Latent profiles of death coping competence among nursing interns: Associations with death attitudes, death exposure, and death education

Background Preparing nursing students to cope effectively with patient death is an important component of nursing education, yet little is known about heterogeneity in death coping competence among nursing students. Objectives This study aimed to identify latent profiles of death coping competence among nursing interns and to examine whether death exposure, death attitudes, and death education are associated with profile membership. Methods A cross-sectional survey was conducted among 366 final-year nursing students from 15 universities undertaking clinical internships at a tertiary teaching hospital in China. Death coping competence, death attitudes, death exposure, and prior death education were assessed using validated questionnaires and structured items. Latent profile analysis was performed to identify subgroups of death coping competence. Multinomial logistic regression was used to examine predictors of profile membership. Results Three profiles of death coping competence were identified: low competence (15.0%), moderate competence (68.3%), and high competence (16.7%). Students who had received formal death education were more likely to belong to the moderate (OR = 1.977, 95% CI [1.068, 3.660], p = 0.030) and high competence profiles (OR = 3.637, 95% CI [1.478, 8.954], p = 0.005). Higher neutral acceptance (OR = 1.234, 95% CI [1.115, 1.365], p < 0.001) and approach acceptance (OR = 1.077, 95% CI [1.026, 1.130], p = 0.003) were associated with increased likelihood of membership in the high competence profile. In contrast, certain forms of death exposure, including witnessing patient death during internship (OR = 0.263, 95% CI [0.099, 0.698], p = 0.007) and attending funerals (OR = 0.318, 95% CI [0.109, 0.933], p = 0.037), were negatively associated with higher competence profiles. Conclusions Death coping competence among nursing students is heterogeneous. Structured death education and adaptive death attitudes were associated with higher competence profiles, whereas unstructured exposure to death was not consistently associated with higher competence. Educational strategies integrating death education and psychological preparation may be relevant for supporting nursing students’ preparedness in managing end-of-life care.