Clinical Legibility: Recognition Infrastructure in Nursing

Area of Science:

• Nursing Theory
• Health Equity
• Epistemology

Background:

• Nursing recognition relies on more than individual judgment, highlighting systemic issues.
• Existing theories on epistemic injustice and clinical gaze lack focus on systemic recognizability.

Purpose of the Study:

• Introduce and define "clinical legibility" as a foundational theoretical construct for nursing.
• Shift the focus of recognition from individual nurses to the infrastructures supporting patient care.
• Distinguish clinical legibility from related concepts like epistemic injustice and diagnostic error.

Main Methods:

• Theoretical analysis building on Fricker's work and critical theories.
• Conceptual development of clinical legibility.
• Identification of three interlocking conditions structuring clinical legibility.

Main Results:

• Clinical legibility is defined as the structural condition enabling equitable capture, recognition, documentation, transmission, and action on patient reality.
• Three conditions for clinical legibility identified: valid inferential instruments, adequate educational repertoires, and robust documentation/escalation systems.
• Clinical legibility clarifies how nursing actions like surveillance, documentation, advocacy, and escalation depend on recognition infrastructure.

Conclusions:

• Clinical legibility is essential for ethical nursing care and a core disciplinary obligation.
• Reforming recognition infrastructure is central to nursing's project, not peripheral.
• Ensuring patient reality is actionable requires robust clinical legibility.