Fear and attitudes toward death in nursing students: A longitudinal study

Nurses are the most involved healthcare professionals in end-of-life care. Although scientific evidence has demonstrated the effectiveness of specific education in this aspect, the optimal timing of its delivery has not been identified.

To determine the characteristics of fear of death and attitudes toward end-of-life care among nursing students during academic education.

This longitudinal observational study was conducted between October 2019 and June 2023.

A total of 486 questionnaires were administered to nursing students from two Spanish faculties.

A data collection sheet was developed to track various sociodemographic variables, which was distributed along with the Collett-Lester Fear of Death Scale and the Frommelt Attitude Toward Care of the Dying scale.

In the Frommelt Attitude Toward Care of the Dying scale, the lowest score for Factor I was observed in the third year (F(3,228) = 153.5, p < 0.001) and for Factor II in the second year (χ2(3) = 186.45, p < 0.001). The best attitude was demonstrated in the final academic year, with statistically significant differences. On the Collett-Lester Fear of Death Scale, the highest fear, both in the overall score and in all four factors, was noted in the first year and the lowest in the final year. We found a significant effect of time on the total score (F(3,300) = 7.43, p < 0.001), with differences observed between the first and other years (p < 0.001). The same pattern was found in Factor 3, fear of the death of others (F(3,300) = 18.7, p < 0.001), and in Factor 4, fear of dying of others.

It is suggested that education be provided on fear of death in the first year, person- and family-centered care in the second year, and end-of-life care in the third year, with interventions lasting more than two months.