LAUSR

The substantial power differential embedded in nurse-patient relationships is long recognised (Briant & Freshwater, 1998). The power differential is particularly stark in mental health nursing. Unlike other domains of nursing, inpatient mental health nursing often involves involuntary detainment, involuntary administration of medication, physical restraint and seclusion. Compounding consumers’ vulnerability further still, severe mental illness is liable to substantially diminish the capacity for autonomy and self-advocacy. Incursions to autonomy and the potential for corollary harms are ever-present in the context of mental healthcare. For this reason, the therapeutic merit of the power differential in mental healthcare has been closely scrutinised. Concerns regarding the therapeutic merit of the power differential in mental health nursing has led to scepticism and troubling indictments (Bladon, 2019; Slemon et al., 2018). Whilst the potential harms of the power differential are clearly documented, these are less frequently contrasted with justifications for the power differential. This paper will discuss justifications for the power differential, with balanced consideration of related harms. In particular, this paper will focus on paternalism and trust as contributors to the power differential. Recommendations for maintaining the therapeutic merit of the power differential are made.