From Philosophy to Practice: Introducing the PIVOT Model for Advancing AI Fluency in AI-Augmented Nursing Care.

Artificial intelligence (AI) is increasingly embedded in health care practice and decision making, heightening the need to strengthen nursing preparation for AI fluency. This paper presents a philosophy-informed framework grounded in the philosophy of AI to guide the human-centered, reflective, and accountable use of AI in nursing practice and leadership. The framework is grounded in 5 philosophical domains: teleology (purpose, goal, and intentionality), ontology (identity, being, and moral agency), axiology (values, meaning, human flourishing, and the moral good), ethics (oversight, responsibility, accountability, and professional stewardship), and epistemology (knowledge generation, interpretation, learning, and transformative application). Recent literature from the past 5 years was used to contextualize the framework and translate its philosophical foundations into 5 integrated dimensions: Purpose, Identity, Values, Oversight, and Transformation, which shape how AI is interpreted, governed, applied, and transformed into meaningful nursing practice and optimal outcomes. The framework provides prioritized, practice-oriented guidance for nurses and nurse leaders, emphasizing professional judgment, human-in-the-loop oversight, transparency, safe reporting, and continuous learning in AI-augmented care environments. Designed to be both conceptually rigorous and operationally applicable, this work proactively aligns AI governance, strategy, and workforce preparation to promote optimal health outcomes.