Negotiating Narratives: Including Patient Perspectives in Mental Health Nursing Documentation

Electronic health records (EHRs) are increasingly central in mental health and substance use care, yet how patient perspectives are captured within standardised systems remains uncertain. This qualitative study explores how healthcare staff experience and perceive the inclusion of patients’ perspectives in clinical documentation in Norwegian mental health and substance use services. Guided by Gadamer’s philosophical hermeneutics, we conducted in-depth interviews with 12 experienced professionals across specialist and primary care settings. The analysis revealed five overarching themes: negotiating narratives, highlighting how language shapes understanding and either validate or stigmatise patients; documenting in the shadows, reflecting tensions between transparency, privacy and safety; between care and control, capturing pressures to emphasise symptoms and risks due to legal and organisational demands; patient`journal as a bridge or barrier and subjective realities, illustrating challenges in balancing objectivity with the relational and emotional nature of mental health work. Across themes, participants expressed that standardised templates, biomedical framings and time constraints often hinder the meaningful inclusion of patient voices. At the same time, recovery‑orientated values underscore the importance of documentation that reflects lived experiences, goals and agency. The findings demonstrate that documentation is not a neutral task but an ethical, relational practice that requires systems and guidelines that support genuine patient involvement.