Effects of an integrated theory-practice palliative care teaching programme on undergraduate nursing students’ awareness, beliefs, and attitudes: a mixed-methods evaluation

Background Nursing students are unprepared for the practical and emotional reality of caring for dying patients due to a theory-practice gap in palliative care teaching. Given the rising demand for palliative care in China, this study aimed to evaluate whether an integrated teaching model combining classroom learning with early clinical immersion could improve nursing students’ palliative care awareness, beliefs, and attitudes. It also aimed to explore their perceptions using a mixed-methods approach. Methods A mixed-methods pre-post quasi-experimental design was employed. The intervention group ( n = 45, 2023 cohort) received integrated teaching, while the control group ( n = 48, 2022 cohort) received conventional instruction. Both groups completed the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD‑B) and a palliative care knowledge questionnaire, which assesses self-reported knowledge and knowledge-related beliefs, pre- and post- intervention. Data were analyzed using descriptive statistics and ANCOVA. Semi-structured interviews explored students’ perceptions; transcripts were analyzed by conventional content analysis. Integration occurred through a joint display. Results The integrated teaching model was associated with significantly higher self-reported awareness of palliative care and stronger knowledge-related beliefs ( P < 0.001; Hedges’ g = 0.82). However, the overall change in attitudes toward caring for dying patients did not differ significantly between the groups ( P = 0.064; Hedges’ g = 0.39). Exploratory item-level analyses, interpreted with caution, suggested improvements in three knowledge-related belief items and two attitude items after Bonferroni correction. Qualitatively, students reported that clinical immersion made theoretical concepts tangible, yet many expressed persistent emotional unpreparedness when facing real death. The qualitative findings were integrated with quantitative results through a joint display. Conclusions These findings suggest that an integrated theory-practice teaching model may support self-reported palliative care awareness and knowledge-related beliefs, but attitude change may require longer clinical exposure and emotional processing. Changes in awareness and beliefs and changes in attitudes may follow different trajectories. This integrated teaching model may represent a context-specific educational approach for bridging the theory-practice gap in palliative care education. As clinical competence was not objectively measured, future studies with randomized designs, longer follow-up, and objective assessments are needed to verify these findings and refine educational strategies. Clinical trial number Not applicable.