Digital Culture, Reflexivity and Care Erosion in Nursing: A Conceptual Model of Reflexive Dissonance Failure

To examine how digitally mediated social environments may interact with nurses' reflexive capacity, professional values and responses to bias, and to develop Reflexive Dissonance Failure (RDF) as a conceptual model for understanding one possible pathway from ethical dissonance to care erosion.

Discussion paper.

This discussion paper uses a critical conceptual synthesis of interdisciplinary literature from nursing, psychology, sociology, ethics and digital media studies. Literature was purposively selected for conceptual relevance to reflexivity, cognitive dissonance, digital influence, implicit bias, moral disengagement, epistemic injustice, compassionate care and care erosion. The synthesis was used to derive and critically examine the proposed RDF model rather than to estimate effects or claim exhaustive evidence coverage.

Digital environments may amplify emotionally salient, selective or stereotype-reinforcing content, but they can also support professional learning, peer connection, advocacy and exposure to diverse perspectives. In the proposed RDF model, cognitive dissonance is treated as a potentially protective ethical signal when a judgement or response conflicts with personal, moral or professional standards. Reflexive engagement may support critical reappraisal and adaptive resolution; RDF refers specifically to situations in which this dissonance is absent, suppressed, ignored or maladaptively resolved through denial, justification, distraction or normalisation. These processes may increase vulnerability to moral disengagement, epistemic injustice and care erosion, although direct causal evidence in nursing remains limited.

RDF is proposed as a testable conceptual model rather than an established causal pathway. It reframes digital influence as one contextual factor that may interact with nurses' ethical agency, reflective capacity, organisational conditions and professional values. The model provides a basis for research on reflexivity, misinformation, bias, compassionate care and equity, while supporting strengths-based educational and organisational strategies for digitally mediated nursing practice.