond. Anwendung therefore helps explain why hermeneutic understanding does not compete with technical intervention but informs its concrete and ethically responsible enactment.

Care may thus be understood as a situated hermeneutic practice in which technical competence, scientific knowledge, and interpretive understanding are not opposing dimensions but mutually informing aspects of professional nursing practice. Within this framework, technique acquires meaning through its responsiveness to the patient's situation, while interpretation remains grounded in the realities of clinical care. This perspective is supported by studies highlighting the importance of nurse–patient relationships, communication, and contextual understanding for both clinical outcomes and the subjective experience of illness (Janes et al. 2021; Healy 2024). The aim of nursing care is therefore not only to contribute to healing, recovery, or stabilization but also to accompany patients as they navigate experiences that may profoundly affect their identity, biography, and sense of possibility.

At this point, Derrida's contribution allows the reflection to be further extended. His notions of “giving time” and “giving life” introduce an ethical dimension that exceeds purely instrumental understandings of care (Derrida 1992). “Giving time” does not simply mean spending more minutes with the patient but creating a space of presence in which temporality is no longer governed exclusively by the Chronos of clinical scheduling but is also responsive to the Kairos of the meaningful encounter. In care, this opportune time emerges when professionals can attend to the patient not merely as a diagnosis or clinical case, but as a person whose experience carries a particular history, meaning, and vulnerability (Niles et al. 2021).

Likewise, “giving life” does not mean mechanically prolonging biological existence, but recognizing and respecting the other's alterity and singular way of inhabiting illness, dependency, suffering, or proximity to death. From this perspective, nursing care includes dimensions that cannot be fully captured by procedural, technical, or managerial frameworks alone. Technical competence remains indispensable, yet caring encounters also involve forms of presence, responsiveness, and ethical attention that resist complete standardization or quantification (Frankenberg 1988; Galvin and Todres 2011).

These considerations suggest that the ontological and hermeneutic dimensions of care are not abstract philosophical additions to clinical practice, but fundamental aspects of how nursing care is understood and enacted. Nursing therefore emerges at the intersection of ontology, hermeneutics, and ethics: a practice through which professionals interpret situations of vulnerability, respond to human finitude, and accompany patients without appropriating their experiences. Far from being merely the application of knowledge, nursing care involves a form of engaged practical understanding in which both the patient's experience and the professional's own identity are continually shaped and transformed. This connection between care, interpretation, and professional self‐understanding provides the basis for the discussion of nursing identity developed in the following section.

3. Identity and the Transfiguration of Care: Towards a Critical Philosophy of Transition

If care has so far been understood as a liminal practice and as an ontological and hermeneutic engagement with vulnerability, it is now necessary to consider its implications for contemporary nursing identity. Ongoing debates within nursing scholarship have highlighted concerns regarding professional identity, task‐oriented models of care, managerial pressures, and the challenge of preserving relational and interpretive dimensions of practice within increasingly complex healthcare systems (Caza and Creary 2016; Ewertsson et al. 2017; Knop et al 2024; Melo and Augusto 2025). Rather than referring to a generalized crisis, these discussions suggest an ongoing struggle over how nursing should understand and articulate its distinctive contribution to care. In this sense, questions of meaning, identity, and professional purpose remain central to contemporary nursing practice.

Nursing identity may be understood not simply as a collection of competencies, roles, or professional functions, but as a historically situated process through which nurses learn to interpret, respond to, and accompany human experiences of vulnerability. Heidegger's notion of Mitsein provides an ontological background for this understanding by reminding us that human existence is always constituted within a shared world of relationships, practices, and meanings (Heidegger 2006). However, the formation of nursing identity cannot be explained solely through coexistence with others. It also involves processes of interpretation through which professionals come to understand both patients and themselves within particular historical, cultural, and clinical contexts.

From a Gadamerian perspective, nursing identity is also shaped by Wirkungsgeschichte (expressed in wirkungsgeschichtliches Bewusstsein or historically effected consciousness). Nurses never approach clinical situations from a neutral or context‐free position; their understanding is formed within inherited professional traditions, institutional practices, languages, educational experiences, and prior clinical encounters. These historically constituted horizons both enable interpretation and establish limits that may need to be questioned and revised. Nursing identity therefore develops through an ongoing engagement with the histories and traditions that shape professional understanding, as well as through encounters capable of widening, correcting, or transforming those horizons (Gadamer 2004).

Within this historically situated process, Gadamer's notion of the fusion of horizons is especially valuable for understanding how nursing identity is continually formed and transformed. Through the notion of the fusion of horizons, identity emerges not as a fixed attribute but as something continually shaped through encounters with different experiences, perspectives, and forms of understanding (Gadamer 2004). Nursing identity is therefore constituted through ongoing dialogue between professional knowledge, clinical experience, ethical reflection, and engagement with patients’ lived realities. Within this framework, care is not external to professional identity but one of the primary ways through which that identity is formed, questioned, and transformed over time (Benner 1994; Spichiger et al. 2005).

Nursing identity, however, is neither fixed nor complete. Rather, it remains an ongoing process of interpretation, revision, and transformation, insofar as nursing practice unfolds precisely at the margins: between health and illness, autonomy and dependence, life and death. The notions of liminality (Turner 1969) and the “limiting limit” (Oñate 2001, 2021) highlight how care is exercised in transitional spaces where established categories and certainties may become unstable. In such contexts, professional identity cannot rely solely on fixed assumptions or predefined responses but must remain open to a reflexive practice capable of inhabiting uncertainty and ambiguity without prematurely reducing them to protocols (Kaehne 2022; Zhao et al. 2024; Hwu and Pai 2025; Latif and Gulzar 2025).

It is within this context that the notion of the “unavailable sacred” acquires its significance. Rather than referring to a religious category, the concept points to dimensions of caring that remain resistant to complete objectification or instrumentalization. Experiences such as radical vulnerability, finitude, dependency, and the irreducible singularity of the other confront nurses with aspects of human existence that cannot be fully translated into metrics, protocols, productivity indicators, or technical procedures alone. From this perspective, the “unavailable sacred” designates not a separate sphere beyond clinical practice, but a reminder that some of the most significant dimensions of care exceed what can be entirely calculated, standardized, or managed. This remainder of meaning calls for an ethical and hermeneutic openness through which professionals remain attentive to the uniqueness of each caring encounter (Galvin and Todres 2011; Oñate 2021).

While Heidegger and Gadamer provide the principal ontological and hermeneutic foundations of the present argument, certain aspects of Nietzsche's thought offer a complementary perspective on professional self‐formation and transformation. Rather than serving as a foundation for an ethics of care, Nietzsche's reflections on becoming, self‐creation, and amor fati may help illuminate how nursing identity remains an unfinished and continually evolving project. From this perspective, professional identity is not understood as a fixed set of competencies or roles, but as an ongoing process through which nurses respond to uncertainty, vulnerability, responsibility, and the demands of practice. Nietzsche's emphasis on becoming what one is can thus be interpreted as an invitation to cultivate a reflective and creative engagement with professional life rather than merely reproducing inherited models of practice (Nietzsche 2021; Kapusta 2026).

This interpretation resonates with the preceding discussion of liminality and hermeneutic openness. Nursing professionals frequently encounter situations that challenge established certainties and require continual reinterpretation of both practice and self‐understanding. In this context, Nietzsche's contribution lies less in providing a model of care than in highlighting the transformative dimension of professional identity. The significance of his thought for nursing therefore resides not in the affirmation of power or domination, but in the possibility of understanding professional development as an ongoing process of self‐reflection, responsibility, and openness to transformation within the realities of caring practice.

This understanding of nursing identity converges with Heidegger's proposal of a form of care that supports the other in becoming themselves and with Orem's emphasis on self‐care, autonomy, and the patient's active participation in their own health processes (Orem 1995; Wang et al. 2022; Ashley 2024). Across these perspectives, care is understood not as the substitution of the patient's agency, but as a practice that seeks to support, sustain, and accompany the person's own possibilities for participation, decision‐making, and self‐understanding, even in situations of chronic illness, dependency, or end‐of‐life care.

Contemporary nursing identity may therefore be understood as an unfinished and dynamic identity, continually negotiated at the intersection of scientific knowledge, technical competence, ethical responsibility, and interpretive understanding. Living within these tensions is not a sign of weakness but a condition of professional maturity and reflective practice. In this sense, the transformation of care does not require abandoning science or evidence‐based practice but situating them within a broader understanding of human vulnerability, temporality, and lived experience (Alanazi et al. 2024). Recent research lends support to many of these philosophical insights. Approaches centered on presence, listening, relational continuity, and sensitivity to the patient's lived temporality have been associated with greater satisfaction, improved therapeutic engagement, and more dignified experiences of illness and care (Wright 2021; Monge‐Moreno 2025b). Such findings suggest that ethical attentiveness, interpretive understanding, and relational engagement are not secondary additions to clinical practice, but important dimensions of high‐quality nursing care.

Nursing thus emerges as a practice situated at the intersection of ontology, hermeneutics, ethics, and clinical expertise. Through caring relationships, professionals interpret situations of vulnerability, respond to human finitude, and accompany patients through experiences that may profoundly affect identity, meaning, and self‐understanding (Mema et al. 2025). Far from being merely the application of knowledge, nursing care may be understood as a form of engaged practical understanding in which both patients and professionals are transformed through the encounter.

4. Conclusions

The analysis developed throughout this article has argued that exclusively technical accounts of nursing care are insufficient to capture the full complexity of nursing practice. Rather than being exhausted by the application of procedures, nursing care unfolds through clinical encounters shaped by ontological, hermeneutic, ethical, and temporal dimensions. Nursing practice may therefore be understood as a situated and relational engagement with experiences of vulnerability, illness, dependency, and human finitude, in which both patients and professionals participate in processes of interpretation, understanding, and meaning‐making.

The concepts of limit, liminality, and temporality explored throughout this article have highlighted the importance of attending to dimensions of care that cannot be fully reduced to productivity indicators, procedural frameworks, or standardized protocols. Sensitivity to different temporal horizons, to the patient's lived experience, and to the singularity of each clinical situation reveals that caring involves more than effective intervention alone. It also requires responsiveness to the meanings through which illness, suffering, dependency, and recovery are experienced and understood. In this sense, nursing care may be understood as a practice of accompanying persons through transitions and transformations while recognizing their dignity, autonomy, and vulnerability.

A central contribution of this work has been to show how Gadamer's philosophical hermeneutics provides a particularly fruitful framework for understanding the nature of nursing care. Through the notion of the fusion of horizons (Horizontverschmelzung), clinical encounters may be understood as dialogical processes in which professional knowledge and patients’ lived experiences enter into a relationship of mutual interpretation. Care is therefore not simply the application of knowledge to a clinical situation, but a situated practice of understanding in which meaning emerges through engagement with the other's experience. This hermeneutic perspective complements the ontological insights derived from Heidegger and enriches contemporary understandings of nursing identity, vulnerability, and professional responsibility.

The articulation of an ontology of care, a hermeneutics of clinical understanding, and an orientation toward autonomy and self‐care allows for a richer and more demanding conception of nursing practice. This perspective does not diminish the importance of scientific knowledge, technical competence, evidence‐based practice, or organizational structures. On the contrary, it suggests that these dimensions acquire their fullest significance when integrated within a broader understanding of care as a relational, interpretive, and ethically situated practice. Professional nursing identity is formed precisely within this ongoing effort to balance scientific rigor, technical excellence, ethical responsibility, and responsiveness to human vulnerability.

From this perspective, nursing care emerges as a space of reciprocal transformation. Patients are not merely recipients of interventions, and professionals are not simply executors of techniques. Rather, both participate in encounters through which new understandings, possibilities, and meanings may emerge. Recognizing this interpretive, relational, and temporal dimension of care not only contributes to more humane clinical practice but also strengthens nursing's capacity to articulate its distinctive contribution within increasingly complex healthcare systems.

Ultimately, the future of nursing will depend not on the adoption of particular philosophical authors or traditions, but on the profession's continuing ability to cultivate forms of reflection that remain attentive to meaning, vulnerability, interpretation, autonomy, and human finitude. In this sense, caring may be understood as a practice of technically competent, ethically responsible, and hermeneutically informed engagement through which professionals and patients participate in the shared task of making sense of illness, vulnerability, and the possibilities of human life.

Author Contributions

Antonio Vázquez‐Sellán: conceptualization, supervision, critical revision of the manuscript, approval of the final version. María Carmen Sellán‐Soto: conceptualization, supervision, critical revision of the manuscript, approval of the final version. Ginés Mateo‐Martínez: conceptualization, literature review, formal analysis, writing – original draft, writing – review and editing, final approval of the manuscript.

Funding

The authors have nothing to report.

Ethics Statement

Ethical approval was not required for this study because it is a theoretical and conceptual analysis and did not involve human participants, animals, identifiable personal data, or biological material.

Conflicts of Interest

The authors declare no conflicts of interest.

Artificial Intelligence Statement

The authors did not use generative artificial intelligence (AI) or AI‐assisted technologies to generate the scientific content, analyses, interpretations, or conclusions presented in this manuscript.

Data Availability Statement

Research data are not shared. No new datasets were generated or analysed during the current study.