The mediating role of death anxiety between meaning in life and spiritual care competence among Chinese nursing interns: implications for healthcare training

In Chinese culture, discussions about death are often considered taboo, which may intensify death anxiety among nursing interns when facing end-of-life situations. Death anxiety may influence their ability to provide spiritual care, yet the underlying mechanisms remain unclear. This study aimed to examine the relationship between meaning in life, death anxiety, and spiritual care competence among nursing interns, and to explore the mediating role of death anxiety. This was a cross-sectional study. A cross-sectional survey was conducted among 737 final-year vocational nursing interns from a medical college in China using whole-cohort sampling. Data were analyzed using SPSS 25.0, including t-tests, ANOVA, Pearson correlations, and mediation analysis via Hayes’ process plug-in. Significant associations were observed among meaning in life, death anxiety, and spiritual care competence. Meaning in life, was positively correlated with spiritual care competence (r = 0.520, p < 0.001) and weakly negatively correlated with death anxiety (r = -0.077, p = 0.036). Death anxiety was negatively correlated with spiritual care competence (r = -0.196, p < 0.001). Mediation analysis showed that death anxiety partially mediated the relationship between meaning in life, and spiritual care competence, with an indirect effect of 0.019 (95% CI: 0.001–0.041), accounting for 2.24% of the total effect. Death anxiety partially mediated the association between meaning in life and spiritual care competence, with a small but statistically significant indirect effect. These findings suggest that addressing death-related concerns and fostering meaning construction within nursing education may support the development of spiritual care competence, consistent with theoretical perspectives emphasizing the buffering role of existential resources.