Factors associated with death coping ability among geriatric nurses and development of culturally sensitive death education interventions

BACKGROUND: As population aging accelerates, the demand for high-quality end-of-life care for older adults continues to increase. Nurses' death coping ability is essential to the delivery of compassionate end-of-life care and to the maintenance of nurses' psychological well-being. However, in cultural contexts where death is often considered a taboo topic, limited evidence is available regarding geriatric nurses' death coping ability, its associated factors, and appropriate strategies for death education. This study aimed to assess the level of death coping ability among geriatric nurses, identify associated factors, and develop culturally sensitive strategies for death education. METHODS: A cross-sectional mixed-methods study was conducted in a tertiary hospital in Kunming, China. Using convenience sampling, 203 nurses were recruited from nine geriatric medical wards, three geriatric surgical wards, and a geriatric intensive care unit. Quantitative data were collected using a demographic information questionnaire and the Chinese version of the Coping with Death Scale. Semi-structured interviews were also conducted to explore nurses' perceptions of death, end-of-life care, and death education. Quantitative data were analyzed descriptively, and qualitative data were examined using thematic analysis. RESULTS: The mean Coping with Death Scale score was 110.12 ± 24.35, with a standardized score rate of 54.19%, indicating a moderate level of death coping ability. Among the six dimensions, life review ability had the highest score, followed by end-of-life coping ability, death acceptance ability, ability to reflect on and express views about death, ability to discuss one's own death, and ability to discuss others' death. The corresponding scores were 33.22 ± 8.765, 18.82 ± 6.698, 18.62 ± 4.203, 15.66 ± 5.057, 14.22 ± 5.735, and 9.58 ± 3.071, respectively. Interview findings showed that traditional cultural beliefs contributed to nurses' avoidance of death-related conversations. Nurses' attitudes toward death were also closely related to how they communicated with and cared for terminally ill patients and their families. CONCLUSION: Geriatric nurses in this hospital demonstrated a moderate level of death coping ability, which appeared to be closely associated with traditional cultural taboos surrounding death. Death education programs for geriatric nurses should therefore be culturally embedded and systematically designed. Recommended strategies include establishing a dynamic assessment system and developing progressive training modules that address self-acceptance of death, communication skills in end-of-life care, and grief support for family members. Nurses' years of professional experience, previous exposure to end-of-life care, cultural background, and religious beliefs should be considered when tailoring these interventions. This study provides an empirical basis for developing culturally sensitive death education in the Chinese nursing context. Future randomized controlled trials are needed to evaluate the long-term effectiveness of these strategies.