Attitudes towards death in nursing staff: The role of resilience

Background Nurses are not always prepared to deal with strong emotions evoked when caring for suffering patients. Their attitudes-towards-death affect care quality provided to dying patients and their own well-being. This study examined resilience's role on attitudes-towards-death and personal/occupational factors related to each attitude before pandemic impact. Methods This observational, cross-sectional study included 743 nursing professionals from Intensive-Care, Palliative-Care and Oncology units in seven public Spanish hospitals. Participants completed the Death-Attitude-Profile-Revised-Scale, Connor-Davidson-Resilience-Scale and an ad-hoc questionnaire between June 2018 and April 2019. MANOVA tests, correlation analyses, mediation analyses, and Principal Component Analysis were performed. Results Neutral-Acceptance was the predominant attitude (M = 5.68, SD = 0.90), followed by Death-Avoidance (M = 4.54, SD = 1.79). Professional level, age, prior death training, healthcare setting, and resilience significantly affected attitudes (all p < .05). Resilience correlated positively with Neutral-Acceptance and inversely with Fear-of-Death and Death-Avoidance. Mediation analyses revealed complete mediation effects of resilience on relationships between professional factors and key attitudes, with some suppression effects indicated by mediation percentages > 100%. Conclusions Both resilience and prior death training play key roles in attitudes-towards-death; therefore, both should be included as core elements in academic and on-the-job nursing training.