Self-Leadership Based on Caring in Primary Nursing: Developing and Validating a Conceptual Model Through a Delphi Study.

AIM: To develop and validate a conceptual model of self-leadership based on caring for primary nursing practice by integrating empirical findings with self-leadership (Manz-Neck) and caring (Watson-Swanson) theories. DESIGN: A preliminary model was developed through the integration of empirical findings from previous qualitative and quantitative studies and informed by self-leadership theory and caring theories. METHODS: A preliminary model was developed by synthesising empirical findings from previous qualitative and quantitative studies with self-leadership (Manz-Neck) and caring (Watson-Swanson) theories to generate an initial conceptual framework, which was subsequently evaluated by an expert panel comprising nursing academics, nurse managers, senior clinical nurses, and primary nurses. RESULTS: The Delphi process refined the model by positioning caring enactment as the central mechanism through which self-leadership capacities are translated into accountable professional agency and practice outcomes, while reflexive feedback supports continuous leadership development through reflective learning and practice experience. CONCLUSION: The model advances nursing leadership scholarship by extending self-leadership theory beyond its traditional intrapersonal focus and conceptualising caring enactment as the mechanism through which leadership capacities become accountable professional practice. It provides a theoretically grounded framework for understanding how frontline nurses translate self-leadership capacities into accountable professional action and sustained practice outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: The model offers nursing managers a practical framework for strengthening frontline leadership through the development of self-leadership capacities, caring enactment, and accountable professional agency. Its application may inform leadership development programmes, reflective supervision, mentorship initiatives, and organisational resources such as leadership support, protected time for reflective practice, and role clarity to strengthen primary nursing implementation aimed at improving continuity of care, quality of nursing care, and workforce sustainability.