Work

The mediating role of death anxiety between meaning in life and spiritual care competence among Chinese nursing interns: implications for healthcare training

Year: 2026

Type: article

Abstract: BACKGROUND: In Chinese culture, discussions about death are often considered taboo, which may intensify death anxiety among nursing interns when facing end-of-life situations. Death anxiety may influence their ability to provide spiritual care, yet the underlying mechanisms remain unclear. AIM: This study aimed to examine the relationship between meaning in life, death anxiety, and spiritual care competence among nursing interns, and to explore the mediating role of death anxiety. METHODS: This was a cross-sectional study. A cross-sectional survey was conducted among 737 final-year vocational nursing interns from a medical college in China using whole-cohort sampling. Data were analyzed using SPSS 25.0, including t-tests, ANOVA, Pearson correlations, and mediation analysis via Hayes’ process plug-in. RESULTS: Significant associations were observed among meaning in life, death anxiety, and spiritual care competence. Meaning in life, was positively correlated with spiritual care competence (r = 0.520, p < 0.001) and weakly negatively correlated with death anxiety (r = -0.077, p = 0.036). Death anxiety was negatively correlated with spiritual care competence (r = -0.196, p < 0.001). Mediation analysis showed that death anxiety partially mediated the relationship between meaning in life, and spiritual care competence, with an indirect effect of 0.019 (95% CI: 0.001–0.041), accounting for 2.24% of the total effect. CONCLUSION: Death anxiety partially mediated the association between meaning in life and spiritual care competence, with a small but statistically significant indirect effect. These findings suggest that addressing death-related concerns and fostering meaning construction within nursing education may support the development of spiritual care competence, consistent with theoretical perspectives emphasizing the buffering role of existential resources.

Source: BMC Palliative Care

DOI: 10.1186/s12904-026-02089-x