Beyond Facilitation: Reconceptualising the Psychiatric Nurse's Role in Shared Decision-Making

From the perspective of psychiatric nursing, this discussion paper reconceptualises the role of psychiatric nurses in shared decision-making (SDM) in mental health care. Although psychiatric nurses are commonly described as facilitators, educators, advocates, coordinators, or supporters of SDM, these representations may underrecognise how knowledge developed through psychiatric nursing practice contributes to decision-making. Drawing on nursing epistemology and contemporary understandings of SDM, this paper conceptualises psychiatric nursing knowing as relational, interpretive, contextual, and longitudinal. Building on these characteristics, three conceptual shifts are proposed: from communication support to knowledge generation, from preference elicitation to collaborative preference interpretation, and from the decision moment to the decision trajectory. These shifts provide the epistemological basis for the Psychiatric Nurse as Core Contributor Framework, comprising five interrelated epistemic domains: Therapeutic Engagement Partner, Preference Interpreter, Clinical Context Integrator, Decision Knowledge Translator, and Implementation and Evaluation Partner. The framework conceptualises psychiatric nurses as making a distinctive and complementary contribution to the generation, interpretation, integration, translation, and application of decision-relevant knowledge alongside biomedical and clinical expertise and service-user lived and experiential knowledge. By making these knowledge processes explicit, the framework aims to strengthen the theoretical and epistemological foundation of psychiatric nursing while supporting more relational, contextually responsive, recovery-oriented, and person-centred approaches to SDM in mental health care.