Finding voice: Grounded theory of dignity among psychiatric inpatients

BackgroundPsychiatric inpatients in China may experience threats to dignity and self-expression within ward environments shaped by stigma, safety concerns, and institutional routines. However, how they navigate these challenges and restore dignity through everyday interactions during hospitalization remains underexplored in psychiatric nursing.AimTo develop a substantive theoretical framework explaining how Chinese psychiatric inpatients experience dignity challenges and navigate pathways toward dignity empowerment and restoration during hospitalization, and what role therapeutic relationships with mental health nurses play in facilitating this process.Research designConstructivist grounded theory following the Charmaz tradition, informed by relational autonomy theory.Participants and research context11 psychiatric inpatients were recruited from the psychiatric ward of a tertiary general hospital in China between March and June 2025, using maximum variation purposive sampling to ensure demographic diversity.Ethical considerationsEthical approval was obtained from the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Reference 2025-2245-01).FindingsThe theoretical model "Finding Voice in Vulnerability" suggests that psychiatric inpatients may navigate dignity challenges through four interconnected relational processes: Cognitive Liberation and Conceptual Reconstruction, Relational Dignity Empowerment, Relational Reconstruction of Valued Identity, and Participatory Treatment Negotiation. The model further suggests that vulnerability may become a relational resource through dignity-affirming interactions that support autonomy and participation in treatment decisions.ConclusionsDignity empowerment may emerge through relational recognition rather than individual autonomy, suggesting a potential reorientation toward relationally informed psychiatric care. The findings suggest that everyday nursing interactions may be important contexts for empowerment, with implications for relational competency training and future longitudinal research across diverse psychiatric settings.