Original title: Learning to support client autonomy during clinical nursing training: an exploratory qualitative descriptive study
Marjolein M C J Knibbeler, Stan Vluggen, Erik J L van Rossum, Sandra M G Zwakhalen +1 · September 2026
Nursing students need to learn how to support a client's autonomyA person's ability to make their own decisions based on what matters to them.. Autonomy means letting people make choices based on their own values, but nurses often mix it up with self-relianceDoing things for yourself without help from others., which just means doing physical tasks alone. Researchers watched nursing students and their supervisors at work, then interviewed them to see how students learn this skill. They found that supervisors and students often confused supporting autonomy with just pushing patients to be independent. Teaching moments were hit-or-miss. Some supervisors explicitly explained autonomy by showing it, giving feedback, and talking it through. However, these clear lessons did not happen regularly. Because of this, students mostly learned without direct instruction. They simply watched their supervisors during everyday care and copied what they saw. The study suggests that supervisors need help to clearly explain autonomy and their reasoning, rather than leaving students to figure it out by copying.
Imagine learning to cook by watching a friend who never explains the reasoning behind their steps. You copy the motions, but you don't understand why some choices matter, so you can't adapt when things go wrong. In this paper, student nurses learn to support patients' right to make their own decisions the same way — by imitating the nurses they train with, who rarely explain what they're doing or why. The result is that students copy surface behaviors without grasping the difference between helping a patient do things alone and respecting the patient's own choices.
Patients in nursing care deserve to make decisions about their own daily lives, but the people caring for them often confuse 'letting a patient do things alone' with 'respecting their choices.' This study shows that nursing students pick up this confusion from their supervisors, mostly by watching rather than through explicit teaching. If training programs want to fix this, they need to make autonomy support a deliberate part of clinical education.
Because this is an exploratory qualitative study, it does not establish cause-and-effect relationships or generalizable patterns. It also does not test whether the recommended interventions actually improve autonomy support. The findings reflect a specific time and region (southern Netherlands, May–June 2024).
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Learning to support client autonomy during clinical nursing training: an exploratory qualitative descriptive study — Marjolein M C J Knibbeler, Stan Vluggen, Erik J L van Rossum et al. — International journal of nursing studies advances — doi:10.1016/j.ijnsa.2026.100669
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.