Ethical experiences of nursing students in inpatient psychiatric units: The autonomy-paternalism tension.

Abstract

BackgroundSymptoms of mental disorder that impair decision-making capacity in inpatient psychiatric units increase the ethical tension between patient autonomy and paternalistic responsibility. Practices such as involuntary admission, compulsory treatment, and physical restraint further intensify this tension, while nursing students are more vulnerable to these ethical dilemmas because of their limited clinical experience.AimThis study aimed to describe nursing students' ethical experiences regarding the autonomy-paternalism tension in inpatient psychiatric units.Research designA qualitative descriptive design was used. Data were collected through reflective journals kept during the clinical placement and semi-structured individual interviews conducted at the end of the placement. These data were analysed using thematic analysis.Participants and research contextThe study was conducted in the nursing department of a public university in Türkiye. Thirty nursing students undertaking clinical practice in inpatient psychiatric units kept reflective journals, and 17 of them participated in individual interviews.Ethical considerationsEthical approval was obtained from the Sakarya University Social and Human Sciences Ethics Committee, and written informed consent was obtained from all participants.FindingsThe findings showed that students experienced the ethical tension between patient autonomy and paternalistic practices both explicitly and implicitly. Three main themes were identified: Experiencing Restrictions on Patient Autonomy, Ethical Silence in Response to Ethical Conflict, and Professional Ethical Development. Students identified the lack of adequate information and insufficient consideration of patients' concerns as ethical problems that undermined patient autonomy. They also reported remaining silent, primarily because of hierarchical structures and their role as students.ConclusionsThe autonomy-paternalism dilemma in inpatient psychiatric units constitutes a multidimensional experiential field for nursing students, intertwined with ethical silence, emotional burden, and processes of professional ethical development.