7 Ways to Reduce Paternalism in Nursing

Sometimes nursing professionals make decisions for patients without fully involving them in the decision-making process. This is known as paternalism in nursing. A nurse might decide which treatment is “best” without explaining other options, or skip over important details to avoid worrying the patient. Sometimes it looks like encouraging a patient to agree with a plan without really listening to their concerns. These moments often happen with good intentions, but they can leave patients feeling powerless and ignored.

What exactly is paternalism in healthcare — and how can you, as a nurse, avoid becoming part of it? This article explores practical tips and strategies to help you provide truly patient-centered care, where patients’ individual needs are taken into consideration.

What Is Paternalism in Healthcare?

Paternalism in healthcare encompasses situations in which a provider (like a nurse, doctor, or care team) makes decisions on behalf of a patient — even when the patient is capable of deciding for themselves — under the justification of acting in their best interest. This approach can unintentionally cause harm, resulting in adverse physical, psychological, and social consequences for patients.

Here are a few paternalism in nursing examples that illustrate what it can look like in everyday practice.

• Withholding information: A nurse in an oncology unit tells a cancer patient to start a chemotherapy regimen immediately, without explaining alternative treatment schedules or palliative care options, assuming the patient wouldn’t make the “right” choice on their own.
• Ignoring personal circumstances: An uninsured patient arrives at a hospital with multiple health concerns. The care team orders a full battery of tests and procedures without explaining the costs or exploring which tests are truly necessary. As a result, the patient accumulates massive medical debt and is forced to pay for procedures they didn’t need, creating serious financial harm.
• Making assumptions: In a long-term care facility, a nurse rearranges a resident’s daily schedule, including meal and nap times, without consulting them, assuming it’s more efficient and “best” for their health.
• Encouraging compliance: During physical therapy, a nurse encourages a stroke patient to attempt exercises they are hesitant about, insisting it’s necessary for recovery, without discussing the reasons behind the patient’s reluctance.
• Rushing decisions: A nurse in a busy emergency room starts a treatment protocol for a patient with high blood pressure without explaining the options, unintentionally ignoring the patient’s input or questions.
• Overriding preferences: A resident of a hospice asks for a specific type of food for lunch, but the nurse serves the standard menu instead, thinking the chosen meal might be unhealthy or difficult to digest.

Paternalistic actions can conflict with core ethical principles of modern nursing, such as patient autonomy, which emphasizes a patient’s right to make informed decisions about their own care based on their values, preferences, and life circumstances.

When autonomy is overlooked, patients may feel powerless, unheard, or frustrated, and face consequences such as bankruptcy from unexpected medical costs, worsening of their condition due to stress, and may develop mistrust toward the healthcare system.

7 Tips to Avoid Paternalism In Nursing

Recognizing paternalism is the first step toward preventing it, but knowing how to change your actions is just as important. The following tips offer practical strategies to guide nurses in fostering patient-centered care.

1. Get Educated About Paternalism

Understanding what paternalism is, its forms, and its potential impact on patients is crucial. Attend workshops, read current research, and discuss ethical cases with colleagues to become more aware of situations where paternalism may arise. Education helps nurses recognize subtle behaviors that may unintentionally undermine patient autonomy.

Don’t know where to begin? Here are some examples of available resources to jumpstart your research:

• Principles of Bioethics in Healthcare Practice by Alison
• Nursing Professionalism by Coursera
• Ethical Considerations in Digital Health by Coursera
• The Patient Will See You Now by Eric Topol
• The Code of Ethics for Nurses set by the American Nurses Association (ANA)

2. Use Decision Aids to Inform Patients Clearly

Tools known as patient decision aids — like brochures, videos, interactive online tools — help present treatment options, benefits, risks, and alternatives in an understandable, unbiased way. These have been shown to improve patients’ understanding and enable decisions that better align with their preferences.

Decision aids support autonomy by ensuring patients are fully informed and have agency, rather than being directed toward what a clinician assumes is “best.”

3. Practice Active Listening

When talking to a patient, have you ever caught yourself thinking about how you’ll respond instead of taking information in? Don’t. Take the time to really hear your patients. Instead, ask open-ended questions, clarify what they mean, and repeat back what you’ve understood to ensure accuracy.

Listening actively shows respect for the patient’s perspective and helps you understand their values, concerns, and priorities before making recommendations.

4. Provide Culturally Congruent Care

Understanding and respecting a patient’s cultural background is one key to avoiding paternalistic care. Patients may have specific beliefs, traditions, or practices that influence their healthcare decisions — ranging from dietary restrictions and modesty preferences to involving family in decision-making.

By providing culturally congruent care, you ensure that care plans align with the patient’s values and beliefs, fostering trust, respect, and collaboration.

5. Ensure True Informed Consent

Obtaining informed consent is more than having a patient sign a form — it’s about making sure they fully understand the procedure, treatment options, risks, benefits, and alternatives before agreeing. Take the time to explain information in plain language, check for understanding, and answer all questions without rushing.

Avoid assuming that a patient’s signature automatically means they are informed; full comprehension and voluntary agreement are key.

6. Encourage Shared Decision-Making

Invite patients to actively participate in their care plan by discussing options, preferences, and goals together. Studies have found that when nurses and other care providers engage patients in decision‐making, patients tend to understand their options better, report greater satisfaction with care, and are more likely to follow through with treatment plans.

To apply it, try using tools like decision making charts that lay out treatment choices side by side, including benefits, risks, and lifestyle implications. Asking open-ended questions such as, “What matters most to you when choosing a treatment?” or “Which side effects are you most concerned about?” can help uncover patient priorities.

7. Reflect on Your Own Biases and Assumptions

Healthcare professionals can unintentionally impose their own beliefs, experiences, or cultural norms on patients. Regularly reflecting on your assumptions helps reduce the risk of paternalism. Consider asking yourself questions like:

• Am I assuming I know what’s best?
• Am I listening to the patient’s perspective?
• Am I giving the patient enough information to make an informed decision?
• Could my personal beliefs or experiences be influencing my recommendations?
• Am I rushing the patient toward a decision without fully exploring their concerns or preferences?

Self-awareness, combined with feedback from colleagues or mentors, can help you provide care that truly respects patient autonomy.

FAQ: Reducing Paternalism in Nursing

Soft vs. hard paternalism: What’s the difference?

Hard paternalism occurs when a provider overrides a patient’s decision even though the patient is fully informed and competent. For example, a nurse may insist a patient undergo a specific procedure or take a medication they have declined, believing it’s in their best interest.

Soft paternalism, on the other hand, happens when a patient lacks sufficient information, capacity, or understanding — for example, acts done because the patient may not yet be competent to make informed decisions. For instance, this can occur if a patient is in a state of acute psychosis or intoxicated and cannot fully comprehend the risks and benefits of a treatment.

When is paternalism justified in healthcare?

Paternalism can sometimes be ethically justified when it protects patients from serious harm, especially if they are unable to make informed decisions. This usually applies in cases of soft paternalism — for example:

• When treating a patient that arrives unconscious after trauma, or under heavy sedation and unable to consent, medical staff may make decisions on behalf of the patient to preserve life or prevent serious harm.
• When treating a patient with severe psychiatric episodes or other conditions compromising decision‑making capacity, paternalistic interventions may be acceptable to protect them from actions that could harm them and others.
• A patient with heart attack arrives at the emergency room but refuses life-saving treatment, worried about accumulating medical debt. They say, “I’ll just drink more water; I can’t afford to be admitted.” In such a case, a nurse can reassure the patient that life-saving medications can be administered regardless of their ability to pay, allowing a more fully informed decision.

How does paternalism undermine the ethical principle of veracity in nursing?

Veracity is the ethical principle of truth-telling in healthcare. In nursing, it means being honest, transparent, and upfront with patients about their diagnosis, treatment options, risks, and outcomes. Paternalism can conflict with veracity when nurses withhold information from a patient, such as not telling a cancer patient about all available treatment options because they believe the patient might make a “wrong” choice.

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