Adult attachment profiles, death attitudes, and intention to remain in nursing among Chinese intern nursing students

Intern nursing students are frequently exposed to patient death during clinical training, yet many receive limited preparation for coping with death-related experiences. Adult attachment may shape how students regulate distress and respond to death-related stressors, but little is known about attachment profiles and their associations with death attitudes and intention to remain in nursing.

This study aimed to identify latent profiles of adult attachment among Chinese intern nursing students and to examine their associations with death attitudes and intention to remain in nursing.

A cross-sectional study was conducted in three teaching hospitals in Hangzhou, China. A total of 1,124 intern nursing students were recruited via convenience sampling.

Data were collected through an online questionnaire. The Adult Attachment Questionnaire, 10-item short form, the Death Attitude Profile-Revised, and a single-item measure of intention to remain in nursing were administered. Latent profile analysis was performed to identify attachment profiles. Profile differences in death attitudes were examined using ANOVA and ANCOVA adjusted for education level. Associations with intention to remain in nursing were assessed using chi-square tests and adjusted logistic regression.

Four distinct attachment profiles were identified: "relatively secure" (41.6%), "mildly insecure" (29.4%), "moderately insecure" (16.5%), and "highly insecure" (12.5%). Profile differences were significant across all five DAP-R subscales and remained significant after adjustment for education level. Compared with the relatively secure profile, the highly and moderately insecure profiles showed higher fear of death, death avoidance, and escape acceptance, and lower neutral acceptance. In adjusted logistic regression, the highly insecure profile (OR = 0.348, 95% CI [0.228, 0.531], p < 0.001) and moderately insecure profile (OR = 0.563, 95% CI [0.373, 0.850], p = 0.006) had lower odds of intending to remain in nursing.

Distinct adult attachment profiles were associated with death attitudes and intention to remain in nursing among Chinese intern nursing students. Students with higher attachment insecurity showed less favorable death-attitude patterns and lower intention to remain in nursing. These findings may inform targeted death education and psychological support, but should be interpreted cautiously given the cross-sectional design, self-reported data, and single-item outcome measure.