Theorizing digital-relational harm in nursing

Digital infrastructures such as platforms, algorithms, and artificial intelligence (AI) are rapidly reshaping the conditions under which nursing care is enacted, raising ethical concerns that extend beyond efficiency. Indeed, as nursing becomes increasingly embedded within platformized and AI-mediated ecosystems, the discipline is confronted with new forms of harm arising from the disruptions to the relational foundations that make ethical nursing possible. Despite this, the discipline lacks a coherent conceptual framework capable of naming, analysing, and responding to the relational injuries produced by digital infrastructures and platformization. This paper introduces the concept of digital-relational harm. Drawing on six philosophical and theoretical traditions: African relational ontology, Western phenomenology and care ethics, Eastern relational philosophies, relational ethics, Labour Process Theory, and digital professionalism, the paper demonstrates that digital-relational harm arises when digital infrastructures disrupt person becoming, displace embodied and intersubjective presence, disturb relational harmony, erode trust and mutuality, fragment labour and continuity, and destabilise professional identity. These disruptions are structural, relational, and ontological. By naming digital-relational harm, the paper reframes digital transformation as an ethical and relational challenge, not merely a technical one, and argues that safeguarding relational integrity must become a central concern in the design, governance, and evaluation of digital health systems. Digital-relational harm offers nursing ethics a new analytic lens for understanding how digital environments shape moral life and provides a foundation for future empirical, theoretical, and policy-oriented work.