Research| Volume 49, ISSUE 1, P109-123.e4, January 2023

Illuminating Emergency Nurses’ Perceptions of Stigma, Attribution, and Caring Behaviors Toward People With Mental Illness Through the Lens of Individualized Care: A Cross-sectional Study

Published:October 17, 2022DOI:



      Emergency nurses’ negative attitudes and lack of caring have been identified as factors affecting the experience of individuals with mental illness in emergency departments. This study examined the relationships between emergency nurses’ perceptions of stigma, attribution, caring behaviors, and individualized care toward people with mental illness.


      A cross-sectional study was conducted among 813 nurses working in United States emergency departments. Data were collected using a demographic questionnaire; the Mental Illness: Clinicians’ Attitudes Scale-4; the Attribution Questionnaire; 24-Item Caring Behaviors Inventory; and the Individualized Care Scale-Nurse version. Data analyses consisted of descriptive and correlation statistics and multiple linear regression.


      The findings from the final regression analysis revealed that caring had a significant relationship with individualized care (version A: β = 0.70, P < .001; Version B: β = 0.73; P < .001). Stigma and attribution had significant inverse relationships with individualized care (β = −0.07, P < .01; β = −0.06, P < .05, respectively).


      The results of this study indicated that emergency nurses’ perception of individualized care toward people with mental illness is mostly associated with the nurses’ level of caring behaviors toward this population. Stigma and attribution had little to no effect. Findings from this study reinforce nurses’ altruistic and caring qualities. The findings suggest the need for a possible paradigm shift from antistigma training to trainings that prioritize caring behaviors toward mental illness. This could ultimately improve health equity, safety, and overall outcomes for people with mental illness.

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      Jennifer T. McIntosh, PhD, RN, CNE, PMH-BC, NEA-BC, Member, Emergency Nurses Association, is a lecturer at Yale School of Nursing, Orange, CT; and is an adjunct faculty at Adelphi University, Garden City, NY and City University of New York School of Professional Studies, New York, NY. ORCID identifier: