Research in Nursing & Health, 2012, 35, 200–213 A Risk to Himself: Attitudes Toward Psychiatric Patients and Choice of Psychosocial Strategies Among Nurses in Medical–Surgical Units Pa ´draig MacNeela, 1 * P. Anne Scott, 2 ** Margaret Treacy, 3 ** Abbey Hyde, 3 ** Rebecca O’Mahony 1 1 School of Psychology, National University of Ireland, Galway, Galway, Ireland 2 President’s Office, Dublin City University, Dublin, Ireland 3 School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland Accepted 3 January 2012 Abstract: Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a criti- cal incident of a patient for whom they had cared. Two attitudinal orienta- tions were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular asso- ciations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in tar- geted therapeutic communication skills. ß 2012 Wiley Periodicals, Inc. Res Nurs Health 35:200–213, 2012 Keywords: mental illness; adherence/compliance; decision making; hospital/ institutional environment; qualitative Certain groups of patients are subject to nega- tive attitudes and consequent stereotyping by healthcare providers. Patients with a pre- existing mental health condition are one such example and are liable to negative evaluations when cared for non-psychiatric healthcare settings (McDonald et al., 2003; Reed & Fitzgerald, 2005). Many psychiatric patients ex- perience distinctive needs, but a response of stereotyping is unlikely to promote psychosocial engagement or relationship building (Hagerty & Patusky, 2003). The health care received by psychiatric patients in general hospitals has been We wish to acknowledge the funding support of the Irish Health Research Board research programme in nursing decision making. We are also grateful to journal reviewers and editors for the helpful and constructive feedback they provided. Correspondence to Pa ´ draig MacNeela *Lecturer. **Professor. Published online 14 February 2012 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/nur.21466 ß 2012 Wiley Periodicals, Inc.