Psychiatric nurses' attitudes towards patient autonomy in depot clinics

The aim of this qualitative study was to explore how psychiatric nurses experience patient autonomy in relation to their professional role in depot clinics.

The administration of depot neuroleptics at outpatient clinics is a common task for psychiatric nurses in many countries. The procedure is characterized by brief contacts often allowing little opportunity for adequate monitoring of the treatment and a dialog between nurses and patients. As nurses have an important role in involving patients in decision-making, there is a need to analyse the nurses' attitudes towards giving depot neuroleptics from the perspective of autonomy.

Nine experienced psychiatric nurses were interviewed using open-ended questions. The steps of a phenomenological descriptive method guided the data analysis.

The structure describes how benevolent attitudes towards patient autonomy motivated the nurses' interventions in relation to how they experienced their own professional authority. The structure consists of four variations: (1) Beneficent interventions used with patients perceived as co-operative when the nurses experienced a high degree of professional authority. (2) Paternalistic interventions used with patients perceived as ambiguous towards medication when the nurses experienced an arbitrary professional authority in collaboration with team members. (3) Weak paternalistic interventions used with patients perceived as unwilling when the nurses experienced having sufficient professional authority in the treatment situation. (4) Nonmaleficent interventions used with patients perceived as being resigned when the nurses experienced a low degree of professional authority within the team.

The findings indicate that psychiatric nurses' experience of their professional authority is closely related to the organization of the depot treatment and that brief contacts do not favour the establishment of collaborative relationships with patients. When injection-giving nurses, as patients' key workers, have overall responsibility for co-ordinating the patients' treatment they can encourage patient autonomy by helping patients understand the meaning of depot medication and its benefits. Further clinical research regarding the involvement of nurses in the treatment as well as patients' experiences of treatment with depot neuroleptics is needed to allow suggestions about improvements of the organization of the treatment.