Designing for Care, Not Just Function: Lessons From a Non-Clinical Artificial Intelligence Innovation in Person-Centred Fundamental Care.

AIM: To examine how artificial intelligence (AI) influences the definition, enactment and preservation of person-centred fundamental care in healthcare contexts, and to develop a complementary framework that positions care as a design constraint. DESIGN: Theoretically informed case analysis. This approach uses a bounded case as a site for developing theoretical propositions rather than for inductive inference. METHODS: A non-clinical conversational AI companion for individuals affected by breast cancer was used as an empirical case to examine how care is shaped through technological systems. The analysis is grounded in the Fundamentals of Care Framework as a normative anchor, positioning the proposed person-centred AI-by-design framework as a complement rather than a replacement. RESULTS: The analysis produced a person-centred AI-by-design framework comprising three interdependent domains: design, evaluation and sustainment. The design domain addresses how technological scope, knowledge sources, relational interaction and data practices determine the care enacted. The evaluation domain shifts focus from performance to lived experience, examining how care is interpreted, negotiated and enacted in context. The sustainment domain identifies risks of scale, including standardization, redistribution of care work and erosion of relational dimensions. Across all domains, care is treated as a governing condition that shapes, rather than follows, technological development. CONCLUSION: AI is not a neutral tool but an active participant in redefining care. If left unexamined, it risks narrowing care to what can be measured, processed and optimized. Repositioning care as a design constraint is therefore necessary to prevent the erosion of person-centred fundamental care within increasingly technology-mediated environments. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This complementary framework advances a governance role for nursing in shaping AI in healthcare. It provides a practical approach to embedding person-centred fundamental care into technological systems, ensuring that relational, contextual and experiential dimensions of care remain visible and protected for patients and caregivers.