Death Anxiety as a Mediator Between Religious Attitudes and Spiritual Care Needs in Hemodialysis Patients

Purpose To examine the mediating role of death anxiety in the relationship between religious attitudes and spiritual care needs among patients undergoing hemodialysis (HD), with implications for holistic nursing assessment and intervention. Design A descriptive, correlational, cross-sectional design. Methods A total of 203 patients receiving HD were recruited. Data were collected using a Descriptive Characteristics Form, the Religious Attitude Scale, the Spiritual Care Needs Scale, and the Death Anxiety Scale (DAS). Mediation was tested using Hayes’ PROCESS Macro with bias-corrected bootstrap confidence intervals (5,000 resamples). Findings Religious attitudes were significantly associated with spiritual care needs, and death anxiety partially mediated this relationship (indirect effect b = −1.754, 95% confidence interval [−2.95, −0.65]). Mean DAS scores exceeded the clinical threshold, indicating prevalent death anxiety across the sample. Conclusions Death anxiety functions as a mediating mechanism linking religious attitudes to spiritual care needs in HD patients. Findings support integrating structured death anxiety screening and culturally sensitive religious support into holistic nursing care, operationalizing the holistic caring process.