Background: Nurses working in high-emotional healthcare settings frequently confront death, requiring not only technical competencies but also adaptive emotional responses. This study examined the relationship between resilience and attitudes towards death among nursing professionals before the COVID-19 pandemic impact.
Methods: This cross-sectional observational study included 743 nursing professionals from Intensive Care, Palliative Care, and Oncology units across seven Spanish public hospitals. Data were collected between June 2018 and April 2019 using the Death Attitude Profile-Revised Scale, Connor-Davidson Resilience Scale, and sociodemographic questionnaires. Statistical analyses included MANOVA, correlation analyses, and mediation analyses.
Results: Neutral-Acceptance was the predominant death attitude (M=5.68, SD=0.90), followed by Death-Avoidance (M=4.54, SD=1.79). Resilience showed significant negative correlations with Fear-of-Death (r=-.20, p<.01) and Death-Avoidance (r=-.13, p<.01), and positive correlation with Neutral-Acceptance (r=.11, p<.01). High-resilience professionals demonstrated significantly lower Fear-of-Death and Death-Avoidance, and higher Neutral-Acceptance than low-medium resilience colleagues. Mediation analyses revealed that resilience completely mediated relationships between professional factors and key death attitudes. Prior death training and professional level significantly influenced attitudes towards death.
Conclusions: Resilience serves as a protective mechanism enabling nurses to develop more adaptive death attitudes. Both resilience-building interventions and specific death education should be prioritized in nursing curricula and ongoing professional development to enhance care quality and protect healthcare workers' psychological well-being.