Legal Literacy in Clinical Nursing Practice: A Walker and Avant Concept Analysis

Background: The legal dimensions of nursing practice have become increasingly complex, yet the concept of legal literacy in clinical nurses remains insufficiently defined. Existing studies use terms such as legal knowledge, legal awareness, legal cognition, and law-based practice capacity inconsistently, which hinders conceptual clarity, valid measurement, and targeted educational intervention. This study aimed to clarify the conceptual boundaries, defining attributes, antecedents, consequences, empirical referents, and operational definition of legal literacy in clinical nurses. Methods: A concept analysis was conducted using Walker and Avant's eight-step method. A systematic literature search was performed across six databases and supplemented by searches in JSTOR and HeinOnline for non-clinical uses of the concept. The search covered database inception to December 2024. Screening and reporting followed PRISMA 2020 guidelines. Fifty-six papers were included. Data extraction and analysis were conducted using content analysis with independent dual-reviewer coding. Results: Legal literacy in clinical nurses was distinguished from four related concepts: legal knowledge, legal awareness, legal cognition, and medical ethics. Three defining attributes were identified: normative understanding, value internalization oriented toward rights and responsibilities, and law-based situational practice. Antecedents were identified at macro, meso, and micro levels, while consequences were observed for individual nurses, healthcare organizations, and patient rights. Analysis of empirical referents revealed a persistent gap between conceptualization and measurement, particularly in assessing law-based situational practice. An operational definition was developed accordingly. Conclusions: Legal literacy in clinical nurses is a multidimensional professional competency integrating legal understanding, rights- and responsibility-oriented value internalization, and the ability to translate these into lawful clinical action. The findings provide a conceptual basis for future instrument development and targeted educational and management interventions.