Nursing Moral Agency in Technology-Mediated Care: Reclaiming Professional Responsibility in the Fifth Industrial Revolution.

Nursing practice is increasingly enacted within environments structured by intelligent technologies that filter perception, generate classifications and shape clinical priorities. While nurse scholars have begun to examine moral agency in the context of artificial intelligence, much of the broader ethical discourse on AI in healthcare continues to foreground governance, safety and institutional accountability, leaving the conditions under which nurses exercise professional moral responsibility comparatively under-theorized. This paper argues that technology-mediated care constitutes a moral environment that reshapes how responsibility is distributed, interpreted and enacted in clinical practice. Drawing on nursing ethics and socio-technical thought, it distinguishes between technical delegation and moral delegation, clarifying that while intelligent systems may inform action, they cannot assume moral answerability. Nursing moral agency is reconceptualized as relationally oriented moral perception, interpretive judgement and accountable action that remains fundamentally non-delegable, even under conditions of extensive mediation. Boundary-setting is advanced as a disciplined ethical practice through which nurses delineate the limits of technological authority and sustain professional responsibility. By articulating moral agency as both situated and irreducible, this analysis contributes a conceptual framework for understanding ethical responsibility in the Fifth Industrial Revolution and re-centres the nurse as the accountable moral subject within technology-mediated care.