Attitudes toward death in nursing staff: the role of resilience

Nurses frequently care for patients at the end of life, yet many lack adequate preparation to manage the associated emotional challenges. Attitudes toward death influence both the quality of end-of-life care and nurses´ own psychological well-being. Although resilience has been identified as a potential protective factor, its role in shaping attitudes toward death among nursing professionals remains insufficiently explored. This study examined the role of resilience in attitudes toward death and analyzed personal and occupational factors associated with these attitudes prior to the COVID-19 pandemic. This observational cross-sectional study included 742 nursing professionals working in Intensive Care, Palliative Care and Oncology units across seven public hospitals in Spain. Participants completed the Death Attitude Profile-Revised, the Connor-Davidson Resilience Scale and an ad-hoc questionnaire assessing sociodemographic and professional variables between June 2018 and April 2019. Multivariate analyses of variance, correlation analyses, mediation and moderation analyses, and principal component analysis were conducted. Neutral-Acceptance was the most predominant attitude toward death (M = 5.68, SD = 0.90), followed by Fear-of-Death (M = 3.70, SD = 1.39) and Death-Avoidance (M = 3.53, SD = 1.59). Attitudes toward death were significantly associated with professional category, age, prior training in death and bereavement, healthcare setting, and resilience (all p<.05). Resilience correlated positively with Neutral-Acceptance and negatively with Fear-of-Death and Death-Avoidance. Mediation analyses showed that resilience fully mediated the relationships between several professional factors and key death attitudes, with suppression effects observed in some models. Resilience and prior training in death and dying appear to play an important role in shaping nurses´ attitudes toward death. Integrating resilience-enhancing strategies and structured death education into both academic curricula and continuing professional training may contribute to nurses´ emotional well-being and to the quality of end-of-life care.