Theory of Clinical Self-Determination (TCSD): A Normative-Critical Nursing Theory

The Theory of Clinical Self-Determination (TCSD) is introduced as a normative-critical nursing theory that examines the relationship between professional autonomy, clinical dignity, institutional protection, and quality of care. The theory proposes that nurses should be recognised as autonomous clinical agents whose protected professional judgement is essential for safe, ethical, and patient-centred care. It argues that strengthening the professional status and dignity of nurses does not oppose patient-centred practice but constitutes a necessary condition for its sustainability. The framework is organised around five foundational concepts: clinical self-determination, protected clinical discretion, a culture of nursing dignity, organisational protection of the professional, and recognition of nursing agency. It further presents theoretical propositions and research implications for future exploration of professional autonomy, moral distress, workplace culture, and healthcare organisation.