Psychiatric nurses' understandings and attitudes toward the participation of patients with mental disorders in shared decision-making: a phenomenological study.

Background: Shared decision-making (SDM) is increasingly promoted in mental health care, but its meaning and feasibility remain contested in closed psychiatric wards where autonomy, fluctuating decision-making capacity, safety, coercion, family involvement, and clinical responsibility intersect. This study explored how psychiatric nurses understand patient participation in SDM and how they position themselves toward its implementation in this setting. Methods: A phenomenological qualitative design was adopted and reported with reference to COREQ. Sixteen psychiatric nurses from closed acute, chronic, and rehabilitation wards of a tertiary psychiatric hospital in Jiangsu Province, China, were purposively sampled between April and June 2024. Seventeen semi-structured face-to-face interviews were conducted because one participant completed a follow-up interview for clarification. Interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi's seven-step method with team-based coding, reflexive memoing, and an audit trail. Results: Five overarching themes emerged. In the domain of understandings, nurses endorsed the value of SDM but interpreted it through situated clinical reasoning, including conflating SDM with informed consent, viewing patients' decision-making capacity as constrained by illness phase and risk, anticipating workload and risk pressure, and positioning nurses mainly as intermediaries rather than co-decision-makers. In the attitudinal domain, support, cautious neutrality, and opposition were better understood as conditional positions along a continuum shaped by patient acuity, ward culture, institutional safeguards, family authority, and perceived medico-legal risk. Conclusion: Psychiatric nurses did not simply accept or reject SDM; rather, they interpreted it through the practical tensions of closed psychiatric care. Promoting SDM in this context requires capacity-sensitive communication, structured risk and capacity assessment, explicit ward-level procedures, interprofessional case discussion, family negotiation strategies, and institutional safeguards that integrate patient participation with safety and legal responsibility.