The Relationship between Life Experiences and Attitudes of Student Nurses toward Providing End-of-Life Care

Date of Award


Degree Name

Ph.D. in Educational Leadership


School of Education and Health Sciences


Charles J. Russo


The capabilities of modern medicine have precluded the sanctity of what it means to die, extending life while too often prolonging suffering along a trajectory of functional decline that typifies terminal illness, leaving patients with little say in how they want to experience their final days (Connors et al., 1995). End-of-life care has evolved to ensure that people with terminal illnesses know what to expect, understand their options, and have a voice in their care. It is the nurse-patient relationship at the bedside where patients express their wishes and the opportunity to advocate for patient-directed end-of-life care occurs. Unfortunately, these nurses often are not prepared for this role, cognitively or attitudinally. With an aging generation of baby boomers and prevalence of chronic illness, the need for nurses to be comfortable with end-of-life caregiving is urgent. This requires nurses to be educated in the principles of end-of-life care and possess attitudes conducive to putting their knowledge into practice. Often, though, nurses are confronted with their own attitudinal barriers toward death and dying borne of experiences in life that must first be overcome to freely empower their patients' voices and choices for care. Using a correlational design, the intent of this study was to learn how to improve nursing education in end-of-life care by determining the relationship between undergraduate student nurses' personal, didactic, clinical, and introspection life experiences with death and dying and their attitudes toward providing care to the dying. The study found that the personal, clinical, and introspective domains were associated with attitudes toward care of the dying with introspection showing the strongest correlation with attitudes. Forward regression, however, revealed that all four domains were predictive of attitudes toward care of the dying. Didactic experiences indirectly predicted attitudes by enhancing clinical experiences at the bedside, resulting in the clinical domain ranking as the strongest predictor of attitudes while introspection emerged as the strongest unique predictor. The value of introspection in ameliorating attitudes toward death and dying borne of experiences in all realms of life was pervasive. The study further investigated the association between attitudes toward death and dying and attitudes toward providing care to the dying. Fear of Death and Death Avoidance were inversely associated with comfort in giving care to the dying whereas Neutral Acceptance was positively associated. This study revealed the complexity of educating to attitudes conducive to comfortably providing nursing care at the end of life, revealing the need for a multimodal approach. Assuming that attitudes engender behaviors, discomfort or aversion toward death may negatively impact giving care at the end of life. The study outcomes recommend introspective exploration of student nurses' attitudes toward death and the origins of those attitudes as well as offering deliberate didactic and clinical experiences with the dying to prepare nurses with the aptitudes and attitudes to comfortably provide end-of-life care.


Nursing, Undergraduate nursing students, attitudes, end-of-life care, life experiences, death and dying

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