{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:19:09Z","timestamp":1787681949191,"version":"build-2784847793"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Key Nursing Research Fund Project of the First Affiliated Hospital of Kunming Medical University","award":["2022HL02Z"],"award-info":[{"award-number":["2022HL02Z"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As population aging accelerates, the demand for high-quality end-of-life care for older adults continues to increase. Nurses\u2019 death coping ability is essential to the delivery of compassionate end-of-life care and to the maintenance of nurses\u2019 psychological well-being. However, in cultural contexts where death is often considered a taboo topic, limited evidence is available regarding geriatric nurses\u2019 death coping ability, its associated factors, and appropriate strategies for death education. This study aimed to assess the level of death coping ability among geriatric nurses, identify associated factors, and develop culturally sensitive strategies for death education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional mixed-methods study was conducted in a tertiary hospital in Kunming, China. Using convenience sampling, 203 nurses were recruited from nine geriatric medical wards, three geriatric surgical wards, and a geriatric intensive care unit. Quantitative data were collected using a demographic information questionnaire and the Chinese version of the Coping with Death Scale. Semi-structured interviews were also conducted to explore nurses\u2019 perceptions of death, end-of-life care, and death education. Quantitative data were analyzed descriptively, and qualitative data were examined using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean Coping with Death Scale score was 110.12\u2009\u00b1\u200924.35, with a standardized score rate of 54.19%, indicating a moderate level of death coping ability. Among the six dimensions, life review ability had the highest score, followed by end-of-life coping ability, death acceptance ability, ability to reflect on and express views about death, ability to discuss one\u2019s own death, and ability to discuss others\u2019 death. The corresponding scores were 33.22\u2009\u00b1\u20098.765, 18.82\u2009\u00b1\u20096.698, 18.62\u2009\u00b1\u20094.203, 15.66\u2009\u00b1\u20095.057, 14.22\u2009\u00b1\u20095.735, and 9.58\u2009\u00b1\u20093.071, respectively. Interview findings showed that traditional cultural beliefs contributed to nurses\u2019 avoidance of death-related conversations. Nurses\u2019 attitudes toward death were also closely related to how they communicated with and cared for terminally ill patients and their families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Geriatric nurses in this hospital demonstrated a moderate level of death coping ability, which appeared to be closely associated with traditional cultural taboos surrounding death. Death education programs for geriatric nurses should therefore be culturally embedded and systematically designed. Recommended strategies include establishing a dynamic assessment system and developing progressive training modules that address self-acceptance of death, communication skills in end-of-life care, and grief support for family members. Nurses\u2019 years of professional experience, previous exposure to end-of-life care, cultural background, and religious beliefs should be considered when tailoring these interventions. This study provides an empirical basis for developing culturally sensitive death education in the Chinese nursing context. Future randomized controlled trials are needed to evaluate the long-term effectiveness of these strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356462","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:27:36Z","timestamp":1787678856000},"page":"e0356462","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with death coping ability among geriatric nurses and development of culturally sensitive death education interventions"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8132-6728","authenticated-orcid":true,"given":"Shixiu","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0374-7763","authenticated-orcid":true,"given":"Zhijing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"pone.0356462.ref001","first-page":"228","article-title":"Research progress on home-based hospice care under the background of \u201cInternet Plus\u201d","volume":"37","author":"MX Liu","year":"2022","journal-title":"J Nurses Train"},{"key":"pone.0356462.ref002","doi-asserted-by":"crossref","first-page":"105161","DOI":"10.1016\/j.nedt.2021.105161","article-title":"How does geriatric nursing education program change the knowledge, attitude and working intention among undergraduate nursing students? A systematic literature review","volume":"108","author":"Z Yan","year":"2022","journal-title":"Nurse Educ Today"},{"key":"pone.0356462.ref003","doi-asserted-by":"crossref","first-page":"23779608221117379","DOI":"10.1177\/23779608221117379","article-title":"Palliative Care: A Concept Analysis Review","volume":"8","author":"W Wantonoro","year":"2022","journal-title":"SAGE Open Nurs"},{"key":"pone.0356462.ref004","doi-asserted-by":"crossref","first-page":"1511697","DOI":"10.3389\/fpubh.2025.1511697","article-title":"Attitudes toward palliative care among cancer patients: a multi-method study","volume":"13","author":"M Zhang","year":"2025","journal-title":"Front Public Health"},{"key":"pone.0356462.ref005","doi-asserted-by":"crossref","first-page":"1529317","DOI":"10.3389\/fpubh.2025.1529317","article-title":"Demystifying death: a qualitative study using the behavior change wheel framework to explore the palliative care education experiences of doctors, nurses, and community residents","volume":"13","author":"G Yang","year":"2025","journal-title":"Front Public Health"},{"issue":"9","key":"pone.0356462.ref006","article-title":"Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study","volume":"17","author":"X Lin","year":"2022","journal-title":"PLoS One"},{"key":"pone.0356462.ref007","first-page":"279","article-title":"Enhancing end-of-life care for older adults: The critical role of nursing","volume":"21","author":"MSS Alkuwaykibi","year":"2025","journal-title":"Rev Diabet Stud"},{"key":"pone.0356462.ref008","first-page":"42","article-title":"Analysis of death attitudes among 331 ICU nurses","volume":"27","author":"JL Luo","year":"2020","journal-title":"J Nurs Adm"},{"key":"pone.0356462.ref009","doi-asserted-by":"crossref","first-page":"103625","DOI":"10.1016\/j.nepr.2023.103625","article-title":"Nursing students\u2019 experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis","volume":"69","author":"SQ Yoong","year":"2023","journal-title":"Nurse Educ Pract"},{"issue":"5","key":"pone.0356462.ref010","article-title":"Big Five Personality Model-based study of death coping self-efficacy in clinical nurses: A cross-sectional survey","volume":"16","author":"X Lin","year":"2021","journal-title":"PLoS One"},{"key":"pone.0356462.ref011","doi-asserted-by":"crossref","first-page":"1082979","DOI":"10.3389\/fpubh.2023.1082979","article-title":"Exploring the needs and barriers for death education in China: Getting answers from heart transplant recipients\u2019 inner experience of death","volume":"11","author":"W Shu","year":"2023","journal-title":"Front Public Health"},{"key":"pone.0356462.ref012","doi-asserted-by":"crossref","DOI":"10.1017\/S147895152510151X","article-title":"Facing death in care: Nurses\u2019 lived experiences in the care of bedridden patients","volume":"24","author":"E Alag\u00f6z","year":"2026","journal-title":"Palliat Support Care"},{"key":"pone.0356462.ref013","doi-asserted-by":"crossref","first-page":"1194460","DOI":"10.3389\/fpubh.2023.1194460","article-title":"Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students","volume":"11","author":"Y Zhu","year":"2023","journal-title":"Front Public Health"},{"issue":"5","key":"pone.0356462.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0323739","article-title":"Do tragic movies about death make you think? Exploring effects of the role of death in the narrative structure of eudaimonic movies on viewers\u2019 reflection, death attitudes, and posttraumatic growth","volume":"20","author":"K van Krieken","year":"2025","journal-title":"PLoS One"},{"issue":"4","key":"pone.0356462.ref015","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1177\/00302228211065963","article-title":"Nurses\u2019 Attitudes Towards Death and Its Relationship With Anxiety Levels","volume":"88","author":"S Duran","year":"2024","journal-title":"Omega (Westport)"},{"issue":"1","key":"pone.0356462.ref016","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1177\/00302228221100638","article-title":"Nurses\u2019 Perceptions on Good Death and Their Attitudes Towards the Care of Dying Individuals","volume":"90","author":"H T\u00fcrkben Polat","year":"2024","journal-title":"Omega (Westport)"},{"issue":"4","key":"pone.0356462.ref017","article-title":"Death of a close friend: Short and long-term impacts on physical, psychological and social well-being","volume":"14","author":"W-M Liu","year":"2019","journal-title":"PLoS One"},{"issue":"3","key":"pone.0356462.ref018","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1177\/0030222820921026","article-title":"Effect of Storytelling Technique on the Attitudes of Nursing Students Toward Death","volume":"84","author":"H \u00d6zveren","year":"2022","journal-title":"Omega (Westport)"},{"issue":"1","key":"pone.0356462.ref019","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12904-022-01054-8","article-title":"The experiences of clinical nurses coping with patient death in the context of rising hospital deaths in China: a qualitative study","volume":"21","author":"J Zhang","year":"2022","journal-title":"BMC Palliat Care"},{"issue":"5","key":"pone.0356462.ref020","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1017\/S1478951518000937","article-title":"Correlates of perceived death competence: What role does meaning-in-life and quality-of-life play?","volume":"17","author":"L Miller-Lewis","year":"2019","journal-title":"Palliat Support Care"},{"key":"pone.0356462.ref021","doi-asserted-by":"crossref","DOI":"10.1111\/jocn.13975","article-title":"How nurses cope with patient death: A systematic review and qualitative meta-synthesis","volume":"27","author":"R Zheng","year":"2018","journal-title":"J Clin Nurs"},{"issue":"4","key":"pone.0356462.ref022","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/15524256.2011.623460","article-title":"Stress and grief among family caregivers of older adults with cancer: a multicultural comparison from Hawai\u2019i","volume":"7","author":"L Anngela-Cole","year":"2011","journal-title":"J Soc Work End Life Palliat Care"},{"issue":"5","key":"pone.0356462.ref023","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1017\/S0144686X23000788","article-title":"What socio-cultural, emotional and relational factors shape older people\u2019s experiences of death and dying in residential aged care? A scoping review","volume":"45","author":"G van Toorn","year":"2024","journal-title":"Ageing Soc"},{"key":"pone.0356462.ref024","doi-asserted-by":"crossref","first-page":"1174325","DOI":"10.3389\/fpubh.2023.1174325","article-title":"Death attitudes and associated factors among health professional students in China","volume":"11","author":"H Han","year":"2023","journal-title":"Front Public Health"},{"issue":"3","key":"pone.0356462.ref025","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/jnu.12550","article-title":"Nursing Professionals\u2019 Attitudes, Strategies, and Care Practices Towards Death: A Systematic Review of Qualitative Studies","volume":"52","author":"D Puente-Fern\u00e1ndez","year":"2020","journal-title":"J Nurs Scholarsh"},{"issue":"1","key":"pone.0356462.ref026","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/s12904-022-01067-3","article-title":"When cultural values meets professional values: a qualitative study of chinese nurses\u2019 attitudes and experiences concerning death","volume":"21","author":"J Tu","year":"2022","journal-title":"BMC Palliat Care"},{"key":"pone.0356462.ref027","doi-asserted-by":"crossref","first-page":"105150","DOI":"10.1016\/j.nedt.2021.105150","article-title":"The relationship between death attitude and professional identity in nursing students from mainland China","volume":"107","author":"L Xie","year":"2021","journal-title":"Nurse Educ Today"},{"key":"pone.0356462.ref028","doi-asserted-by":"crossref","first-page":"114034","DOI":"10.1016\/j.socscimed.2021.114034","article-title":"Values, skills, and decision-making: A cultural sociological approach to explaining diagnostic disclosure","volume":"279","author":"X Mei","year":"2021","journal-title":"Soc Sci Med"},{"issue":"45","key":"pone.0356462.ref029","article-title":"Knowledge and attitudes toward end-of-life care among community health care providers and its influencing factors in China: A cross-sectional study","volume":"98","author":"H Shi","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"pone.0356462.ref030","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ejon.2015.10.003","article-title":"Caring for dying cancer patients in the Chinese cultural context: A qualitative study from the perspectives of physicians and nurses","volume":"21","author":"F Dong","year":"2016","journal-title":"Eur J Oncol Nurs"},{"issue":"1","key":"pone.0356462.ref031","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.ijnurstu.2014.09.009","article-title":"Chinese oncology nurses\u2019 experience on caring for dying patients who are on their final days: a qualitative study","volume":"52","author":"R-S Zheng","year":"2015","journal-title":"Int J Nurs Stud"},{"issue":"3","key":"pone.0356462.ref032","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1177\/00302228231158911","article-title":"Relationship between Death Coping and Death Cognition and Meaning in Life among Nurses: A Cross-Sectional Study","volume":"91","author":"T Lv","year":"2025","journal-title":"Omega (Westport)"},{"issue":"1","key":"pone.0356462.ref033","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12904-020-00581-6","article-title":"Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study","volume":"19","author":"S Kim","year":"2020","journal-title":"BMC Palliat Care"},{"key":"pone.0356462.ref034","first-page":"608","article-title":"Death competence and the professional will","volume":"34","author":"CA Corr","year":"2010","journal-title":"Death Stud"},{"key":"pone.0356462.ref035","first-page":"4","article-title":"Chinese translation and psychometric testing of the Death Coping Self-Efficacy Scale","volume":"36","author":"RS Zheng","year":"2021","journal-title":"J Nurs Sci"},{"issue":"1","key":"pone.0356462.ref036","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12904-021-00738-x","article-title":"Nurses\u2019 knowledge and attitudes towards palliative care and death: a learning intervention","volume":"20","author":"Y Hao","year":"2021","journal-title":"BMC Palliat Care"},{"key":"pone.0356462.ref037","first-page":"1701","article-title":"Relationship between death coping ability and death education needs among ICU nurses","volume":"43","author":"M Chen","year":"2024","journal-title":"Int J Nurs"},{"key":"pone.0356462.ref038","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.gerinurse.2024.05.024","article-title":"Compassion fatigue in palliative care: Exploring Its comprehensive impact on geriatric nursing well-being and care quality in end-of-life","volume":"58","author":"AN Alruwaili","year":"2024","journal-title":"Geriatr Nurs"},{"issue":"2","key":"pone.0356462.ref039","doi-asserted-by":"crossref","DOI":"10.1097\/NCC.0000000000000839","article-title":"Death Self-efficacy, Attitudes Toward Death and Burnout Among Oncology Nurses: A Multicenter Cross-sectional Study","volume":"45","author":"R Zheng","year":"2022","journal-title":"Cancer Nurs"},{"issue":"5","key":"pone.0356462.ref040","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1002\/agm2.12367","article-title":"Comprehensive geriatric assessment and palliative care","volume":"7","author":"A Castagna","year":"2024","journal-title":"Aging Med (Milton)"},{"key":"pone.0356462.ref041","first-page":"931","article-title":"Relationship among death attitudes, death coping ability, and death education needs among nurses in tertiary hospitals","volume":"39","author":"DY Chu","year":"2023","journal-title":"Chin J Pract Nurs"},{"issue":"3","key":"pone.0356462.ref042","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1080\/07481187.2022.2048282","article-title":"Funeral arrangements requested by suicide decedents in Shanghai and Wuhan, China","volume":"47","author":"F Li","year":"2023","journal-title":"Death Stud"},{"key":"pone.0356462.ref043","doi-asserted-by":"crossref","first-page":"4781","DOI":"10.2147\/JMDH.S489758","article-title":"Factors Influencing Coping with Death Competence Among Chinese Oncology Nurses: A National Cross-Sectional Study","volume":"17","author":"Y Gong","year":"2024","journal-title":"J Multidiscip Healthc"},{"issue":"1","key":"pone.0356462.ref044","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s12904-025-01754-x","article-title":"Death coping ability, death attitude, and professional quality of life among geriatric nurses: a multicentre cross-sectional study","volume":"24","author":"W Liu","year":"2025","journal-title":"BMC Palliat Care"},{"key":"pone.0356462.ref045","first-page":"5129","article-title":"Status and influencing factors of hospice care attitudes among clinical nurses","volume":"28","author":"SY Zhou","year":"2022","journal-title":"Chin J Mod Nurs"},{"issue":"2","key":"pone.0356462.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259647","article-title":"Nurses\u2019 knowledge, attitudes, and willingness to practice hospice care: An analysis of influencing factors","volume":"17","author":"L Chen","year":"2022","journal-title":"PLoS One"},{"key":"pone.0356462.ref047","first-page":"78","article-title":"Investigation of palliative care knowledge and hospice care attitudes among nursing staff in Qinghai Province","volume":"35","author":"SQ Pan","year":"2020","journal-title":"J Nurs Sci"},{"key":"pone.0356462.ref048","first-page":"1795","article-title":"A review on nurses\u2019 death competence","volume":"54","author":"W Chen","year":"2019","journal-title":"Chin J Nurs"},{"issue":"12","key":"pone.0356462.ref049","doi-asserted-by":"crossref","first-page":"7780","DOI":"10.1002\/nop2.2025","article-title":"Death education for undergraduate nursing students in the China Midwest region: An exploratory analysis","volume":"10","author":"F-J Su","year":"2023","journal-title":"Nurs Open"},{"issue":"7","key":"pone.0356462.ref050","article-title":"Knowledge, attitude and self-efficacy towards palliative care among nurses in Mongolia: A cross-sectional descriptive study","volume":"15","author":"JS Kim","year":"2020","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356462","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:27:46Z","timestamp":1787678866000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356462"}},"subtitle":[],"editor":[{"given":"Suzanne","family":"Rose","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":50,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356462","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}