Empathy toward persons with mental illness: Nursing students' culturally shaped subjectivity through Q-methodology

BACKGROUND: Empathy is essential in mental health nursing, as nurses serve as the first point of contact for individuals and families, playing a key role in building therapeutic relationships and providing culturally safe care. Despite its importance, empathy remains a complex and underexplored concept, particularly in culturally diverse contexts. OBJECTIVE: The current study subjectively explored the cultural factors influencing nursing students' empathy toward people with mental illness. DESIGN: Q-methodology was used to investigate the subjective perspectives of nursing students on empathy. PARTICIPANTS: Nursing students were recruited to represent culturally diverse backgrounds. The sample included 23 undergraduate nursing students residing in Australia. METHODS: Participants ranked 40 statements derived from a literature review on cultural tightness, relational mobility, and causal attributions of mental illness. Participants shared their subjective viewpoints by arranging the statements onto a quasi-normal distribution grid (Q-sort). The completed Q sorts were analysed using by-person factor analysis, and responses to follow-up open questions were used to enrich the interpretations of the factors. RESULTS: Two viewpoints explaining 49% of the variance were identified by the nursing students: "The Role of Internal Attributions and Intentional Relationships" and "The Role of External Attributions and Biological Scepticism" in empathising with people with mental illness. CONCLUSIONS: This study underscores the importance of understanding nursing students' socio-cultural norms, particularly as they may reflect Westernised or acculturated perspectives. The findings from this study can help inform clinical practices and interventions aimed at addressing knowledge gaps in understanding mental illness symptoms. This support is especially important as nursing students prepare for roles in mental health care settings.