Neutral Acceptance Research Articles

AGE DIFFERENCES IN DEATH ATTITUDES IN THE CONTEXT OF MULTIDIMENSIONAL TORNADO IMPACTS

Abstract This study examined the age differences in various attitudes towards death following tornado exposures, as well as the moderating effect of multidimensional tornado impacts. Data used was from the first wave of longitudinal study “Vulnerability and Resilience to Disasters” (N = 1,067). Latent class analysis was conducted to explore the underlying patterns of negative tornado impacts based on 15 indicators. Three latent classes were identified: low overall impacts with high power outage rate (Low-PO), moderate overall impacts with high emotional distress (Moderate-ED), and severe overall impacts. Subsequently, the results of linear regressions showed that relative to young-old adults aged 65-74, those aged 18-34 were more likely to have an intense fear of death and those aged 75+ were less likely to have an intense fear of death (Death Fear); people aged 18-34 were more likely to avoid thought of death when it entered mind (Death Avoidance); and those aged 18-34 and 35-49 were less likely to agree that death is an entrance to a place of ultimate satisfaction (Approach Acceptance). However, compared to younger and middle-aged adults, young-old adults were more likely to avoid thought of death when it entered mind and were less likely to agree that death is a natural aspect of life (Neutral Acceptance) if they belonged to the Moderate-ED class. These findings highlighted the resilience and death anxiety of older adults after experiencing multidimensional tornado impacts, which can provide important implications for the development of age-responsible mental health programs in post-disaster recovery.

NURSES’ KAP ANALYSIS FOR PALLIATIVE CARE PATIENTS WITH HEART FAILURE

Heart failure patients admitted for palliative care require specialized management to alleviate symptoms and enhance their quality of life. Nurses play a pivotal role in delivering palliative care; however, their knowledge, attitudes, and practices significantly influence patient outcomes. This study aims to assess these parameters in nurses working in intensive care and cardiology settings. Objective: T o evaluate the knowledge, attitudes, and practices of nurses working with palliative care patients with heart failure. Methods: A cross-sectional study was conducted in the Nursing Department of Nishtar Hospital, Multan from October 2023 to October 2024. A total of 100 nurses working in the ICU and Cardiology department with heart failure patients admitted for palliative care were included in the study. Data was collected through questionnaires. Knowledge was assessed by the 30-item Palliative Care Quiz for Nursing, attitude regarding death was evaluated by a 32-item Death Attitude Profile and practice was assessed by 6-item perceptions of preparedness and ability to care for the dying (PPACD) R-I scale. Results: The mean knowledge score was 13.8 ± 2.55 with a satisfactory score in only 46% of participants. Only 29% were aware of symptom management in terminally ill patients. The mean attitude score was 133.6 ± 108.4 and the mean practice score was 16.2 ± 5.1. No significant association between knowledge scores and previous palliative care training was noted (r=0.1) but attitude scores were positively related to age and experience. The approach acceptance (r=0.292) and neutral acceptance (r=0.339) were significantly associated with practice. Conclusion: Nurses working in the palliative care unit possessed unsatisfactory knowledge, attitudes, and practices to manage patients with heart failure. Intervention programs and the inclusion of palliative care subjects in the curriculum can improve these results and avert the healthcare hazard.

Gender Perspective on Neutral Acceptance of Death: A Study of Nepalese Youth

Background & Objective: This study explores gender differences in the neutral acceptance of death among Nepalese youth. Neutral acceptance is defined as the recognition of death as a natural and inevitable part of life without judgment or strong emotions. Methods: A cross-sectional, explanatory quantitative study was conducted among 196 college students using simple random sampling. Data were collected through the Death Attitude Profile—Revised (DAP-R), specifically focusing on neutral acceptance. The study employed statistical tests such as the Chi-Square test and independent samples t-test to assess gender differences in attitudes toward neutral acceptance. Results: The findings revealed significant gender differences in neutral acceptance of death. Female participants exhibited a higher mean score (M = 4.23) compared to males (M = 3.93). Statistical analysis (p = 0.003) confirmed that females are more likely to adopt a neutral acceptance of death than males. Conclusion & Recommendation: The study concludes that Nepalese females tend to exhibit a higher neutral acceptance of death than males, likely due to cultural and social factors that encourage emotional openness and caregiving roles. These findings suggest the need for further exploration of how gender influences death attitudes and coping mechanisms in Nepalese society. Novelty: This research fills a gap in understanding gender-specific differences in neutral death acceptance, shaped by societal norms and cultural factors. The study provides insights into how male and female perspectives on death vary, offering valuable information for mental health, policy, and cultural discussions around death and gender roles in Nepalese society.

Attachment styles and empathy in trainee nurses: the mediating and moderating roles of attitudes toward death.

A growing body of evidence has shown that attachment styles and death attitudes have a significant impact on empathy. This study aimed to explore the precise role of death attitudes in the relationship between attachment styles and empathy levels among trainee nurses. A total of 626 Chinese trainee nurses with different attachment types were enrolled, and their attachment styles, death attitudes, and empathy levels were assessed using the Revised Adult Attachment Scale, the Death Attitude Profile-Revised, and the Jefferson Scale of Empathy-Healthy Professionals, and finally, data from 566 participants were included for statistical analysis. We found that among trainee nurses with secure attachment type, fear of death, approach acceptance, escape acceptance, and neutral acceptance (-) mediated the relationships between attachment-related avoidance/anxiety and their overall empathy levels and all its dimensions; in the preoccupied type, only neutral acceptance (-) mediated the relationships between attachment-related avoidance and their overall empathy levels and compassionate care; and in the fearful type, only fear of death mediated the relationship between attachment-related avoidance and compassionate care. Furthermore, in the secure type, neutral acceptance attenuated the negative predictions of attachment-related avoidance on overall empathy level and perspective taking. Attitudes toward death played different mediating and moderating roles in the relationship between attachment styles and empathy among trainee nurses with different attachment types. In addition to acculturated empathy-specific training, targeted education related to death for trainee nurses with different attachment types is needed to prevent their compassion fatigue.

Critical Care Experience Shapes Respiratory Therapists' Attitudes toward Death: A Survey Study.

Respiratory therapists (RTs) frequently encounter death in their work with critically ill patients. Healthcare providers' attitudes toward death significantly affect their approach to caring for dying patients; however, there is a lack of knowledge on RTs' attitudes toward death. This study examines how the work environment and personal characteristics of RTs influence their attitudes toward death. Utilizing the Death Attitude Profile-Revised-Chinese questionnaire, a cross-sectional survey compared non-critical care RTs (non-CCRTs, N = 86) to critical care RTs (CCRTs, N = 85). Non-CCRTs displayed significantly lower scores in overall acceptance of death compared to CCRTs (p = 0.015) and a tendency to actively avoid thoughts about death (p = 0.005). CCRTs scored higher in "neutral acceptance" (p = 0.015), and non-CCRTs exhibited higher scores on items reflecting a negative attitude toward death. RTs with shorter professional tenures showed heightened fear of death and avoidance tendencies. Perception of life and death education correlated with higher "fear of death" and "death avoidance" scores (p = 0.001). The findings indicate that CCRTs demonstrate a more neutral acceptance of death. Additionally, experience, sex, mental health status, and life-death education exposure significantly influence RTs' attitudes toward death.

Attitudes toward Death among Health Care Professionals in the Balkan Region.

Background and Objectives: Death is an unavoidable experience in any person's life and affects not only the dying person but also their caregivers. The dying process has been displaced from homes to health care facilities in the majority of cases. Facing death and dying has become an everyday life of health care professionals (HCP), especially in palliative care (PC) settings. This study aimed to investigate the death attitudes among HCPs in Serbia. Materials and Methods: The Serbian version of the Death Attitude Profile-Revised (DAP-RSp) was used as a measurement instrument. Results: The average age of the 180 included participants was 42.2 ± 9.9 years; the majority were females (70.0%), with more than 10 years of working experience (73.0%), physicians (70.0%) and those working in a non-oncological (non-ONC) field (57.78%). The mean total score of DAP-RSp was 124.80 ± 22.44. The highest mean score was observed in the neutral acceptance dimension (NA) (5.82 ± 0.90) and lowest in the Escape acceptance (EA) (2.57 ± 1.21). Higher negative death attitudes were reported among nurses compared to physicians (p = 0.002). Statistically significant differences were observed in the fear of death (FD) and death avoidance (DA) domains, favoring PC specialists and oncologists (p = 0.004; p = 0.015). Physicians working in Oncology (ONC) showed lower FD values (p = 0.001) compared to non-ONC departments. Conclusions: Attitudes toward death among HCPs are of great importance for the well-being of both HCPs and patients. Negative attitudes can lead to deficient care. The fear of death is highly represented among Serbian HCPs working in non-ONC fields, including both nurses and physicians. This study emphasizes the need for further research to comprehensively explore and understand HCPs' attitudes toward death. This research highlights the need for the development of an educational curriculum across all levels of medical education, aimed at overcoming the fear of death and enhancing coping strategies, which will improve the care for patients diagnosed with terminal illnesses.

Changes Due to Patient Deaths: Medical Students’ Expectations vs. Health Professionals’ Experiences

ContextPreparing healthcare professionals for inevitable encounters with patient deaths is crucial to preventing maladaptive professional bereavement outcomes. ObjectivesThis study aimed to explore the discrepancies between medical students’ pre-patient death expectations and healthcare professionals’ post-patient death experiences regarding accumulated global changes due to patient deaths (AGC), identify heterogeneous expectation patterns among students, and reveal risk factors for worthy-of-concern expectation patterns. MethodsCross-sectional survey data from 231 professional caregivers and 405 medical and nursing students were used. Independent t tests and analyses of covariance were run for staff-student AGC comparisons. Latent profile analysis (LPA) among students was followed by logistic regression. ResultsThe students scored higher than did the staff in two AGC factors: more acceptance of limitations and more death-related anxiety. LPA identified four latent expectation patterns, with the “overoptimistic” (27.8%) group being worthy of concern, as students overestimated positive changes and underestimated negative changes. The overoptimistic pattern was predicted by students' motivations to study medicine, which were driven by “interests,” “career opportunities,” and “improving medical services in the hometown,” rather than “by chance,” and higher scores on the death attitude of "neutral acceptance." ConclusionIn general, students tend to overestimate the long-term impacts of patient deaths. However, approximately 1/4 of students hold overly optimistic expectations, which are predicted by motivations to study medicine and death attitudes.

The Associations of Perceived Self-Efficacy with Emotional Intelligence, Personality, Resilience, and Attitudes Towards Death among Midwives.

Midwives' self-efficacy can significantly affect the provided care and, therefore, maternal and neonatal outcomes. The aim of the present study was to investigate associations of perceived self-efficacy with emotional intelligence, personality, resilience, and attitudes towards death among midwives in Greece. From 2020 to 2022, a total of 348 midwives were recruited in this descriptive cross-sectional study. The participants were employed as independent professionals, in public hospitals or regional health authorities. Data collection involved five research instruments: the General Self-Efficacy Scale (GSES), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Eysenck Personality Questionnaire (EPQ), the Connor-Davidson Resilience scale (CD-RISC), and the Death Attitude Profile-Revised (DAP-R) scale. The mean score for the GSES was 29.1 (SD = 4.2), suggesting a moderately elevated level of self-efficacy among midwives. The results revealed that higher scores on the GSES were significantly associated with higher scores on the Extraversion subscale (p < 0.001) and lower scores on the Neuroticism (p < 0.001) and Lie (p = 0.002) subscales of the EPQ. Additionally, high self-efficacy was significantly correlated with high emotional intelligence (p < 0.001), high neutral acceptance of death (p = 0.009), and high resilience (p < 0.001). These findings highlight the relationship between the self-efficacy of Greek midwives and various psychological factors, as well as the multifaceted nature of self-efficacy and its importance for midwives' psychological well-being and professional functioning.

The Relationship between Attitudes toward Death and Emotional Intelligence, Personality, Resilience, and Justice Beliefs: A Cross-Sectional Study of Midwives in Greece.

Midwifery practice inevitably includes miscarriages, stillbirths, and neonatal deaths. The aim of the present study was to investigate the relationship between attitudes toward death and emotional intelligence, personality, resilience, and justice beliefs among midwives in Greece. A descriptive cross-sectional study was conducted from 2020 to 2022 among 348 midwives employed in public hospitals, in regional health authorities, or as independent professionals. Research instruments included the Death Attitude Profile-Revised, the Connor-Davidson Resilience Scale, the Trait Emotional Intelligence Questionnaire-Short Form, the Eysenck Personality Questionnaire, and the Belief in a Just World scale. The results revealed that greater emotional intelligence was significantly associated with higher scores in the escape acceptance subscale. Midwives scored low on the neutral acceptance subscale (2.9 ± 0.8), with the highest score being recorded in the escape acceptance subscale (4.6 ± 1.0), which was significantly associated with greater emotional intelligence. Neuroticism was significantly associated with the death avoidance, approach acceptance, fear of death, and escape acceptance subscales. Finally, the subscale of distributive justice beliefs for self and others was significantly associated with the subscales of death avoidance and approach acceptance. These findings highlight the nuanced perspectives within the healthcare community. As we delve deeper into the complexities of end-of-life care, understanding these diverse attitudes is crucial for providing comprehensive and empathetic support to both patients and healthcare professionals.

A cross-cultural analysis of the relationship between the level of depression and attitudes toward death in cancer patients

Introduction♦Over the last 10 years, the number of cancer patients in the world has increased by almost 23%, and the number of cancer deaths has also increased by about 10%. Malignant neoplasms still remain as one of the main causes of mortality in the population. Patients with oncopathology are characterized by a high level of depression which leads to inadequate attitudes towards the disease and its treatment, and this may further act as a risk factor for disease susceptibility and aggravate its course (Schulz-Kindermann, 2021). It is relevant to search for variables that act as a personal resource in coping with cancer. It is hypothesized that one such personal resource is the specificity of attitudes towards death.ObjectivesTo conduct a comparative analysis of the relationship between the level of depression and the peculiarities of the attitude to death in cancer patients in Russia and Germany.Methods▪Beck Depression Inventory to determine the level of depression severity.▪Death Attitude Profile-Revised to determine the type of attitude to death.For statistical processing of data, the SPSS 23.0 statistical package was used with a preliminary check for normality of distribution using the Kolmogorov-Smirnov statistical criterion.SELECTIONThe sample consisted of a total number of 50 cancer patients with 25 each undergoing treatment in Russia (Moscow) and in Germany (Munich). The study was based on the sample obtained from the P. A. Herzen Moscow Research Oncological Institute and the Helios Munich-West Clinic. Overall, the sample was relatively gender-balanced.ResultsThe following results were obtained from the study: 1.The mean value of depression level in cancer patients is higher in Russia than in Germany.2.The level of depression in cancer patients in both the countries is correlated with:▪marital status (p=0.36)▪stage of disease (p=0.001)▪type of treatment (p=0.001)▪belief in God (p=0.024)▪adherence to a particular religious denomination (p=0.008)3.The level of depression was correlated with a certain type of attitude towards death: a higher level of depression was associated with scores on the “fear of death” scale (p=0.000), and a lower level (or lack of ) with the “neutral acceptance of death” scale (p=0.000)4.The fear of death is seen to be most common in the sample of patients from Russia, while the neutral acceptance of death is more prevalent in the sample from Germany.ConclusionsThe results suggest that a positive attitude to death (neutral as one of these types) is correlated, along with other factors, with lower levels of depression, which may be a personal resource in coping with the disease.This allows us to make the assumption that when providing psychological support to cancer patients, it is necessary to pay attention not only to the attitude to life and illness, but also to the attitude to death.Disclosure of InterestNone Declared

Investigation on the Attitudes and Perspectives of Medical and Nursing Staff About Euthanasia: Data From Four Regional Greek Hospitals.

The good and benefit of the patient are the main drivers of the decisions that health professionals are asked to make. However, the definition of the good and the actions required for benefit are not always simple and self-evident. The intractable ethical dilemma of euthanasia has been the subject of extensive debates over the years, and numerous studies have been carried out in an attempt to record the attitudes and opinions of both health professionals and the general population. This research aims to investigate the opinions and perspectives of the medical and nursing staff of the four regional hospitals regarding euthanasia and to detect the factors that advocate for and against it. Two hundred and eighteen medical and nursing staff members from four regional hospitals in Lasithi participated in the research, whose opinions and influencing factors were investigated using a questionnaire consisting of four sections. The first included demographic and general characteristics questions; the second was the Euthanasia Attitude Scale (EAS); the third was the Death Attitude Profile-Revised (DAP-R); and the last was the Daily Spiritual Experience Scale (DSES). The SPSS software version 25.0 (IBM Corp., Armonk, NY) was used to analyse the data. Of the total, 78.0% of the participants were women, with an average sample age of 44.5 years. 65.1% were married, 23.4% were physicians, while 76.6% were nurses. The mean Euthanasia Attitude score (70.89) is moderate, ranging from 30 to 120, with higher scores suggesting more favourable sentiments. Euthanasia was viewed positively by 24.3% of respondents. There was no significant difference in positive attitudes between medical and nursing staff. However, the nursing staff had significantly lower average levels of General Orientation for Euthanasia, for the Role of Healthcare Professionals in Euthanasia, Values & Ethics, or Daily Spiritual Experience, and conversely higher levels of scores on Patients' Rights Issues for Euthanasia or Death Acceptance. Health professionals were found to have moderate attitudes about euthanasia, with no significant difference between them, as well as moderate degrees of death and everyday spiritual experience. Overall, a more favourable euthanasia attitude was shown to be strongly associated with individuals who were single, divorced, or widowed, with less death acceptance or more neutral acceptance, but not with daily spiritual experience.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students.

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China. The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes. Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention. This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Attitudes toward death and burnout syndrome in geriatrics and gerontology healthcare personnel

IntroductionGeriatric and gerontology healthcare workers are associated with a series of psychosocial risks such as death, bereavement and illness, and this implies a significant emotional and work overload, which can lead to negative attitudes toward death. ObjectiveThe aims of this study were to assess attitudes toward death, the level of burnout and the relationship between geriatrics and gerontology professionals. MethodA correlational, cross-sectional study was conducted, in which the 42 participants in the sample completed an online questionnaire including the Revised Profile of Attitudes to Death (PAM-R) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). ResultsThe results obtained show that the predominant attitude toward death in the sample is that of neutral acceptance, and with regard to burnout syndrome, moderate average levels are found in the dimensions of emotional exhaustion and personal accomplishment, but a low level of depersonalisation. ConclusionHealthcare workers with attitudes of greater fear of death or acceptance of escape tend to experience higher levels of emotional exhaustion and depersonalisation, as do those with an attitude of death avoidance, who also have lower personal fulfillment.

Death attitudes and Chinese college students’ mental health: A latent profile analysis

Death attitudes can have significant impacts on individuals’ mental health. The present study used a person-centered approach to identify 588 Chinese college students’ profiles of death attitudes (i.e., fear of death, death avoidance, neutral acceptance, escape acceptance, and approach acceptance), as well as their associations with socio-demographic factors and mental health outcomes. Latent profile analysis identified five subgroups of students: healthy (28.8%), acceptant (11.7%), indifferent (43.5%), paradoxical (10.7%), and avoidant (5.3%). The healthy profile had the most favorable mental health outcomes, whereas the paradoxical profile had the least favorable mental health outcomes. Moreover, women and students from better-resourced universities were more likely to report adaptive patterns of death attitudes. Our findings demonstrated the advantages of using a person-centered approach to achieve a more nuanced understanding of Chinese college students’ death attitudes in relation to their mental health. The findings can inform death-related education and mental health interventions for college students.

Investigating the Relationship Between Spiritual Health, Meaning in Life, and Death Attitudes among COVID-19 Patients Discharged from ICUs: A Cross-Sectional Study in Iran.

The COVID-19 pandemic has been shown to affect both physical and mental health. Because of this mental health burden, it is important to pay attention to issues such as the relationship between spiritual health, death attitudes and meaning in life - all issues made more prominent during the pandemic. This study was conducted to determine the correlation between these three factors - spiritual health, meaning in life, and death attitudes, among patients with COVID-19 discharged from the intensive care units of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran.This cross-sectional, descriptive-analytical study was conducted between April 2020 and August 2021 with 260 participants. The data collection instruments were a demographic characteristics questionnaire, Polotzin and Ellison's Spiritual Health Questionnaire, The Meaning in Life Questionnaire (MLQ), and Death Attitude Profile-Revised (DAP-R).The correlation between meaning in life, spiritual health, and death attitudes was determined by Spearman's correlation coefficient. The research results showed that there is an inverse and significant correlation between spiritual health and death attitudes (p = 0.01); an inverse, but insignificant correlation between existential health and subscales of death attitudes, except for the subscales of approach acceptance and neutral acceptance (p > 0.05); and an inverse, but insignificant, correlation between spiritual health and death attitudes, (p > 0.05). In addition, there was an inverse and significant correlation between the presence of meaning in life and escape acceptance (p = 0.002); an inverse and significant correlation between the search for meaning in life and neutral acceptance (p = 0.007); and an inverse and significant correlation between the meaning in life and death attitudes (p = 0.04). Besides, the findings showed an inverse but insignificant correlation between all spiritual health subscales and the meaning in life subscales (p > 0.05). Spiritual health has an inverse correlation with death attitudes.Also, there is an inverse correlation between the total score of spiritual health and death attitudes. Regarding the subscales of spiritual health, there is an inverse correlation between existential health and death attitudes subscales, except for approach acceptance and neutral acceptance. Also, the results showed an inverse and significant correlation between meaning in life and death acceptance and avoidance subscales, and there was an inverse and significant correlation between the meaning in life and death attitudes. Finally, the increase in spiritual health reduces patients' risks of thinking about death. The research results double the significance of the role of nurses, especially those dealing with critically ill patients and those who have experienced severe disease conditions.

Death attitudes and volunteering motives of youth during the flood in Kerala, India.

The current investigation aims to gauge the connection between death attitudes, volunteering motives, and sociodemographic variables among youth in Kerala. The 150 participants who had volunteered to offer help in flood relief camps and rehabilitation programs from 3 districts in Kerala were given Voluntary Function Inventory (Clary et al., 1998) and Death Attitude Profile-Revised (Wong et al., 1994). Results of the study suggest that neutral acceptance of death attitude is positively related to volunteering motives. Likewise, volunteering motives vary significantly according to gender, marital status, socioeconomic status, and health perception, while death attitude differs significantly based on religion. This study directly implies terror management theory, which states that when reminded of their mortality, people intensify the desire to express culturally prescribed prosocial attitudes and engage in more volunteering behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design

To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death. This study was designed using a mixed-methods design. Two campuses of a university school of nursing in China. First grade Bachelor of Nursing Science students (n=191). Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis. The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z=-5.354, p<0.001) and expression of thoughts about death (Z=-3.89 b, p<0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing. Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.

Nursing Students’ Knowledge, Attitudes and Death Attitude Regarding Palliative Care: A Descriptive Correlational Study

Nursing staff are the main implementers of palliative care and nursing students are the main reserve of palliative care staff, and the importance of palliative care education in China is increasing. A questionnaire-based, cross-sectional survey was surveyed from November 2020 and January 2021 in Chongqing China. The survey included the Revised Chinese version of the Palliative Care Quiz for Nursing, palliative care attitude questionnaire and the Chinese version of the Death Attitude Profile-Revised. The final sample consisted of 1168 nursing students (response rate = 91.5%). The median knowledge was 11.00 (9.00, 12.00), and among the four areas of knowledge, the use of pain medication and psychosocial and spiritual care were less correct, 29.9% and 43.3%, respectively. 63.10% of students scored seven points or more on attitudes regarding palliative care and they had highest scores on neutral acceptance in the attitude of death. In addition, we only found a correlation between knowledge and attitudes. The results of this study showed that nursing students' attitudes toward palliative care and death are positive and should be continued and sustained, but there are still deficiencies in hospice knowledge, and we should increase education and learning content in this problematic area. Therefore, it is strongly recommended that systematic and comprehensive palliative care education be introduced into the Chinese nursing curriculum.

The impact of death attitudes on death education needs among medical and nursing students

BackgroundMedical and nursing students will play an essential role in delivering palliative care in the future. Death education is important in preparing them for future palliative care, however, little is known about students education needs and how death attitudes affect such needs in Mainland China. ObjectivesThe purpose of this survey was to investigate the death education needs of medical and nursing students and to evaluate the impact of death attitudes on death education needs. DesignMulti-center, cross-sectional survey. SettingsFourteen medical and nursing colleges & universities in Hunan, Sichuan, Liaoning, Guangdong, Shandong, and Shanxi provinces in China. ParticipantsThe sample included 1044 medical and nursing students from six provinces. MethodsIn this multi-center cross-sectional study, all data were collected through an online questionnaire that included demographic information and questions on death-related experiences. In addition, the Death Attitude Profile-Revised and the Death Education Needs Scale were used to evaluate students' death attitudes and death education needs , respectively. ResultsThe students had a mean death education needs score of 38.85 ± 7.25 (range: 10–50), yet only 20.9 % of them had received palliative care-related training. Being female (B:3.869, 95 % CI:2.849–4.889), fear of death (B:0.119, 95 % CI:0.005–0.232), and neutral acceptance (B:0.787, 95 % CI:0.638–0.936) were associated with higher death education needs, while death avoidance (B: −0.226, 95 % CI: −0.368 ~ −0.083), approach acceptance (B: −0.126, 95 % CI: −0.215 ~ −0.036), and escape acceptance (B: −0.198, 95 % CI: −0.322 ~ −0.073) were associated with lower death education needs. ConclusionsThe high level of death education needs and low training rate in palliative care among medical and nursing students in mainland China indicates a gap that needs to be addressed. Students' death education needs were affected by gender and death attitudes, which provides implications for the future development of palliative care training models.

Exploring the impacts of a coffin-lying experience on life and death attitudes of medical and nursing students: preliminary findings

BackgroundPhysicians and nurses often exhibit strong negative emotional and behavioral reactions when patients they care for die, and death education helps them cope with these difficulties. When implementing death education, the literature shows that experiential activities are more effective than lecturing, and progressive exposure is the best way to reduce death anxieties. This study examined the effects of coffin-lying, an activity sometimes seen in Asian cultures, on life and death attitudes of medical and nursing students.MethodsDuring a period from 2020 to 2021, 134 medical and nursing students from a medical university in northern Taiwan voluntarily participated in this study. Among them, 53 were in the experimental group, who participated in a coffin-lying activity for nearly 3 hours, and the other 81 were in the control group. All participants filled out questionnaires 1 week before the activity (T1), 1 week after the activity (T2), and 6 ~ 11 weeks after the activity (T3). Three waves of data were analyzed by a repeated-measure multivariate analysis of variance (MANOVA).ResultsThe effects of “love and care” and “feeling of existence” were only manifested at T2, however, the scores of “fear of death” and “death avoidance” between the experimental and control groups significantly differed at T2 and T3. In addition, there were no significant differences between the experimental and control groups in “neutral acceptance”, “approach acceptance”, or “escape acceptance”.ConclusionsThe coffin-lying activity based on desensitization was effective in improving “fear of death” and “death avoidance”, and the effects were sustained to 6 ~ 11 weeks. Coffin-lying is not only a well-designed activity that quickly reduces negative tendencies toward death, but it is also worth adopting by medical and nursing schools to make death education more comprehensive.