Attitudes Toward Death and Medical Empathy in Nursing Students Caring for Palliative Care Patients
DOI:
https://doi.org/10.5294/aqui.2026.26.1.2Keywords:
Empathy, nursing students, attitude to death, hospice and palliative care nursing, nursingAbstract
Introduction: Palliative care is a fundamental field within nursing, yet it poses an emotional challenge for many students in training. It is therefore essential to consider the role of affective variables in the caregiving process, such as empathic competencies and expressed attitudes toward death. Objective: To examine the structural relationships between medical empathy and attitudes toward death among nursing students, identifying the most influential variables, their clusters, and the stability of their interconnections. Materials and Methods: A cross-sectional survey study was conducted with a sample of 354 adult nursing students (276 women) who were doing professional internships in palliative care. The Jefferson Scale of Empathy – Student Version (JSE-S) and the Revised Death Attitude Profile (DAP-R) were used. Data were analyzed using psychological network analysis, with 5,000 bootstrap samples to assess metric stability, and Spearman’s coefficient was applied to examine the structure of correlations. Results: The empathic dimension of compassionate care was negatively associated with the tendency to avoid death (ρ = -0.218, p < 0.001) or escape (ρ = -0.252, p < 0.001) when reflecting on patients’ deaths, while perspective taking emerged as the most stable variable within the network structure. Both empathic dimensions were positively related to neutral acceptance of death (p < 0.001). Conclusion: Clinical empathy generates less polarization toward patient death in nursing students; their professionalization requires training in emotional skills that impact the quality of their care.
Downloads
References
Pan American Health Organization – World Health Organization. Palliative care [Internet]. Washington, D.C.: PAHO/WHO; 2023. Available from: https://www.paho.org/es/temas/cuidados-paliativos
Moran S, Bailey ME, Doody O. Role and Contribution of the Nurse in Caring for Patients with Palliative Care Needs: A Scoping Review. PLoS ONE. 2024;19(8):e0307188. https://doi.org/10.1371/journal.pone.0307188
Araujo MCR, da Silva DA, Wilson AMMM. Nursing Interventions in Palliative Care in the Intensive Care Unit: A Systematic Review. Enferm Intensiva. 2023;34(3):156-72. https://doi.org/10.1016/j.enfi.2022.04.001
Alwawi AA, Abu-Odah H, Bayuo J. Palliative Care Knowledge and Attitudes towards End-Of-Life Care among Undergraduate Nursing Students at Al-Quds University: Implications for Palestinian Education. Int J Environ Res Public Health. 2022;19(15):9563. https://doi.org/10.3390/ijerph19159563
Sánchez-Cárdenas M, Rojas C. Manual básico de enfermería paliativa. Bogotá: Universidad El Bosque; 2022. Disponible en: https://cuidadospaliativos.org/uploads/2022/6/Manual-Basico-de-enfermeria-paliativa.pdf
Pontón YD, Narváez VPD, Andrade BM, Terán JJL, Reyes-Reyes A, Calzadilla-Núñez A. La empatía de los enfermeros con los pacientes en los hospitales públicos. Rev Lat Am Enfermagem. 2023;31:e3968. https://doi.org/10.1590/1518-8345.6591.3969
Hojat M, DeSantis J, Ney DB, DeCleene‑Do H. Empathy of Medical Students and Compassionate Care for Dying Patients: An Assessment of “No One Dies Alone” Program. J Patient Exp. 2020;7(6):1164-8. https://doi.org/10.1177/2374373520962605
Yu CC, Tan L, Le MK, Tang B, Liaw SY, Tierney T, et al. The Development of Empathy in the Healthcare Setting: A Qualitative Approach. BMC Med Educ. 2022;22(1):245. https://doi.org/10.1186/s12909-022-03312-y
Alruwaili AN, Alruwaili M, Ramadan OME, Elsharkawy NB, Abdelaziz EM, Ali SI, et al. Compassion Fatigue in Palliative Care: Exploring Its Comprehensive Impact on Geriatric Nursing Well-Being and Care Quality in End-Of-Life. Geriatr Nurs. 2024;58:274-81. https://doi.org/10.1016/j.gerinurse.2024.05.024
Díaz-Rodríguez M, Alcántara Rubio L, Aguilar García D, Puertas Cristóbal E, Cano Valera M. Orientaciones formativas para un cuidado humanizado en enfermería: una revisión integrativa de la literatura. Enferm Glob. 2020;19(58):640-72. Disponible en: https://scielo.isciii.es/scielo.php?pid=S1695-61412020000200020&script=sci_arttext
Aryuwat P, Holmgren J, Asp M, Radabutr M, Lövenmark A. Experiences of Nursing Students Regarding Challenges and Support for Resilience During Clinical Education: A Qualitative Study. Nurs Rep. 2024;14(3):1604-20. https://doi.org/10.3390/nursrep14030120
Weisse CS, Melekis K, Hutchins B. Providing End-Of-Life Care: Increased Empathy and Self-Efficacy among Student Caregivers in Residential Homes for the Dying. Am J Hosp Palliat Med. 2018;36(6):538-45. https://doi.org/10.1177/1049909118820844
Lind M, Koch MK, Bluck S. Nursing Students’ Empathic Communication: Role in Recognizing and Treating Chronic Pain Patients. Patient Educ Couns. 2024;123:108236. https://doi.org/10.1016/j.pec.2024.108236
Sukcharoen P, Polruk J, Lukthitikul S, Inta P, Khampolsri T, Rueangram S, et al. Undergraduate Nursing Students’ Experiences of Palliative Care in the Intensive Care Unit. BMC Nurs. 2023;22:251. https://doi.org/10.1186/s12912-023-01406-6
Jiao JR, Zheng YX, Hao WN. Empathy Ability of Nursing Students: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2022;12;101(32):e30017. https://doi.org/10.1097/MD.0000000000030017
Gázquez-López M, Álvarez-Serrano MA, Martín-Salvador A, Pérez-Morente MÁ, García-García I, González-García A, et al. Attitudes towards People Living with HIV/AIDS through the EAPVVS-E: A Descriptive Analysis in Nursing Students. Nurse Educ Today. 2025;144:106418. https://doi.org/10.1016/j.nedt.2024.106418
Barrué García P, Sánchez Gómez M. La experiencia emocional de enfermeras de la Unidad de Hospitalización a Domicilio en cuidados paliativos: Un estudio cualitativo exploratorio. Enferm Clin. 2021;31(4):211-21. https://doi.org/10.1016/j.enfcli.2020.11.006
Ramón FM, López FR, León AC, Zamora RMA, Ruíz MAV, García CdlC, et al. Actitudes del personal de enfermería ante la muerte de sus pacientes. Rev Cuid. 2021;12(1): Article 1. https://doi.org/10.15649/cuidarte.1081
Gül Ş, Demir Karabulut S, Eren H, Durmuş İskender M, Göçmen Baykara Z, Keles Ş, et al. Nursing Students’ Experiences with Death and Terminal Patients During Clinical Education. OMEGA - J Death Dying. 2020;85(3):628-49. https://doi.org/10.1177/0030222820950510
Rivera DIC, Zambrano LYC, Romero LAL. Actitudes de las enfermeras frente a la muerte de los pacientes en una unidad de cuidados intensivos. Rev Cienc Salud. 2019;17(3):Article 3. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.8368
Shaughnessy J, Zechmeister E, Zechmeister J. Research Methods in Psychology. McGraw-Hill; 2012.
Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, Veloski J, Magee M. The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data. Educ Psychol Meas. 2001;61(2):349-65. https://doi.org/10.1177/00131640121971158
Madera-Anaya M, Tirado-Amador L, González-Martínez F. Factores relacionados con la empatía en estudiantes de Enfermería de la Universidad de Cartagena. Enferm Clin. 2016;26(5):282-9. https://doi.org/10.1016/j.enfcli.2016.06.004
Gesser G, Wong PT, Reker GT. Death Attitudes across the Life-Span: The Development and Validation of the Death Attitude Profile (DAP). Omega (Westport). 1988;18(2):113-28. https://doi.org/10.2190/0DQB-7Q1E-2BER-H6YC
Cáceres Rivera DI, Cristancho LF, López Romero LA. Actitudes de las enfermeras frente a la muerte de los pacientes en una unidad de cuidados intensivos. Rev Cienc Salud. 2019;17(3):98-110. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.8368
Gorchs-Font N, Ramon-Aribau A, Yildirim M, Kroll T, Larkin PJ, Subirana-Casacuberta M. Nursing Students’ First Experience of Death: Identifying Mechanisms for Practice Learning. A Realist Review. Nurse Educ Today. 2021;96:104637. https://doi.org/10.1016/j.nedt.2020.104637
Yoong SQ, Wang W, Seah ACW, Kumar N, Gan JON, Schmidt LT, Lin Y, Zhang H. Nursing Students’ Experiences with Patient Death and Palliative and End-Of-Life Care: A Systematic Review and Meta-Synthesis. Nurse Educ Pract. 2023;69:103625. https://doi.org/10.1016/j.nepr.2023.103625
Fajardo E, Díaz-Narváez VP, Ferrero JC, Utsman R, Calzadilla-Núñez A, Díaz-Calzadilla PA. Empathy in Nursing Students: Cross-Sectional Study. Rev Salud Uninorte 2021; 37(1):112-28. https://doi.org/10.14482/sun.37.1152.41
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Marylolis Vergara Mercado, Silvana Lorena Moran Zambrano, José Hernando Ávila-Toscano, Laura Isabel Rambal-Rivaldo, Juan Casimiro Rangel
This work is licensed under a Creative Commons Attribution 4.0 International License.
1. Proposed Policy for Journals That Offer Open Access
Authors who publish with this journal agree to the following terms:
- The journal and its papers are published with the Creative Commons License Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). You are free to share copy and redistribute the material in any medium or format if you: give appropriate credit, provide a link to the license, and indicate if changes were made; don’t use our material for commercial purposes; don’t remix, transform, or build upon the material.
