Objective:

To explore how psychiatric nurses understand patient participation in shared decision-making (SDM) and their positioning towards its implementation in closed psychiatric wards.

Approach:

• Study Design: A phenomenological qualitative design was adopted, involving semi-structured interviews with psychiatric nurses.
• Participants: Sixteen psychiatric nurses from closed acute, chronic, and rehabilitation wards of a tertiary psychiatric hospital in Jiangsu Province, China.
• Data Collection: Seventeen semi-structured face-to-face interviews were conducted, recorded, transcribed, and analyzed using Colaizzi’s method.

Key Findings:

• Nurses value shared decision-making (SDM) but interpret it through clinical reasoning, conflating it with informed consent.
• Decision-making capacity is perceived as constrained by the patient's illness phase and associated risks.
• Nurses often see themselves as intermediaries rather than co-decision-makers in the SDM process.
• Attitudes towards SDM vary along a continuum influenced by factors such as patient acuity, ward culture, and perceived risks.

Interpretation:

Psychiatric nurses navigate practical tensions in closed psychiatric care regarding shared decision-making.

Limitations:

• The study is limited to a specific cultural and legal context in China.
• Findings may not be generalizable to other psychiatric settings or countries.

Conclusion:

Promoting shared decision-making in closed psychiatric wards requires tailored communication, structured assessments, and institutional safeguards.