Coping with Death Among Nurses in Ecuador: A Mixed-Methods Study

Background/Objectives: Coping with death is an essential yet challenging aspect of nursing. In Ecuador, limited training and cultural factors may influence how nurses face the process of death and dying. This study aimed to explore nurses' perspectives and highlight the degree of congruence between the numerical and discursive data provided by participants. Methods: A sequential explanatory mixed-methods design (QUAN → qual) using questionnaires and qualitative interviews was employed. The quantitative phase included 497 nurses who completed the Bugen Coping with Death Scale and the qualitative phase involved semi-structured interviews with 18 nurses. Quantitative data were analysed descriptively, while qualitative data underwent thematic analysis. Integration occurred at the methodological level-through the building of the qualitative data collection instrument-and at the levels of analysis and interpretation. Results: Nurses demonstrated moderate coping levels on the Bugen Coping with Death Scale. Although many reported being comfortable discussing death, qualitative data revealed substantial emotional distress and limited preparedness-particularly when facing their own mortality or the death of loved ones. Nurses expressed fear of suffering, sadness, and helplessness, especially when caring for dying children or young mothers. Communication with patients and families at the end of life emerged as a major challenge. Spirituality was identified as a key coping resource. Conclusions: Coping with death remains a complex and emotionally demanding process for nurses in Ecuador. Continuous education, emotional support, and training in spiritual and psychological dimensions of care are essential to strengthen nurses' resilience and enhance the quality of care.