Attitudes of nurses toward life-sustaining treatment and its influencing factors: A mixed-methods study

This study aimed to identify factors influencing nurses' attitudes toward life-sustaining treatment (LST) in the Republic of Korea and to explore how perceptions of a good death and contextual factors shape these attitudes.

An explanatory sequential mixed-methods study was conducted at two tertiary hospitals from July to November 2024. In the quantitative phase, 104 nurses completed a cross-sectional survey, and multiple linear regression was used to identify factors associated with LST attitudes. In the qualitative phase, eight purposively sampled nurses participated in semi-structured interviews, which were analyzed using conventional content analysis. Findings were integrated through a joint display.

Quantitative findings showed moderate good death perceptions (mean = 2.91) and negative LST attitudes (mean = 3.52). Male gender (β = 0.32, P < 0.001) and stronger good death perceptions (β = 0.26, P = 0.005) were associated with more negative LST attitudes. Qualitative findings identified seven domains: experiences of close others' deaths; direct patient care experience; depth of LST knowledge; patient age, prognosis and recovery potential; family economic burden; traditional Korean cultural values; social acceptance and legal liability concerns. Integrated findings showed that traditional cultural values and gender roles contextualized the association between gender and gender roles. At the same time, experiences of death and end-of-life care explained the association between good death perceptions and LST attitudes.

Nurses' LST attitudes are shaped by good death perceptions as well as personal, clinical, and sociocultural factors. These findings provide an empirical basis for developing competency-based LST education, standardized case-based protocols, and culturally sensitive practice guidelines to support nurses in end-of-life decision-making.