With the increasing prevalence of an aging population and a rising annual mortality rate, palliative care has emerged as a critical modality for enhancing the quality of life for patients in end-stage conditions [1]. Palliative care provides comprehensive physical, psychological, spiritual and social care for dying patients with life-limiting illness [2]. This holistic approach not only helps patients with life-limiting illness ends with death comfortably, peacefully, and with dignity but also improves the quality of life, reduces medical costs, and optimizes the utilization of medical resources [3].
As the main practitioners of palliative care, nurses play a vital role in supporting communication among doctors, patients and families [4]. They serve as coordinators within multidisciplinary care teams, and their comprehensive caregiving capacities significantly influence the quality of palliative services.
The concept of 'death coping ability' refers to the capacity and skills to manage one's own or another's death, incorporating relevant attitudes and beliefs [5]. It involves strategies employed by individuals to mitigate stress when confronted with death [6]. This comprehensive ability to handle death events is an indispensable professional skill for palliative care nurses and an important indicator of their overall competency [7]. Due to the nature of their work, palliative nurses inevitably face death events, which can pose significant challenges, especially for those with limited experience and preparation [8]. Previous studies have indicated that in palliative care practice, nurses may experience a range of emotions including calm acceptance, overwhelming emotional dietress such as fear of death, and sadness, which can lead to depression following the death of patients [9]. When regulating emotions, palliative care nurses expend considerable emotional labor, managing their emotional expressions and interactions with patients [10]. Emotional labor involves adjusting and expressing emotions according to professional role requirements, empathizing genuinely with patients, and addressing negative emotions with a rational and professional attitude [11]. The strategies of emotional labor mainly include surface acting, deep acting and the expression of natural emotions. Surface acting involves passively repressing one's true emotions to display expressions that conform to norms, without altering the inner emotions. Deep acting, on the other hand, involves actively regulating and transforming one's internal emotional experience to align both internal and external emotions with the norms. Natural emotional expression refers to employees expressing their genuine emotions at work, unaffected by the organization's emotional rules. The process of emotional labor goes beyond merely regulating emotions; it also involves understanding and conceptualizing death[12]. Nurses with varying levels of death coping ability may exhibit different outcomes in managing death events, potentially leading to differences in their levels of emotional labor. However, current research primarily focuses on one of these aspects, with minimal information on the relationship between death coping ability and emotional labor. To address this gap, we conducted this cross-sectional survey.
Several factors correlate with a high ability to cope with death among palliative care nurses, including age, educational background, attitudes towards death, palliative experience, and personal bereavement experiences [13–14]. Research underscores a significant association between palliative experience and the ability to manage death effectively [15]. Nurses with extensive palliative care experience generally exhibit a more robust ability to cope with death, likely due to their enhanced understanding of death and familiarity with effective coping strategies, enabling them to accept and manage death events more calmly [16]. Additionally, research has indicated that attitudes towards death are predictors of death coping ability; a negative attitude may affect the level of death coping ability [17–18]. Conversely, nurses with limited palliative experience or those new to the field often demonstrate a reduced ability to cope with death. This may be attributed to traditional Chinese cultural perspectives that view death as a taboo, fostering negative emotional responses such as avoidance and fear. This cultural influence can lead to inadequate preparation for handling palliative -related matters, including death, thereby hampering nurses’ emotional regulation. Previous studies have found that death coping ability is positively correlated with care performance and tends to increase with age and accumulated palliative care experience [15]. Such experiences enrich nurses' perceptions and reflections on life, which in turn enhances their emotional regulation and ability to cope with death events effectively [19].
Prior studies on the ability to cope with death primarily assessed the level of research tools available, failing to classify and refine the group characteristics related to the death coping ability of palliative care nurses. To address this gap, this study employed latent class analysis (LCA) to identify different potential categories of death coping ability among palliative nurses and to explore the correlation between these categories and emotional labor. This approach is potentially beneficial for nursing managers to better understand the emotional labor process that palliative nurses undergo when coping with death events.
LCA is a person-centered statistical method designed to reveal hidden clusters within data by considering correlations between variables [20]. It categorizes individuals marked by multiple variables into mutually exclusive groups, ensuring minimal variation of observed variables within each category while maximizing the differences between categories. Currently, LCA is widely utilized to explore the heterogeneity within nurse groups. In this study, LCA was used to delineate the characteristics of different categories of palliative nurses' death coping abilities and to investigate their relationship with emotional labor. This analysis can inform the development of targeted educational and training strategies, ultimately enhancing the quality of palliative care services.