10 Strategies for Nurses to Avoid Paternalism in Patient Care

Written By: Darby FaubionDarby Faubion RN, BSN, MBA

Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA

If you are a nurse, you understand that finding a balance between offering guidance based on your experience and respecting your patient's autonomy is crucial. Without this balance, it is easy for nurses to take a one-sided approach to patient care that is not patient-centered, often referred to as paternalism. Paternalism can be intentional or unintentional. It is every nurse's responsibility to make conscious decisions to help reduce the risk of it occurring.

I know what it is like to want the best for patients and must admit there have been times when I struggled with what I believed to be the best option for their care, especially when my experience seemed to contradict their choices. Something important to consider is, "What strategies can nurses use to avoid paternalism in patient care?” In this article, I will answer that question by sharing 10 strategies for nurses to avoid paternalism in patient care. By following these tips, you can find ways to provide patient care that promotes the independence and dignity of your patients, fosters respectful, collaborative nurse-patient relationships, and improves patient outcomes.

What Strategies Can Nurses Use To Avoid Paternalism In Patient Care?

(The following are the 10 strategies for nurses to avoid paternalism in patient care.)

STRATEGY #1: Respect Patient Autonomy

Patient autonomy is the principle that recognizes the rights of patients to have the authority to make decisions regarding their health and treatment plans. When nurses respect a patient's right to autonomy, it creates a dynamic where the approach to patient care is collaborative, instead of coming from only the nurse or other team member's views. Patient autonomy rejects the idea of having authority over our patients and instead embraces the idea that patient care should be based on a partnership, which reduces the risk of paternalism in nursing.

STRATEGY #2: Engage in Active Listening

I don't know about you, but one thing that really aggravates me is trying to talk to someone who acts uninterested in what I am saying. Imagine being a patient and feeling as though your nurse is disconnected from your conversation. As nurses, it is sometimes easy to get caught up in busy schedules and rush through the day. Unfortunately, doing so can leave patients feeling as though their thoughts, experiences, or needs are not as important to us as they are to them.

When nurses do not take the time to engage patients and actively listen, it increases the risk of making assumptions and the likelihood of demonstrating paternalism. You can avoid paternalism in patient care by taking the time to listen to your patients and truly hear what they have to say.

STRATEGY #3: Demonstrate Cultural Competence

In my years of experience in nursing, one thing I can honestly say that significantly impacts every aspect of patient care is whether nurses are culturally competent. Cultural competence in nursing is simply the ability of nurses to care for patients while respecting the patient's values and beliefs. As a nurse, when you take the time to understand and respect the cultural backgrounds, beliefs, and preferences of your patients, it makes them feel heard and respected. As a result, stronger relationships form, and patients become more involved in their care, which is a vital step toward helping nurses avoid paternalism in patient care.

STRATEGY #4: Practice Effective Communication

When it comes to patient care, effective communication is a critical skill. The nurse who learns the art of effective, therapeutic communication can positively impact patients, their teams, and the organizations that employ them. On the other hand, nurses who do not value and foster good communication between themselves and their patients often take more of a paternalistic approach in their roles. Paternalism occurs in these situations because the lack of communication takes patients out of the equation, leaving the nurse to make decisions on behalf of the patient without regard for what the patient thinks, feels, or wants. To avoid paternalism in nursing, it is crucial to develop and hone strong communication skills.

STRATEGY #5: Encourage Shared Decision-Making

One of the top strategies nurses can implement to avoid paternalism in patient care is to encourage shared decision-making. Shared-decision making is a collaborative process that actively involves patients, showing respect for their perspectives and preferences. It is especially helpful in improving patient outcomes because patients who are engaged in decision-making are more likely to be compliant with their treatment plan. Shared decision-making is an essential strategy to avoid paternalism because it ensures patient care is personalized and aligned with the patient's individual wants and needs instead of having them dictated by the nurse.

STRATEGY #6: Build Solid Nurse-Patient Relationships

If I had to choose one piece of advice to give nurses that would benefit them and their patients, it would be to build strong nurse-patient relationships. Building solid relationships creates an atmosphere of mutual respect and trust where patients feel more at ease discussing their concerns and preferences regarding care. When patients feel it is safe to share their opinions and make independent decisions, it allows open, genuine dialogue through which nurses can learn what is important to patients and implement their choices into their care plan. Strong nurse-patient relationships have a way of shifting the dynamic of patient care from a one-sided approach to a partnership, honoring the patient’s right to autonomy and avoiding paternalism in patient care.

STRATEGY #7: Involve Your Patient’s Support System

A nurse who is acting paternalistically would, typically, prefer to make decisions for their patient, thinking they know what is best. In this case, it is common for a patient’s loved ones to feel pushed aside or excluded from what is going on with their care.

Whether a patient is experiencing an acute illness or dealing with a chronic condition, one thing that seems to ease their mind is having a good support system of family and friends. It is important for nurses to acknowledge the value of a patient’s support system and, when possible, to include those people in their patient’s care. Getting your patient’s support system involved in their care is an excellent way to demonstrate your respect for the patient and avoid paternalism in patient care.

STRATEGY #8: Respect Patient Privacy

All patients have a legal right to privacy. In fact, it is one of their most basic rights, and it is every nurse’s responsibility to ensure that right is protected. Respecting patient privacy not only fosters respect and promotes collaboration but also decreases the likelihood of nurses making decisions for patients without their consent. By protecting your patient’s right to privacy, you show that you value their confidentiality and autonomy, ensuring care is patient-centered with their input, which is a great way to avoid paternalism.

STRATEGY #9: Identify and Address Personal Biases

Personal biases occur when nurses make assumptions about a patient's preferences, needs, or abilities. Biases can be conscious or unconscious, and it takes a genuine willingness to be honest with oneself to identify and overcome them. Personal biases may manifest as stereotypical thinking about a person's culture, assumptions about gender, sexual preference, or age, or preconceived beliefs about health concerns or behaviors. Because personal biases undermine patient autonomy and individualized patient care, it is crucial that nurses identify and address them. By doing so, it makes it easier to provide respectful, client-centered care and avoid paternalism in patient care.

STRATEGY #10: Be a Patient Advocate

I have been a nurse for many years, and I can honestly tell you that I believe one of the most important things we do as nurses is to advocate on behalf of our patients. Being a patient advocate requires a willingness to defend our patient’s rights and support their preferences and decisions, even if we would not make the same decisions ourselves. Advocacy is one way to guard against paternalism in nursing because it emphasizes the patient’s wants and needs instead of the nurse’s opinions or preferences.

My Final Thoughts

From building strong relationships with patients and their loved ones, educating, and empowering patients, and advocating for those in need, nurses play significant roles in their patient's lives. With the many responsibilities that come with being a nurse, it is important to learn to engage in behaviors that promote patient-centered care and autonomy, avoiding paternalism. The first step is to ask, “What strategies can nurses use to avoid paternalism in patient care?”

Having been a nurse for more than 25 years, I understand the feeling of wanting to make decisions for patients based on my experience. However, I have learned to appreciate and value a patient’s right to be informed and make decisions for themselves. In this article, I shared 10 strategies for nurses to avoid paternalism in patient care. By implementing these simple strategies, you can work with your patients to ensure they receive quality, compassionate care based on evidence-based research and practices while promoting their independence and right to decide.

List Of Sources Used For This Article

1. “Patient Autonomy in Nursing and Healthcare Contexts” (Springer Publishing)
2. “Understanding Communication in Nursing (With Examples, Importance, & How to Improve)” (nursingprocess.org)
3. “What Is Cultural Competence in Nursing? (With Examples, Importance, & Barriers)” (nursingprocess.org)