Professional death avoidance and associated factors among intensive care unit nurses in China: a multicenter...

Nurses in intensive care units (ICUs) frequently encounter patient death, ethical dilemmas, and emotionally demanding clinical situations. These experiences may be associated with emotional exhaustion, moral distress, and professional death avoidance. Professional death avoidance refers to a work-context-specific tendency to distance oneself from death-related professional situations, including communication, care tasks, emotional engagement, and reflection related to patient death. Understanding the current status of professional death avoidance and its associated factors is important for developing supportive strategies in critical care settings.

This study aimed to investigate the current status of professional death avoidance among ICU nurses and to examine its associations with emotional exhaustion, moral distress, and demographic and occupational characteristics.

A multicenter cross-sectional study was conducted from September to October 2025 among 367 registered nurses from three tertiary hospitals in Sichuan Province, China. Participants completed validated questionnaires assessing professional death avoidance, emotional exhaustion, moral distress, and demographic and occupational characteristics. ICU work experience, job satisfaction, education level, monthly income, religious belief, ethics training, and family support were analyzed as potential associated factors. The Job Demands-Resources Model was used as a conceptual framework for variable selection and interpretation, rather than as an empirically tested theoretical model. Data were analyzed using descriptive statistics, univariate tests, Spearman rank correlation analysis, and exploratory stepwise multiple linear regression.

The mean professional death avoidance score was 38.26 ± 15.75. Univariate analysis showed significant differences in professional death avoidance scores according to ICU work experience, education level, monthly income, religious belief, ethics training, family support, and job satisfaction (P < 0.05). Professional death avoidance was positively correlated with emotional exhaustion (r = 0.447, P < 0.001) and moral distress (r = 0.526, P < 0.001). Exploratory multiple linear regression showed that ICU work experience, job satisfaction, emotional exhaustion, and moral distress were independently associated with professional death avoidance, collectively explaining 33.6% of the variance.

ICU nurses in China reported a moderate level of professional death avoidance. Shorter ICU work experience, lower job satisfaction, higher emotional exhaustion, and higher moral distress were statistically associated with higher levels of professional death avoidance. These findings suggest that professional death avoidance may be related to both emotional depletion and ethical strain in ICU practice. Supportive workplace strategies addressing psychological well-being, moral distress, job satisfaction, and coping resources may help improve nurses' engagement in death-related and end-of-life care, but longitudinal and intervention studies are needed to clarify causal relationships and evaluate intervention effectiveness.