Pensar Enfermagem / v.29 n.Sup / Jan-Dec 2025
DOI: 10.71861/pensarenf.v29iSup.428 / e00428
Theoretical Article
How to cite this article: Santos N, Matias S, Pereira A, Pinto C, Oliveira R, Domingues S, Santos AC,
Pestana H, Nunes E, Lucas P
.
Nurse Managers as Promoters of Health Literacy Supported by Information
Systems.
Pensar Enf [Internet]. 2025 Jan-Dec; 29(Sup): e00428
. Available from:
https://doi.org/10.7
1861/pensarenf.v29iSup.428
Nurse Managers as Promoters of Health Literacy
Supported by Information Systems
Abstract
Introduction
Health literacy, a multidimensional concept essential to equity and the sustainability of
healthcare systems, empowers individuals to make informed decisions and use services
effectively, overcoming sociocultural and economic barriers. Nurse managers play a
strategic role in its promotion by combining leadership with standardized nursing
information systems. This article offers a reflective analysis of this integration, with a
particular focus on advancing health literacy.
Objective
To analyze the competencies of nurse managers and their interaction with nursing
information systems in promoting health literacy.
Methods
This is a theoretical reflection grounded in a narrative literature review. Recent publications
and foundational works were analyzed, emphasizing the evolution of concepts,
technological integration in healthcare, and nursing management practices. The analysis is
structured around four thematic axes that link conceptual foundations with practical
implications.
Results
Findings indicate that the relationship between health literacy and health information
systems significantly affects the safety and quality of care. Nurse managers emerge as key
facilitators, leveraging information systems to promote health literacy, thereby empowering
both healthcare professionals and the public to manage information more effectively.
Integrating these dimensions systems has proven essential for improving clinical practice,
enabling more effective leadership and more data-informed decision-making.
Conclusion
This theoretical reflection highlights the role of nurse managers in promoting health literacy
by integrating leadership competencies, strategic information management, and effective use
of health information systems. This integrative approach positions nurse managers as
catalysts for citizen empowerment, contributing to equitable, informed, and sustainable care
practices. By proposing an interdisciplinary conceptual framework, the study expands the
discussion of nursing management as a driver of quality and empowerment in advancing
health literacy.
Keywords
Nursing; Nursing Administration Research; Health Literacy; Health Information Systems;
Health Policy.
Nuno Santos1,2
https://orcid.org/0009-0002-2466-359X
Silvia Matias2,3,4
https://orcid.org/0009-0009-1348-8758
António Pereira2,5
https://orcid.org/0000-0002-9574-4760
Carolina Pinto6
https://orcid.org/0009-0006-0126-2987
Rafael Oliveira2,7
https://orcid.org/0009-0006-3828-846X
Sandra Domingues2,8
https://orcid.org/0000-0002-1501-5227
Ana Claúdia Santos7
https://orcid.org/0009-0008-5150-0335
Helena Pestana5
https://orcid.org/0000-0001-7804-2989
Elisabete Nunes2,8
https://orcid.org/0000-0001-7598-0670
Pedro Lucas2,8
https://orcid.org/0000-0002-2560-7306
1 Hospital da Luz de Lisboa, Lisbon, Portugal.
2 Nursing Research, Innovation and Development
Center, Lisbon, Portugal.
3 Loures Odivelas Local Health Unit, Lisbon, Portugal.
4 Nursing School of Lisbon, Lisbon, Portugal.
5 Western Lisbon Local Health Unit, Lisbon, Portugal.
6 São José Local Health Unit, Lisbon, Portugal.
7 SAMS Hospital Lisbon, Lisbon, Portugal.
8 Santa Maria Local Health Unit, Lisbon, Portugal.
Corresponding author:
Nuno Santos
E-mail: n.santos@campus.esel.pt
Received: 08.03.2025
Accepted: 08.05.2023
Editor:
Marcelle Miranda da Silva
Santos, N.
Theoretical Article
Introduction
Although originally coined as a neologism to highlight the
urgent need to improve population literacy 1, the concept
of health literacy was only fully recognized as a foundational
pillar of nursing as both a discipline and a practice in the
early 21st century.2,3 Recognized by the World Health
Organization as a cornerstone of population well-being 4,
health literacy is now a key strategy for addressing
economic, social, demographic, cultural, and ethnic
vulnerabilities. 5–7
The evolution of the health literacy concept—which
encompasses not only the ability to read and interpret
information but also the capacity to assess and apply
knowledge in practical contexts—underscores the
importance of an integrated approach that includes
cognitive, social, and digital dimensions.
The digital transformations of recent decades have
substantially redefined how individuals engage with the
health–illness process.8 Today’s healthcare systems
recognize people as active members of care teams,
assigning them a central role in their own health journeys
through informed and deliberate decision-making. 7,9,10
In this transitional landscape, both clinical nurses and nurse
managers are positioned as key agents in promoting health
literacy by assessing individuals’ knowledge levels and
implementing interventions to support their development.
10,11 To make this possible, health information systems
must incorporate a standardized, systematized, and
universally accessible language. 8,12,13
The value nurse manager’s value lies in the ability to
integrate leadership, education, and information
management with nursing information systems,
transforming these systems into strategic tools for
advancing health literacy. By facilitating access to
information and supporting autonomous, informed
decision-making, nurse managers enhance care quality,
reinforce equity, and elevate health literacy as a core
element of healthcare management and innovation.
Building health literacy capacity is essential for equipping
professionals with specialized competencies, developing
tailored educational materials, and optimizing available
resources.14–16 Nurse managers are responsible for
fostering a supportive nursing practice environment and
ensuring the availability of necessary resources to
implement robust interventions. Proactive leadership,
coupled with integrated and innovative strategies, plays a
critical role in reinforcing equity, effectiveness, and
sustainability within healthcare systems—ultimately
promoting well-being and improving quality of life. 8
However, socioeconomic disparities and communication
barriers continue to hinder the effectiveness of health
literacy interventions, particularly in settings with limited
access to high-quality health information. Moreover,
although the benefits of health literacy are widely
acknowledged, there is still a scarcity of research examining
how health information systems intersect with nurse
managers’ competencies. 17
The innovative contribution of this study lies in articulating
the conceptual evolution of health literacy, the
advancement of standardized health information systems,
and the managerial competencies of nurse leaders. By
presenting an integrated perspective that remains
underexplored in the scientific literature, this work expands
the current discourse on nursing management as a catalyst
for quality improvement and empowerment in promoting
health literacy.
Methods
This study is guided by the following research question: To
what extent do nurse managers’ competencies and the use
of health information systems enhance person-centered
health literacy?
This is a theoretical reflection based on a narrative literature
review. The analysis primarily draws on studies published
within the past five years, along with foundational
references that inform the historical and theoretical
development of the core concepts under examination. This
combination allowed for the identification of studies that
examined the relationship between the integration of health
technologies and the improvement of health literacy among
healthcare users, as well as innovative practices in nursing
service management.
This analysis aims to explore the challenges and
opportunities currently faced by nurse managers within
dynamic healthcare systems and to examine their
contribution to advancing health literacy.
To support a comprehensive exploration of the research
question, the discussion is structured into four sections.
The first defines and contextualizes health literacy,
highlighting its progression and impact. The second
explores the role of health information systems, focusing
on terminology, electronic platforms, and interoperability.
The third addresses the competencies related to nursing
management and regulation. Finally, the fourth section
presents a critical and reflective discussion of the main
findings grounded in the study’s conceptual foundations.
Results
Health literacy
At the outset of this section, it is essential to examine the
key concepts and variables that support this integrative
perspective, to outline a comprehensive strategy to
optimize care delivery and health outcomes.18 Health
literacy functions as both a quality and effectiveness
indicator and stands out as a critical determinant of
population well-being by equipping individuals with the
ability to access, assess, and use health information. 2,19–24
Historically, although the term was first introduced by the
Organisation for Economic Co-operation and
Development (OECD)25, it was in 1974 that Simonds
brought together the notions of “education” and “health”
to highlight the role of health education in school-based
settings. 26 The concept has since evolved from a set of
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basic functional skills to a robust set of empowerment
tools.
Health literacy can be conceptualized as a dynamic interplay
between knowledge and prior health-related experiences. It
is closely associated with a wide range of socioeconomic
and demographic factors, including age, gender, ethnicity,
educational attainment, income, occupation, literacy skills,
language proficiency, and self-perceived health status.
These variables contribute to both intra- and intergroup
disparities, significantly influencing one’s capacity to
develop and apply health literacy and to access high-quality
health information and services. This process involves not
only knowledge acquisition but also the development of
essential personal skills that support the adoption of
healthy behaviors and lifestyle changes. 21, 27–32
In addition, several authors argue that health literacy must
be understood as the capacity to influence, engage, educate,
and support not only individuals but also organizations,
communities, healthcare professionals, media, and
policymakers. This holistic perspective seeks to strengthen
the competencies needed for people to navigate the
healthcare system effectively, overcome barriers, and
promote a culture of prevention. 33–38
Three levels of health literacy are commonly recognized—
functional, interactive, and critical—while a European
definition introduces an integrated model that accounts for
both individual competencies and contextual and social
factors shaping the understanding of health information.
2,39–41 Within this framework, health literacy is further
defined by three complementary dimensions: personal,
referring to an individual’s ability to access, understand,
assess, and apply health information; organizational,
focused on how institutions organize and disseminate
information; and professional, which relates to the capacity
of healthcare professionals to communicate effectively with
diverse populations.42–45 Table 1 summarizes and
categorizes the interaction between these levels and
dimensions of health literacy.
Table 1 – Health literacy levels and dimensions
Building on this framework, the 2019 European Health
Literacy Survey revealed that approximately 30% of
respondents reported inadequate or problematic levels of
health literacy.46,47 The results showed that participants
found it easier to acquire information related to health
promotion than to engage in disease prevention or navigate
healthcare services.46 Notably, the highest levels of health
literacy were recorded in Central and Northern European
countries 6, in contrast to the national context, where more
vulnerable groups—including individuals with low
educational attainment, those over 65 years old, and
immigrants with limited perceptions of healthcare quality—
exhibited lower levels of health literacy. 40,48–55 Meanwhile,
Portugal’s Directorate-General of Health, through its
2019–2021 Health Literacy Action Plan, identified the
country as having a relatively high proportion of individuals
with “sufficient” health literacy. 56,57
Health literacy requires a solid theoretical foundation to
explain the many factors that influence it. Conceptual
models provide this foundation, guiding both analysis and
intervention from an integrated, holistic perspective [58].
In the field of communication, the ACP Model—
Assertiveness, Clarity, and Positivity—stands out as a
practical strategy for healthcare professionals to effectively
promote health literacy. This model consists of three core
components: assertiveness, which emphasizes balance in
the therapeutic relationship; clarity, which ensures that
information is understandable regardless of how it is
presented; and positivity, which promotes a constructive
and resilient mindset that facilitates understanding of one’s
health status and supports the adoption of healthy
behaviors. 59–62
However, traditional approaches focused solely on one-
way information transmission have proven insufficient to
foster adequate levels of health literacy. According to the
Nursing Care Quality Standards established by the
Portuguese Order of Nurses, professional practice must
ensure care that is safe, effective, timely, and person-
centered. 12 Therefore, it is essential to adopt strategies that
foster dynamic therapeutic relationships grounded in active
citizen engagement, shared responsibility for the care
process, and continuous health education.
Within this framework, Afaf Meleis’s Transition Theory
serves as a key theoretical model, recognizing that
transitional processes—whether related to health
conditions, organizational change, or skill development—
require intentional nursing interventions to facilitate
individuals’ adaptation and empowerment.63 Engel’s
Biopsychosocial Model 64, which incorporates biological,
psychological, and social factors in understanding health
and illness, underscores the importance of health literacy as
a fundamental element in informed health management.
This model’s principles call for a care approach that is
person-centered rather than task-centered. 65
This paradigmatic shift is strongly supported by the person-
centered approach, which emphasizes the promotion of
communication that is clear, accessible, and tailored to
individual needs.66–68 The evolution of care practices—
from a traditional model grounded in professional authority
to a holistic framework incorporating cultural, social, and
Santos, N.
Theoretical Article
personal belief systems—has become essential to
advancing health literacy. 69
McLeroy’s Ecological and Social Model70 acknowledges
that health is shaped by interrelated factors across multiple
levels, from the individual to the policy domain. Within this
framework, health literacy should be viewed as a
multidimensional process requiring not only the
development of individual competencies but also the
creation of supportive social, institutional, and political
environments that facilitate access to information and
informed decision-making in health.
Since the adoption of the Ottawa Charter, individuals have
increasingly been viewed not merely as recipients but as
decision-makers, managers, co-producers, evaluators, and
agents of change in their own health. 71 At the international
level, recent public policies have reinforced this
perspective. The National Action Plan to Improve Health
Literacy 72 and the Health Literacy Promotion and Education
Strategy 73 outline educational and communication strategies
that highlight the central role of education and
communication in improving healthcare and strengthening
health literacy. The European Commission, through the
European Health Literacy Survey (EHLS), has advanced
integrated policies aimed at monitoring and enhancing
health literacy levels while reducing disparities among
Member States.19
In Portugal, the commitment to health literacy is closely
tied to the evolution of public health policies, which have
shifted from an assistance-based model to one that
recognizes the universal right to health74, as enshrined in
the Health Framework Law.75 Article 12 of this law
highlights the need to integrate health literacy into strategic
areas such as education, labor, and social and
environmental welfare, involving local governments as well
as public, private, and nonprofit entities. This legal
framework ensures that health literacy remains a central
element in all public health decision-making processes.76
The 2019–2021 Health Literacy Action Plan77 and the
current 2023–2030 National Plan for Health Literacy and
Behavioral Sciences78 reinforce the goal of reducing
inequalities and empowering the population to make
informed choices. Several national initiatives promote
access to health information and support healthcare
professional training while encouraging healthy and
inclusive lifestyles. 56,79–81
Aligned with international guidelines 82,83, the 2021–2026
National Patient Safety Plan incorporates health literacy as
a strategy to enhance empowerment and active public
participation in care safety.84–86 Portugal’s decentralized
administrative structure assigns local governments and
intermunicipal entities a central role in promoting health
literacy by managing investments, building partnerships,
and mobilizing stakeholders. 87–90
In sum, health literacy extends beyond the simple
accumulation of knowledge; it constitutes a dynamic and
multifaceted process essential for advancing a more
informed and healthier society. Its progression—from early
health education concepts to a contemporary framework
encompassing cognitive, social, critical, and digital
dimensions—underscores the importance of adopting an
integrated and participatory perspective. Implementing
innovative and comprehensive strategies, supported by
active professional leadership—particularly from nurse
managers—is key to fostering equity, effectiveness, and
sustainability in healthcare systems, transforming them into
spaces where well-being and quality of life are truly
prioritized.8 Therefore, these disparities must be considered
in health policy development and resource allocation to
ensure equity and social justice. 91-93
Health Information Systems
Health literacy, as a dynamic and multidimensional process
that underpins the empowerment of individuals,
professionals, and communities, is put into practice
through health information systems. These systems
function as operational tools for fostering clear
communication, active participation, and informed
decision-making by organizing, protecting, and sharing
clinical data and sensitive indicators—key elements that
define the theoretical models and integrated policies
discussed in the previous section.
In nursing management, this integration is reflected in the
capacity to design personalized care strategies and optimize
resource allocation, ensuring effective, high-quality, and
continuous care in accordance with the Nursing Care
Quality Standards. 12 The integration of these standards
with health information systems has the potential to
identify and overcome barriers to accessing information,
promote measurable, evidence-based practices, and align
care delivery with recognized quality models. 94 Using
health information systems to extract data supports the
development of nursing-sensitive indicators, enhancing the
visibility and value of nursing practice and enabling real-
time monitoring of professional activities. 95-97
The historical evolution of health information systems—
from early electronic records to interoperable, user-
centered platforms—represents a logical progression in
transforming healthcare systems: bridging theory and
practice, advancing excellence, and consolidating health
literacy as a pillar of quality, safety, and innovation.
Initially focused on financial management support, health
information systems gradually incorporated clinical data
through electronic health records, later evolving into
personal health records and, more recently, personal
health information systems. 7,13,98 This modernization has
enabled the structuring and protection of sensitive data
while also promoting interoperability across different
sectors of the healthcare system and driving the
development of initiatives in the field of information and
communication technologies. It is rooted in a foundation
of collaboration and knowledge sharing. 95,99
Studies such as the Portuguese Health Literacy Survey
(HLiteracia em Saúde-PT), conducted in 2014, underscore
the relevance of information sources as essential tools for
improving population health literacy. These findings
emphasize the critical role of information and
communication technologies—particularly health
information systems—in enhancing access to high-quality
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information and supporting informed decision-making by
citizens [37]. Integrating health information systems into
health literacy promotion strategies provides a powerful
tool for empowering individuals, enabling them to make
informed and contextually appropriate decisions through
centralized access to clinical data and health indicators.
By securing and sharing sensitive clinical data and
promoting structured intersectoral interoperability, health
information systems increase safety, reduce errors, and
personalize treatment—strengthening health literacy and
fostering person-centered, humanized care. At the same
time, nurse managers, supported by these systems, plan,
coordinate, and assess care quality through real-time
indicators, optimizing resources and promoting excellence
in care delivery. 100–104
In summary, health literacy—as a dynamic and
multidimensional empowerment process—takes concrete
form through health information systems, which put into
practice transparent communication, shared decision-
making, and personalized care. By integrating theory with
technological innovation, a paradigm emerges in which the
person receiving care—as both a care recipient and an
informed citizen—transitions from a passive role to that of
an active participant within a collaborative network that
supports clinical excellence, equity, and the humanization
of healthcare services. Figure 1 illustrates the intersection
of health literacy, nurse management, and health
information systems, positioning the citizen at the center as
the key figure, thereby validating their role in shared health
decision-making.
Figure 1 - Intersection of health literacy, nurse manager,
and health information systems.
Nursing management and regulation
Promoting health literacy is a central responsibility of nurse
managers, who—acting as educators, organizational
facilitators, and managers of human and material
resources—play a proactive role in shaping health policy,
ensuring the continuous improvement of nursing care
quality, managing services and units to better meet users’
healthcare needs, and integrating health information
systems to create supportive nursing practice environments
oriented toward citizen empowerment. 3,105–107 This role
requires a well-defined set of competencies, including
reflective practice and in-depth knowledge of population
needs. Its relevance is outlined in the Nurse Manager
Competency Profile Regulation, which highlights the
importance of advanced knowledge in management and
organizational consulting. 106
Consistent with the ethical principles of autonomy, dignity,
freedom, and beneficence set forth in the Nurses’ Code of
Ethics108, the nurse manager becomes a key figure in
supporting the full realization of these values by equipping
nurses to promote health literacy. Accordingly, this
professional is responsible for implementing continuous
quality improvement processes, managing risks, and
monitoring practice-sensitive indicators using internal
audits and quality data to assess conditions and plan
strategic interventions. These responsibilities require solid
technical expertise combined with advanced
communication, motivational, and innovation skills—
essential for leading nursing teams in complex and high-
pressure care environments. 109–110 However, the nurse
manager’s mission goes beyond organizational efficiency:
they serve as catalysts for promoting health literacy,
embedding this dimension into their daily management
practices.
By leading teams in the collection, analysis, and
dissemination of reliable clinical information—and by
promoting the integration of health information systems
designed to support health education—nurse managers
actively contribute to citizen empowerment, fostering more
autonomous, informed, and responsible participation in
healthcare decision-making.3,106,112 Strategic quality
management and health literacy promotion are
interdependent dimensions of their role, in which the nurse
manager’s leadership ensures that healthcare services not
only deliver care but also educate and empower the
population. This alignment strengthens sustainability,
equity, and the humanization of care, positioning health
literacy as a foundational pillar for continuous
improvement and the positive transformation of healthcare
organizations. 107,113
As highlighted in the literature, the nurse manager also
serves as a key educator. 3,107,109,113 In high-complexity care
settings, this role demands transformational leadership
grounded in a proactive, adaptable, and future-oriented
approach—capable of mobilizing teams around shared
goals of quality, safety, and equity in care delivery. 113,114
This form of leadership goes beyond administrative
functions: it is educational and inspirational, promoting the
development of supportive nursing practice environments
where citizens are empowered to make informed decisions
about their health. 14,15,107,114
Accordingly, it is essential to ensure that the necessary
resources are available to implement effective health
literacy promotion interventions, recognizing that such
investments not only lead to individual and population-
level health gains but also help prevent professional
burnout and increase organizational health literacy. 6,14–
16,115,116 Evidence indicates that systematic strategies—such
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Theoretical Article
as adopting standardized interventions like a health literacy
promotion checklist—can positively affect population
health literacy levels by facilitating communication between
professionals and citizens and promoting more
participatory, person-centered care. 47,112 In this context,
Portugal’s Directorate-General of Health published the
Framework for the Development of Health Literacy Promotion
Projects, which explicitly recommends using this tool as a
structural element of good healthcare practices. 47
The nurse manager’s leadership in integrating health
information systems represents a strategic pillar in
promoting both health literacy and eHealth literacy. 117,118
By incorporating health information systems into care
management, nurse managers ensure that clinical
information is not only securely and interoperably recorded
and shared but also structured in ways that make it
understandable, accessible, and useful to citizens. 98,99,119,120
Health information systems that feature patient portals,
teleconsultations, shared care plans, and digital educational
content create opportunities for individuals to develop the
skills needed to locate, interpret, evaluate, and apply health
information independently. 121,122
As a facilitator, the nurse manager is responsible for helping
adapt these systems to the population’s actual
informational needs.123 By incorporating health literacy–
sensitive indicators into planning, monitoring, and
evaluation processes, nurse managers ensure that health
information systems function not only as management
tools but also as pedagogical resources essential to citizen
empowerment. Their work strengthens the connection
between clinical data and meaningful knowledge for
individuals, supporting shared decision-making, informed
self-care practices, and active participation in personal
health management. 124,125
Figure 2 highlights the nurse manager, equipped with the
four core pillars of their role and grounded in the
conceptual models that underpin their practice.
In summary, the nurse manager embodies a
multidimensional profile that brings together leadership,
health education, and strategic management with the
transformative potential of health information systems. By
integrating these systems in an accessible and educational
way, they promote health literacy, equipping citizens to
make more autonomous and informed decisions.
This approach improves care quality, equity, and
humanization, positioning health literacy as a foundational
pillar of management practice and a key driver of positive
transformation within healthcare organizations. 107, 126
Figure 2 – Conceptual Framework.
Discussion
The findings of this theoretical reflection underscore the
strategic role of nurse managers in promoting health
literacy—not only by leading organizational processes but
also by driving cultural transformations that frame
knowledge as a tool for citizen empowerment and as a
foundation for building a more equitable, efficient, and
sustainable healthcare system. 3,14,16,112,113,116,127 In this
context, health information systems emerge as essential
tools that support this process by enabling the collection,
analysis, and dissemination of relevant data, thereby
fostering knowledge sharing between professionals and
citizens. 100–104 The nurse manager serves as a catalyst in
creating an organizational culture that values education and
innovation—both essential to motivating and empowering
teams to adopt innovative practices that advance health
literacy. 3,14,105–107
This multidimensional profile—integrating leadership,
technological competence, and health education—
reinforces care quality, equity, and humanization. As a
strategic nursing leader, the nurse manager emerges as a key
figure in building synergies among stakeholders to promote
strategic alignment that places citizens at the center of the
healthcare system. 3,105–107
A critical analysis of the theoretical models presented in this
study highlights their epistemological value in supporting
the nurse manager’s role in advancing health literacy.
Meleis’s Transition Theory positions the nurse manager as
an active facilitator of adaptation and citizen
empowerment. This perspective legitimizes the
implementation of deliberate and systematic educational
strategies designed to guide individuals through vulnerable
transitions and maximize their capacity for informed,
conscious participation in care. 63
The ACP Model provides practical guidance on how
communication between healthcare professionals and
citizens can be structured to strengthen therapeutic
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relationships that are both effective and engaging. In this
model, communication is understood as a core leadership
competency in nursing—particularly relevant in
management contexts, where fostering positive relational
environments is a prerequisite for organizational alignment
and the adoption of innovative processes. 59–62
McLeroy’s Ecological Model, in turn, broadens the analysis
to encompass multiple levels of health influence and guides
nurse managers toward multilevel strategic engagement.
When interpreted through this model, promoting health
literacy requires coordinated efforts integrating public
policy, institutional practices, and community action. Nurse
managers are, therefore, called to transcend operational
boundaries and position themselves as mediators between
clinical practice, institutional governance, and the policy
sphere. 107,113
From this perspective, Engel’s Biopsychosocial Model
introduces an essential interpretive lens. This holistic
framework reinforces the need for health literacy
interventions to move beyond purely informational
approaches and instead adopt person-centered, culturally
sensitive strategies responsive to diverse populations’
real-world contexts. By embracing this complexity, nurse
managers not only broaden the scope of educational
practice but also adopt a critical stance toward reductionist
biomedical models. 64, 65
The person-centered approach introduces a crucial ethical
and relational dimension by placing the citizen at the center
of the care process. This orientation resonates with the
empowerment mission underlying health literacy
promotion, requiring nurse managers to ensure
organizational practices that uphold autonomy,
self-determination, and respect for individual uniqueness.
66–68
In line with these frameworks, the Nurse Manager
Competency Profile highlights the concept of
transformational leadership, advocating for a
transformative stance that not only drives internal
processes but also helps establish an organizational culture
that fosters health literacy and advances innovations that
add value to healthcare services. 106,114,128
Accordingly, health information systems must be
recognized as strategic instruments that facilitate
knowledge flow, promote the sharing of best practices,
support evidence-based decision-making, and enhance
transparent communication between professionals and
citizens.13,95,96,98,99,119 However, adopting these systems
depends on the presence of leadership capable of
articulating a conceptual framework that cultivates an
environment conducive to organizational learning.
The literature emphasizes that nurse managers are
simultaneously visionaries, communicators, and caregivers
to their teams.105,106,109,110,113 This combination of
competencies is particularly critical to ensuring that health
literacy is embedded as a core organizational value.
In light of the analysis presented, it is evident that nurse
managers possess a set of core competencies that position
them as central actors in advancing health literacy due to
their strategic leadership, change management capabilities,
and capacity to generate value in healthcare services. Their
critical engagement with the conceptual framework reflects
their role’s complexity and multidimensional nature,
reinforcing the importance of a systems-based, person-
centered, communicatively effective approach grounded in
evidence-based practice. 12,47,112
In this context, health information systems emerge as
foundational tools for enhancing knowledge collection,
analysis, and dissemination, thereby supporting informed
decision-making and organizational innovation. However,
their effectiveness is intrinsically dependent on the
presence of transformational leadership capable of
implementing these systems critically and reflectively,
fostering supportive nursing practice environments that
promote professional autonomy and citizen empowerment.
14,105–107 The interplay between nurse manager
competencies and health information systems thus
constitutes a strategic lever for institutionalizing health
literacy as a central pillar of care quality, equity, and
sustainability in healthcare delivery.
Conclusion
This theoretical reflection presents an innovative
perspective by demonstrating that the nurse manager plays
a critical role in promoting health literacy by integrating
leadership competencies, care organization, and the
strategic use of health information systems. The
articulation between nursing management, information,
and health literacy enables the individualization of care and
fosters citizen empowerment, aligning clinical practice with
the principles of equity and quality. In fact, the literature
indicates that healthcare organizations that institutionalize
health literacy strengthen citizen engagement and improve
the quality of care.
This work makes an original contribution by highlighting
an interdisciplinary field that remains largely
underexplored: the synergy between health literacy, health
information systems, and the strategic intervention of the
nurse manager. Rather than addressing these domains in
isolation, it proposes an integrated conceptual framework
in which the nurse manager emerges as a key facilitator of
informational transformation. This holistic perspective
transcends the traditional boundaries of nursing research
and introduces a new lens that recognizes scientific
knowledge as a means of empowerment—not only for
professionals but also for citizens. By emphasizing this
articulation, the study contributes to advancing the state of
the art and opens new pathways for empirical research to
explore the framework’s various dimensions.
Despite its conceptual contributions, this work presents
limitations that must be acknowledged. As a primarily
theoretical and reflective study, it does not rely on original
empirical data, limiting its findings’ immediate
generalizability. This lack of empirical evidence warrants
caution in interpreting the results and underscores the need
for future studies to validate the proposed framework in
real-world contexts.
Santos, N.
Theoretical Article
Implementing integrated strategies that address multiple
dimensions of professional practice is recommended to
support the effective translation of knowledge into clinical
practice and achieve measurable improvements in health
outcomes. Specifically, there is a critical need to invest in
the continuing education of nurse managers through
structured programs that strengthen competencies in
health literacy, data analysis, and health technology
management. In parallel, ensuring health information
systems’ interoperability and standardization through
mechanisms incorporating standardized ontologies and
terminologies is essential. Moreover, empirical research
should be encouraged to examine the interaction between
nursing practice and innovative technologies in order to
support effective, citizen-centered interventions and
inform the formulation of innovative, equitable, and
sustainable public health policies.
This analysis achieved its objective of examining nurse
manager competencies and their articulation with health
information systems in promoting health literacy. The
nurse manager emerges as a strategic actor with a critical
role in information management, care planning and
monitoring, and the coordination of multidisciplinary
teams. Health information systems serve as essential tools
for decision support, operationalizing care processes, and
reinforcing practices focused on quality and safety.
Authorship
NS: Conception and design of the study; Collection of data;
Analysis and interpretation of data; Obtaining funding;
Writing the manuscript; Critical revision of the manuscript;
Approval of the final version of the manuscript and
assumption of responsibility for it.
SM: Conception and design of the study; Collection of data;
Analysis and interpretation of data; Obtaining funding;
Writing the manuscript; Critical revision of the manuscript;
Approval of the final version of the manuscript and
assumption of responsibility for it.
AP: Study conception and design; Data collection; Data
analysis and interpretation; Obtaining funding; Writing the
manuscript; Critical revision of the manuscript; Approval of
the final version of the manuscript and taking responsibility
for it.
CP: Study conception and design; Data collection; Data
analysis and interpretation; Obtaining funding; Writing the
manuscript; Critical revision of the manuscript; Approval of
the final version of the manuscript and assumption of
responsibility for it.
RO: Study conception and design; Data collection; Data
analysis and interpretation; Obtaining funding; Writing the
manuscript; Critical revision of the manuscript; Approval of
the final version of the manuscript and assumption of
responsibility for it.
SD: Conception and design of the study; Collection of data;
Analysis and interpretation of data; Obtaining funding;
Writing the manuscript; Critical revision of the manuscript;
Approval of the final version of the manuscript and
assumption of responsibility for it.
ACS: Conception and design of the study; Collection of
data; Analysis and interpretation of data; Obtaining funding;
Writing the manuscript; Critical revision of the manuscript;
Approval of the final version of the manuscript and
assumption of responsibility for it.
HP: Critical revision of the manuscript; Approval of the
final version of the manuscript and assumption of
responsibility for it.
EN: Critical revision of the manuscript; Approval of the
final version of the manuscript and assumption of
responsibility for it.
PL: Critical revision of the manuscript; Approval of the final
version of the manuscript and assumption of responsibility
for it.
Conflicts of interest and Funding
The author(s) declare(s) that there is no conflict of interest.
Sources of support / Financing
This research received no specific funding from the public,
commercial or non-profit sectors.
Data availability statement
The data supporting the conclusions of this study was
obtained from public sources available on the internet and
in various databases. All the data used is publicly accessible
and does not involve personal information.
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