Learning to support client autonomy during clinical nursing training: an exploratory qualitative descriptive study

Supporting clients' autonomy in daily living care is vital for dignity and quality of life. In practice, autonomy is often conflated with self-reliance; however, whereas self-reliance concerns performing activities independently, autonomy concerns making decisions according to one's own values and preferences. Little is known about how nursing students learn to support clients' autonomy during clinical training.

We explored how nursing students learn to support clients' autonomy through interactions with clinical supervisors during clinical training.

In an exploratory qualitative descriptive study guided by an interpretivist orientation (May-June 2024), we investigated how nursing students learned to support clients' autonomy through 25 non-participant observations in clinical practice and 22 follow-up semi-structured interviews with students (N = 25) and clinical supervisors (N = 21) across long-term, community, and acute care settings in the southern Netherlands. Data were analysed using a hybrid deductive-inductive thematic analysis.

Autonomy-supportive behaviour was present in practice, although it varied across situations and was not always applied. Supervisors and students often interpreted autonomy support as promoting self-reliance rather than supporting clients' preferences and participation in decision-making. While some supervisors explicitly taught autonomy support through demonstration, feedback, and reflection, these learning opportunities were inconsistent. Consequently, students mainly learned implicitly by observing and imitating supervisors, who acted as role models during everyday care.

Autonomy support was rarely made explicit and was frequently confused with self-reliance. Consequently, students' learning opportunities were inconsistent and largely implicit. To better support patient autonomy in nursing and community care in the Netherlands, we suggest that supervisors should be supported in making autonomy-supportive practices and their underlying reasoning explicit through structured reflection. In addition, educational programs and practice settings should consider collaborating to develop structured learning opportunities focused on autonomy support.