Strengthening Holistic Nursing Competence Among Emergency Nurses in the Digital Era: The Roles of Clinical...

Digital technologies and artificial intelligence are rapidly transforming emergency nursing, raising concerns about how nurses can sustain holistic, person-centered care in highly technologized environments. Organizational conditions such as the clinical governance climate, along with nurses' psychological and technological capacities, may play a decisive role in shaping holistic nursing competence in digitally evolving emergency care environments; however, their combined influence remains understudied. This study examined how clinical governance climate, digital empathy, and artificial intelligence attitude interact to shape holistic nursing competence among emergency nurses.

A cross-sectional study was conducted among 443 emergency nurses from 8 hospitals in Egypt. Data were collected over a 3-month period in 2025 using validated instruments measuring clinical governance climate, digital empathy, artificial intelligence attitude, and holistic nursing competence. Descriptive and correlational analyses were performed, and a moderated mediation model using the PROCESS model 14 was used to test conditional effects.

Clinical governance climate significantly predicted digital empathy and holistic nursing competence. Digital empathy strongly predicted holistic nursing competence (unstandardized coefficient = 0.33; P<.001). Artificial intelligence attitude had a significant direct effect on holistic nursing competence (unstandardized coefficient = 0.28; P<.001) and moderated the relationship between digital empathy and holistic nursing competence (interaction unstandardized coefficient = 0.32; P<.001). Digital empathy mediated the relationship between clinical governance climate and holistic nursing competence (indirect unstandardized coefficient = 0.15; P<.001), with a stronger indirect effect among nurses reporting more favorable attitudes toward artificial intelligence.

Supportive clinical governance strengthens holistic nursing competence directly and through enhanced digital empathy. Positive artificial intelligence attitudes further amplify nurses' capacity to translate empathy into holistic care, underscoring the need for governance-driven support, empathy training, and artificial intelligence-readiness strategies in emergency nursing.