The Nordic state of nursing research: The case of Sweden

The historical development of research into nursing in Sweden has, over the past few decades, undergone a profound transformation, from a marginal, practice-oriented activity to a recognised academic discipline grounded in theory, methodology and evidence-based practice. This editorial offers a reflective overview of the historical evolution of research into nursing in Sweden, its current opportunities and challenges, and its prospective role within an increasingly interdisciplinary landscape of health science research.

The formal establishment of research into nursing in Sweden was closely linked to the higher education reform of 1977, ¹ through which nursing education was incorporated into the university system and thereby granted a formal research mandate. During the 1970s, the first Swedish registered nurses (RNs) earned doctoral degrees, often within related fields such as medicine, psychology or pedagogy. ² The first professorship in nursing was established in 1987 and held by Astrid Norberg at Umeå University. Norberg, together with other early pioneers, played a crucial role in shaping the academic identity of nursing and in laying the epistemological foundations of the discipline.

The 1990s marked a formative decade for Swedish nursing research, characterised by a growing cohort of nurse scholars committed to strengthening the scientific legitimacy of nursing practice. ² Inspired by American nursing researchers and the emerging paradigm of academic caring, a conception of nursing grounded in theory and evidence, in which the best available scientific knowledge and proven experience form the basis for practice, ³ researchers increasingly articulated the distinctive contribution of nursing to health and society. Concepts such as the nursing process, nursing diagnosis and person-centred care gained prominence in both education and research. At the same time, tensions became evident between nursing's practical and ideological roots and the epistemic demands of scientific legitimacy. Early studies focused on the nature of caring relationships and the core aims of nursing, promoting health and alleviating suffering, whereas subsequent research increasingly examined the organisational and contextual conditions under which nursing is delivered. Over time, Swedish nursing research expanded from exploring the fundamentals of caring to developing and evaluating nursing interventions, systems and quality-of-care frameworks. Through this gradual evolution, the field has consolidated its position as a dynamic academic discipline characterised by theoretical development, methodological sophistication and a sustained commitment to improving nursing through evidence-based practice.

Institutionally, this development was supported by the establishment of doctoral programmes in nursing, national research schools and dedicated funding streams from agencies such as the Swedish Research Council and Vårdalstiftelsen. Together, these initiatives strengthened the scientific infrastructure of the discipline. Nonetheless, research into nursing continues to evolve, reflecting ongoing efforts to integrate scientific rigour with the lived realities of clinical practice.

Today, professional nursing practice in Sweden rests on the theoretical and empirical foundations of the discipline, while the profession as a whole depends on the continuous generation and translation of scientific knowledge. For us as researchers, this development entails a responsibility to remain closely connected to clinical practice – ensuring that nursing research not only meets academic standards of excellence but also contributes to evidence-based and contextually relevant care.

Nursing research in Sweden: established, although challenges remain

Today, it constitutes a well-established academic discipline. More than 4000 registered nurses hold doctoral degrees, just over 3% of the national nursing workforce, and the number of full professorships is slowly increasing, currently around 150 (0.1%). ⁴ The research landscape is broad and diverse, encompassing areas such as older people's health, mental health, chronic illness, reproductive and sexual health, autonomous nurse-led roles, nurses’ scope of practice and professional identity, models of care, person-centred care, patient safety, quality of care, and the working conditions of healthcare professionals. This breadth reflects both the complexity of contemporary healthcare and the societal challenges shaping its development. Swedish nursing research is predominantly person-centred and clinically oriented, responding to growing expectations for societal relevance, clinical innovation, cost-effectiveness and evidence-based practice. A substantial body of work focuses on care for older people and individuals living with chronic conditions, addressing both new models of service delivery and evolving professional roles. Increasingly, nursing research also engages with global and multicultural perspectives, recognising how population mobility, diversity, and social change affect the provision of equitable and contextually relevant care.

Despite this progress, nursing research faces persistent challenges that threaten its long-term sustainability. Resource constraints, the impending retirement of senior scholars, unclear career trajectories and competing clinical and teaching demands risk undermining research capacity and continuity.^5,6 At the same time, rapid digitalisation, the integration of artificial intelligence, increasing privatisation and enduring inequalities in access to care introduce new methodological and ethical complexities. These developments make it imperative for nursing to engage actively in interdisciplinary research not only to respond to emerging healthcare realities, but also to shape them. Such engagement requires an expanded methodological repertoire, including mixed-methods designs, implementation science frameworks, and participatory approaches capable of capturing the dynamic interplay between patients, healthcare teams and organisational structures. ⁷ As digital tools and AI-driven solutions become embedded in care, ethical standards must evolve accordingly to safeguard participants’ rights, privacy and well-being. Beyond structural and financial barriers, further challenges demand attention: the need for robust supervision and mentorship for doctoral students, the development of clinically relevant research questions and clear postdoctoral career pathways. Together, these elements are essential for cultivating future research leaders. Building strong interdisciplinary teams and fostering creative and critical thinking are equally important for advancing nursing as a practice-based discipline. Recruiting and retaining the next generation of nurse researchers will be decisive for sustaining nursing science and its contribution to resilient, evidence-based healthcare.

A persistent implementation gap remains because research findings are insufficiently translated into clinical practice. This underscores the need for systematic implementation strategies, ⁷ including clinical research partnerships, co-production models and established frameworks for complex interventions, such as the Medical Research Council's Framework for Complex Interventions. ⁷ Encouragingly, awareness of nursing research as a driver of sustainable care, equity and patient involvement is growing. One notable development is the increased emphasis on public, patient and professional involvement (PPPI) in research. ⁸ PPPI adds value by shaping research agendas, prioritising relevant research questions and identifying outcomes that matter in practice. By integrating diverse perspectives, PPPI strengthens both the relevance and impact of nursing research, at the same time as enhancing its legitimacy and societal trust. This participatory approach aligns with person-centred care and reinforces nursing research's role in shaping a responsive, inclusive and evidence-informed healthcare system.

At a time when nursing research in Sweden faces both heightened expectations and structural vulnerability, the integration of theoretical models and methodological frameworks becomes a strategic necessity rather than a methodological preference. Research that is theoretically grounded and methodologically coherent is better equipped to address complex clinical realities, support implementation and generate knowledge that is both credible and usable in practice. Recent Swedish studies illustrate how such integration can strengthen relevance, feasibility and long-term impact. One example is the ongoing SexCanWebEd-Nurse project,^9,10 which combines a theoretically informed understanding of sexuality ¹¹ with a structured, practice-oriented training model BETTER, ¹² embedded within the Medical Research Council framework and principles of PPPI. Early findings indicate high acceptability and engagement, highlighting how systematic end-user involvement enhances both feasibility and clinical uptake. Crucially, this integrated approach enables research to move beyond isolated interventions towards adaptable and sustainable solutions. Ongoing work to tailor the intervention to gynaecological cancer care, using mixed methods, registry data and co-creation, demonstrates how theory- and framework-driven research can retain scientific rigour while responding to changing clinical contexts. In this way, the integration of theory, method and stakeholder perspectives directly addresses the persistent implementation gap identified in Swedish nursing research.

Evidence-based nursing must be a cornerstone of Swedish healthcare. Clinical decision-making and nursing interventions should be grounded in robust scientific evidence rather than tradition or routine. However, nursing research has long struggled for recognition, and nurses remain underrepresented in policy and strategic decision-making arenas. Although nurses are highly trusted by the public, their scientific contributions are often overlooked, limiting their influence on healthcare development. Strengthening evidence-based nursing therefore requires a shift in how nursing research is valued and integrated into healthcare systems. Nursing research plays a crucial role by generating knowledge that informs national guidelines and policy. For example, research on person-centred care has influenced guidelines for chronic disease management issued by the Swedish National Board of Health and Welfare, ¹³ while palliative care research has shaped both national guidelines ¹⁴ and higher education curricula. To remain relevant and impactful, nursing researchers must engage actively in policymaking and healthcare governance. Supporting nurses with PhDs and professors to work across clinical and academic contexts is not optional – it is essential for a responsive and sustainable healthcare system.

While randomised controlled trials (RCTs) have long been regarded as the gold standard in medical research, their dominance has also shaped nursing intervention research.^3,15 At the same time, growing recognition of clinical complexity has increased the use of complementary approaches, including observational studies and mixed methods. ⁷ These approaches capture interactions among patient experiences, staff working conditions and organisational factors that cannot be fully examined in controlled environments. By integrating intervention studies with observational data, nursing research builds an evidence base that is both rigorous and attuned to clinical realities, an essential step in closing the implementation gap.

Funding and career structures remain central challenges. As both an art and a science, nursing has historically struggled for legitimacy within academic and policy arenas, a legacy that continues to influence funding opportunities. Competition for grants is intense, and practice-oriented nursing research risks being deprioritised in favour of traditional hypothesis-driven medical research. Limited postdoctoral opportunities, unclear career pathways and a shortage of senior role models further constrain the field's development. ⁵ These barriers also reinforce the implementation gap because few clinicians have protected time for research or knowledge translation. The clinical–academic career pathway remains underdeveloped, and many managers lack the support structures needed to foster research engagement. Nevertheless, positive trends are emerging. Funding bodies increasingly recognise the value of nursing research, particularly in implementation science and clinical studies. National conferences and digital knowledge platforms are enhancing the field's visibility and accessibility, reflecting growing awareness that research must not only be produced, but also translated into action.

Through methodological breadth, policy engagement and clinical relevance, strengthened by meaningful PPPI, nursing research in Sweden is well positioned to contribute to a more equitable, sustainable and evidence-based healthcare system, nationally and across the Nordic region.^16,17 However, this potential will not be realised without deliberate and sustained action. Policy-makers, funders, academic leaders and healthcare organisations must recognise nursing research as a strategic investment rather than a peripheral endeavour. Without strengthened clinical–academic career pathways, protected research time and systematic support for implementation, Sweden risks underutilising one of its most trusted professions and weakening the evidence base of its healthcare system.

Integration without dilution: safeguarding nursing science

Nursing research in Sweden is increasingly situated within broader academic domains such as Health Sciences and Public Health. Hence, it is timely to also reflect on the implications for research into nursing in an era of academic integration. This integration offers important opportunities for interdisciplinary collaboration, methodological development, and enhanced societal relevance – benefiting not only the academic community, but also, crucially, patients and their families. Integrative models of care, for example, demonstrate how nursing research contributes comprehensive perspectives on health, existential well-being and social sustainability, enriching wider health science agendas. At the same time, this integration presents significant challenges. There is a tangible risk that nursing's distinctive contributions, such as attention to the nurse–patient relationship, fundamental care needs and symptom management, may be diluted within broader, and often medically dominated, health science research frameworks. As nursing becomes embedded in larger academic structures, its epistemological foundations and professional identity cannot be assumed; they must be actively articulated, defended and developed.

Preserving the integrity and distinctiveness of nursing science therefore requires sustained investment in nursing-led theory development, methodological competence and epistemological clarity. Core nursing competencies, including person-centred care, teamwork, evidence-based practice, quality improvement, informatics, leadership, pedagogy and patient safety, must remain central to both nursing research and education. These competencies are not ancillary; they constitute nursing's unique contribution to knowledge production and healthcare improvement.

Integration into broader academic and clinical fields also demands deliberate strategic positioning. Nursing researchers must assert the relevance of nursing perspectives in interdisciplinary contexts, ensuring that nursing contributes not only clinical expertise, but also ethical, relational and contextual understandings of care. This requires active participation in cross-sectoral research, engagement in policy and governance processes, and visible leadership in the development of healthcare systems that are equitable, sustainable and responsive to human needs. Ultimately, the future of nursing science depends on its capacity to balance integration with disciplinary clarity. Collaboration across fields is essential, but it must not come at the expense of nursing's core values, knowledge traditions and societal mandate. Maintaining this balance is not a defensive stance; it is a strategic imperative for ensuring that nursing science continues to shape healthcare in ways that are evidence-informed, ethically grounded and attuned to the realities of everyday care.

Concluding remarks

Nursing research in Sweden has evolved from a marginalised, practice-based endeavour into an established academic force with clear potential to shape the future of healthcare. This transformation reflects decades of sustained commitment to developing robust theoretical foundations, methodological rigour and clinical relevance. However, realising this potential fully requires continued and strategic investment in doctoral- and post-doctoral education, strengthened national and international collaboration, and the consolidation of a distinct and confident disciplinary identity within the broader academic landscape.

Maintaining relevance and impact demands a critical and ongoing examination of the focus and direction of nursing research. While the term research waste may appear provocative, ¹⁸ it serves as a necessary reminder of the obligations of equity, transparency and accountability in the production of scientific knowledge.^16,17 The growing complexity of contemporary and future healthcare systems calls unequivocally for evidence-based and sustainable knowledge; knowledge grounded in nursing research that is itself sustainable. We must therefore insist on asking: What do we study in nursing, for what purposes and through which approaches? Despite an extensive body of research on registered nurses, patients, relatives and healthcare systems, there remains a striking lack of knowledge concerning the mechanisms and outcomes of nursing interventions. Addressing this gap is not optional – it is essential for advancing both clinical practice and health policy.

What is now required is nursing research that is firmly anchored in the lived realities of care while possessing the capacity to transform them – a science that does not merely describe practice, but actively innovates and leads change. By embracing interdisciplinary collaboration without relinquishing nursing's distinctive epistemological and ethical perspectives, and by drawing strength from solid theoretical and methodological frameworks combined with meaningful involvement of patients, professionals, and the public, Swedish research into nursing is well positioned to assume a leading role in shaping a more equitable, sustainable, and person-centred healthcare system.