BACKGROUND: Many critical care nurses provide care to patients who are injured or ill and are at the end-of-life. Therefore, they are at high risk for developing negative emotional responses due to exposure to patient suffering and death.
OBJECTIVE: To determine the association between attitudes towards care of the dying, resilience, and Sense of Coherence.
METHODS: A cross-sectional descriptive approach was used. Head nurses at 74 hospitals in Japan were sent a letter about the study; 29 head nurses agreed to send information to the critical care nurses in their hospital. Demographic factors, attitudes towards care of the dying, resilience, and Sense of Coherence were collected using Google Forms. Structural equation modelling was used to analyze the associations among the variables.
RESULTS: A total of 229 nurses completed the survey. The average years of clinical experience were 10.5 ± 8.4 years. Factors directly related to positive attitudes towards care of the dying were higher resilience, more years of clinical nursing experience, and having a Master\'s degree. Sense of Coherence was the strongest predictor of resilience. Other predictors for higher resilience included confidence in nursing skills, social support, and religious beliefs towards death. The main predictor for higher Sense of Coherence was workplace satisfaction.
CONCLUSIONS: Nurses with higher resilience had more positive attitudes about care of the dying. Individual factors, such as a Sense of Coherence, confidence in caring for patients, and religious beliefs were the most important factors related to resilience.
CONCLUSIONS: It is necessary to support newer nurses especially those with lower educational attainment, to increase workplace satisfaction, Sense of Coherence and resilience. It is necessary to develop educational programs focused on care of dying patients and to evaluate their effect so that critical care nurses have a positive response to caring for dying patients.

This study assessed suicidal risk in patients suffering from non-psychotic depressive disorders within various clinical and nosological forms (F31-F34 mood disorders and F60.31-emotionally unstable personality disorder). Clinical and psychological features were presented, as well as predictors of suicidal risk in patients of these groups. We performed a comparative analysis of the anxiety and depression level, the level of mental pain, fear of death and the severity of anti-suicidal motives in patients with affective disorders and borderline personality disorder (BPD). Based on the results, 100% of patients in these clinical nosological groups were found to have a high level of suicidal risk. Patients with affective disorders have weak anti-suicidal motives and are not fully aware of the consequences of their own death. Patients with BPD have a higher suicidal risk than patients with affective disorders; they are characterized by less pronounced social orientation, demonstrativeness, self-centeredness, less pronounced levels of anxiety and fear of death.

OBJECTIVE: To explore the influencing factors of attitudes about death among undergraduate nursing interns.
METHODS: The study subjects were selected from the full-time fourth year undergraduate nursing interns in Jiangxi University of Technology from January to March 2021 by convenience sampling method. The general information questionnaire was designed by our hospital, and attitude towards death referred to the Chinese version of Death Attitude Depiction Scale (Revised) (DAP-R). Univariate and multivariate Logistic regression analysis was performed on the factors that may affect nursing interns.
RESULTS: A total of 210 nursing undergraduate interns were investigated in this study. The total score of DAP-R scale was (89.27±7.26) with a range of 72 and 112. Dimensions were ordered according to the average scores for the items of natural acceptance, escaping from death, fear, approaching acceptance and fleeing acceptance. Univariate and multivariate logistic regression analyses were conducted to analyze the factors that might affect the attitude. Items with statistical significance in univariate analysis, including religious belief, death of the patients cared for during the internship, reading the books related to death and the family\'s open discussion on the topic of death were entered into the regression model (all P<0.05). The formula of DAP-R total score prediction model was as follows: DAP-R total score = 62.980 + 3.056 * religious belief + 4.381 * death of patients cared for during internship + 5.727 * reading books on death + 3.531 * family open discussion on the topic of death.
CONCLUSIONS: The undergraduate nursing interns in our school have a good attitude towards death, but still exhibit a negative attitude in fearing death.

Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children\'s hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children\'s hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.1-3.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 1-4.1), had a religious belief (p = 0.003, 95% CI: 1.4-10.5), actively practiced their religion (p < 0.001, 95% CI: 1.6-6.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.7-30.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants.Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.
Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.

OBJECTIVE: The scope and types of health interventions in the dying process are the subject of a social and professional debate that has been increasing in recent years. The objective of the study was focused on analyzing the perceptions of professionals and relatives of patients who have recently died and assessing the degree of compliance with the rights established in the current legislation on this subject.
METHODS: Qualitative research with a hermeneutical phenomenological approach carried out in 2019 by conducting and analyzing two discussion groups with health professionals from hospital and primary care, and four groups with relatives of recently deceased patients, divided by age ranges: 18- 30 years old, 31-45, 46-60 and over 60.
RESULTS: The total number of people included in the study was 28 participants. Family members and professionals find it difficult to communicate with each other in the context of health care at the end of life. Family members and professionals agree on their preference to die at home. There are specific deficiencies in knowledge about the terminology used at the end of life. The term \"euthanasia\" is the one best known by family members.
CONCLUSIONS: Deficiencies in knowledge of the rights established in the regulations related to the death process have been detected, both in relatives of patients and in professionals. These deficiencies contribute to breaches of legal regulations. Communication difficulties related to death between the professionals-patient-family trinomial are the most relevant related factor.
OBJECTIVE: El alcance y los tipos de intervenciones sanitarias en el proceso de la muerte están siendo motivo de un debate social y profesional que se ha acrecentado en los últimos años. El objetivo del estudio se centró en analizar las percepciones de profesionales y familiares de pacientes que han fallecido recientemente y evaluar el grado de cumplimiento de los derechos establecidos en la legislación vigente a este respecto.
METHODS: Investigación cualitativa de enfoque fenomenológico hermenéutico llevada a cabo en 2019 mediante la realización y análisis de dos grupos de discusión con profesionales de salud de atención hospitalaria y atención primaria, y cuatro grupos con familiares de pacientes fallecidos recientemente, divididos por rangos de edad: 18-30 años, 31-45, 46-60 y más de 60.
RESULTS: El total de personas incluidas en el estudio fue de 28 participantes. Familiares y profesionales encuentran dificultades para comunicarse entre sí en el contexto de la atención sanitaria al final de la vida. Familiares y profesionales coinciden en su preferencia de fallecer en su domicilio. Existen carencias puntuales en el conocimiento sobre la terminología empleada en el final de la vida. El término “eutanasia” es el más conocido por los familiares.
CONCLUSIONS: Se han detectado carencias en el conocimiento de los derechos establecidos en la normativa relativa al proceso de la muerte, tanto en familiares de pacientes como en profesionales. Estas carencias contribuyen a incumplimientos de la normativa legal. Las dificultades comunicativas relacionadas con la muerte entre el trinomio profesionales-pacientes-familiares son el factor relacionado más relevante.

OBJECTIVE: We investigated the relationship between nursing staff\'s knowledge of hospice care and psychological states, including grief and attitude towards death.
METHODS: From October 2018 to December 2018, a total of 1900 professional nursing staff of secondary and tertiary levels in Qinghai Province were chosen as the research subjects. Professional questionnaires were used to evaluate their knowledge level of Hospice Care (HC), psychological states, grief and attitude towards death, while the correlation between HC knowledge level and the latter three were analyzed.
RESULTS: In Qinghai Province, the nursing staff had the highest scores in terms of knowledge levels of HC symptom control with a score of 4.48±1.65, and the lowest score of 1.79±1.12 in terms of knowledge levels of death education. In the Death Attitude Profile-Revised (DAP-R) scale, there was a negative correlation between fear of death, death avoidance, escape acceptance, and HC knowledge total score (P<0.05), while there was a positive correlation between natural acceptance and HC knowledge score (P<0.05). There was no statistical correlation between the total score of approach acceptance and HC knowledge (P>0.05). In the Grief Experience Questionnaire (GEQ) questionnaire, there were negative correlations between the total score of HC knowledge and body reaction, general grief response, seeking to explain and respond to special death forms (P<0.05). Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were negatively correlated with HC knowledge scores (P<0.05).
CONCLUSIONS: There is a correlation between nursing staff\'s knowledge level of hospice care and the psychological state, partial grief and attitudes towards death. The improvement of levels of nursing staff\'s HC knowledge plays a positive role in maintaining their healthy psychological state, alleviating their grief and helping them to actively face death.

BACKGROUND: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety.
OBJECTIVE: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS.
METHODS: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0).
RESULTS: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0.
CONCLUSIONS: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.

This study aimed to examine the relationship between nursing students\' perception of spiritual care and their attitudes towards death. This cross-sectional study was conducted in Turkey between March and April 2021 with 601 nursing students using the Google Forms questionnaire. The \"Spirituality and Spiritual Care Rating Scale (SSCRS)\" and \"Attitude towards Death Scale (ATDS)\" were utilised to assist with data collection and analysis. While there was no relationship between the students\' total SSCRS and total ATDS scores, there was a positive relationship between the total SSCRS and the Neutral Acceptance-Approach Acceptance Subscale (r = 0.129, p = 0.002), and a negative relationship between SSCRS and the Fear of Death and Avoidance of Death Subscale (r =  - 0.097, p = 0.017). Providing support in terms of spiritual care and viewing spiritual care as related to nursing were related to the total SSCRS score. Alcohol use, viewing spiritual care as related to nursing, self-perceptions of spirituality, and fear of death were associated with the total ATDS score (p < 0.05). It is recommended that spiritual care and death perceptions be addressed more comprehensively in the educational curriculum of nursing students.

The present study was designed to determine the relation between attitudes to death and perceptions of spiritual care in nursing students. It is a descriptive study and included 290 fourth-year nursing students (intern students). Data were collected with a descriptive characteristics form, Frommelt Attitude Towards Care of the Dying Instrument and Spirituality and Spiritual Care Rating Scale. SPSS version 21 was used for data analysis. There was a significant positive relation between the mean scores for Spirituality and Spiritual Care Rating Scale and Frommelt Attitude Towards Care of the Dying Instrument. It can be recommended that courses about death and spiritual care should be offered and integrated into nursing curricula.

OBJECTIVE: Many medical schools in Taiwan have adopted a dignified \"silent mentor\" initiation ceremony to strengthen student\'s medical humanity and increase their learning attitudes. This ceremony consists of introductions of the body donor\'s conduct and deeds, wreath-laying, and a tea party. However, few empirical studies have examined the influences of the ceremony and dissection on medical humanity. This study explored if the initiation ceremony and the course can help students care more about others, develop more positive attitudes toward death, improve learning effectiveness in the course, and decrease negative emotions the first time they see a cadaver.
METHODS: The Attitudes Towards Death and Love and Care subscales of the life attitude inventory, Learning Effectiveness of Gross Anatomy Laboratory Scale (LEGALS), and Emotional Reactions Towards Cadavers Scale were adopted to examine differences before (T1) and after (T2) medical students attended an initiation ceremony at a university in northern Taiwan. Whether these effects lasted to the end of the semester (T3) was also tested.
RESULTS: After the ceremony, students\' attitudes towards death increased, negative emotions towards cadavers decreased, but love and care and the LEGALS did not significantly change. Data from T3 showed a similar pattern, but high-level emotions (e.g., being respected, cherished, and grateful) and the LEGALS were significantly higher than those at T1.
CONCLUSIONS: The initiation ceremony, which showed a body donor\'s deeds and attitudes toward life and death when they were alive, could help medical students gain more mature attitudes towards death and decreased negative emotions. Learning between T2 and T3 might have caused significant changes in high-level emotions and the LEGALS at T3. Arranging reflective writing with guided discussion by a teacher before and after the ceremony is highly recommended.