Abstract
Objective
This study aimed to explore the association between different personality traits and death-coping self-efficacy of intensive care unit (ICU) nurses.
Methods
A total of 350 questionnaires were distributed, and 301 valid questionnaires were finally collected. The research tools included a general information questionnaire and a death-coping self-efficacy questionnaire to collect nurses’ demographic information.
Results
The overall score of ICU nurses’ death-coping self-efficacy was 98.52 ± 18.18, of which the hospice care dimension had the highest score (44.70 ± 8.25) and the grief coping dimension had the lowest score (28.21 ± 6.76). Personality traits of conscientiousness (p < 0.001), agreeableness (p < 0.001) and openness (p < 0.001) were significantly positively correlated with death-coping self-efficacy, whereas neuroticism was significantly negatively correlated with it (p < 0.001). Multiple linear regression analysis showed that whether or not they had participated in palliative care education courses within 1 year (p = 0.022), the experience of accompanying the death of a family member (p < 0.001), their attitude towards death (p < 0.001), as well as rigour (p = 0.002), agreeableness (p < 0.001) and openness (p < 0.001) were important influencing factors of death-coping self-efficacy, with a model determination coefficient R2 of 0.373 and an adjusted R2 of 0.364.
Conclusion
The self-efficacy of ICU nurses in coping with death is at a moderate to high level, and different personality traits have a significant impact on their self-efficacy in coping with death. High conscientiousness, agreeableness and openness personality traits help to improve self-efficacy in coping with death, whereas high neuroticism may reduce it.
Clinical trial number
Not applicable.
Keywords: Intensive care unit, Nurses, Self-efficacy, Psychological adaptation
Introduction
The intensive care unit (ICU) is one of the departments in medical institutions where patients are most seriously ill. In their daily work, nurses in the ICU must frequently face patients who are critically ill or even dying. This special professional situation requires nurses to possess exceptional psychological resilience, emotional regulation capabilities and stress management skills to cope effectively with high-pressure clinical environments and ethically complex scenarios. However, work experiences related to death often bring a strong psychological burden to nurses, manifested as negative emotions, such as anxiety and depression, which not only affect the nurses’ mental health but may also weaken the efficiency and quality of their nursing work [1]. To alleviate this negative impact and improve nurses’ ability to deal with death-related events, the concept of ‘death-coping self-efficacy’ has gradually been proposed and applied to related research [2–4]. Death-coping self-efficacy refers to the ability and confidence of nurses in assessing the needs of patients and their families, assisting in dealing with care issues, managing symptoms, comforting family members and organising subsequent funeral arrangements when facing the death of patients [2]. This ability is crucial for nurses’ performance in hospice care, as it enables them to provide compassionate and effective support to patients and their families during end-of-life care [3, 4].
Critical care and hospice care are closely related yet distinct in their focuses and practices. Critical care primarily aims to save lives and maintain the physiological functions of critically ill patients through intensive medical interventions [5]. In contrast, hospice and palliative care focus on providing relief from the symptoms and stress of a serious illness, aiming to improve the quality of life for patients and their families [6]. In the ICU setting, the transition from critical care to palliative care or end-of-life care can be challenging but is essential when curative treatments are no longer effective [7]. Critical care nurses play a crucial role in this transition, as they are often the ones who provide continuous care and support to patients and their families during this difficult period. They need to balance the goals of prolonging life and providing dignified end-of-life care, which requires a deep understanding of both critical care and palliative care principles [6].
Personality traits are relatively stable psychological and behavioural tendencies of individuals and are important variables affecting their coping abilities. In personality psychology, the ‘Big Five Personality Traits’ are widely used to describe individual personality traits and comprise the following five dimensions: conscientiousness, agreeableness, extraversion, openness and neuroticism [8]. Conscientiousness reflects the strength of an individual’s self-discipline and sense of responsibility; agreeableness refers to the level of cooperation and empathy with others; extraversion is manifested in sociability and vitality; openness is related to innovative thinking and the ability to accept new things; and neuroticism refers to emotional stability and stress-coping ability [9]. Studies have shown that different personality traits have a significant impact on an individual’s coping style, self-efficacy and mental health level. For example, individuals with high rigour are more likely to adopt a problem-solving-oriented coping style and have a higher sense of self-efficacy; individuals with high agreeableness and high openness are more likely to show cooperative and creative behaviours in social interactions; and individuals with high neuroticism are usually accompanied by higher levels of anxiety and emotional instability and tend to adopt negative coping strategies [10].
A review of the existing literature reveals that personality traits have been widely studied in relation to self-efficacy across various domains. For instance, conscientiousness and openness have been shown to positively correlate with self-efficacy in academic and professional settings. Agreeableness and extraversion have been linked to higher self-efficacy in social and interpersonal contexts [11]. In the context of academic achievement, studies have demonstrated that personality traits such as openness and conscientiousness contribute to academic self-efficacy, which in turn affects academic performance [12]. Although the correlation between personality traits and self-efficacy has been confirmed, there are limited studies combining personality traits with ICU nurses’ death-coping self-efficacy. In the high-pressure environment of the ICU, nurses with different personality traits may show very different psychological and behavioural responses. For example, nurses with high agreeableness and high openness personality traits may be more willing to communicate deeply with patients and their families and provide emotional support, whereas nurses with high neuroticism may find it difficult to carry out nursing work effectively due to excessive worry [13]. Therefore, investigating the relationship between personality traits and death-coping self-efficacy in ICU settings is critical for designing targeted interventions to enhance nurses’ psychological resilience, improve their adaptive behaviours in high-stress scenarios and optimise communication, emotional support and clinical decision-making in end-of-life care. This quantitative approach allows for the identification of specific personality traits that significantly impact death-coping self-efficacy, providing a theoretical basis for individualised nursing interventions.
In addition, from the current research status, there is no unified research conclusion on the self-efficacy of ICU nurses in coping with death. Some studies focus on nurses’ attitudes towards death and its influencing factors but ignore the moderating effect of personality traits – an important variable – on self-efficacy in coping with death [14]. Further exploration of the specific impact mechanism of personality traits on death-coping self-efficacy can provide a theoretical basis for the design of personalised nursing intervention measures.
Therefore, this study aims to analyse the relationship between various personality traits and death-coping self-efficacy among ICU nurses. By identifying specific personality traits that significantly influence death-coping self-efficacy, the study offers a theoretical foundation for developing targeted interventions. It provides a scientific basis for nursing managers to create more tailored and personalised training programmes, ultimately enhancing the nursing quality and mental health of ICU nurses and delivering higher quality hospice care services to patients and their families.
Materials and methods
Participants
This study adopted the convenience sampling method. A total of 301 ICU nurses from three tertiary-level A hospitals in Beijing were selected between August 2022 and September 2022. The inclusion criteria were as follows: (1) a registered clinical nurse with a nursing qualification certificate; (2) engaged in clinical nursing work in the ICU for ≥ 1 year; (3) received informed consent and offered voluntary participation in the study. The exclusion criteria were as follows: (1) personnel who were unable to participate in the survey due to shift work, further studies or being away; (2) participants who provided incomplete questionnaires; (3) nurses in managerial roles without direct patient care responsibilities (to maintain homogeneity of clinical exposure); (4) individuals who reported significant distress during the survey process (ethical exclusion to prevent psychological harm). Based on a reasonable ratio of the number of questionnaire items to the sample size (10–20 times) [14] and taking into account the 10% invalid questionnaire ratio, the minimum sample size was determined to be 178 cases. The actual valid sample size included was 301 cases.
This study was approved by the Ethics Committee of Beijing Friendship Hospital (Protocol Number: [2023-P2-364-01]). The implementation of the study strictly followed the ethical guidelines of the Declaration of Helsinki. The purpose of the survey and the principle of confidentiality were stated at the beginning of the questionnaire. All research participants gave informed consent and participated voluntarily.
Measurement
General Information Questionnaire: the researchers designed a general information questionnaire based on relevant literature, including demographic characteristics (gender, age, marital status, education level, religious beliefs) and work characteristics (years of work experience, whether they had participated in palliative care education courses within 1 year, experience of accompanying a relative who has passed away) [15]. Participation in palliative care education courses was defined as participation in online or offline training on palliative care-related content, with each course lasting ≥ 40 min. Palliative care education courses cover a wide range of topics, including pain management, symptom control, communication skills and psychological support. These courses aim to enhance healthcare professionals’ ability to provide comprehensive care for patients with serious illnesses and improve their death-coping self-efficacy.
Chinese Big Five Personality Inventory (CBF-PI): the CBF-PI was compiled by Wang et al. [16]. This study used a short version of the questionnaire that included 40 items and five dimensions. The five dimensions were conscientiousness, agreeableness, extraversion, openness and neuroticism. The Likert 6-point scoring method was used, with the scale ranging from ‘1 = completely inconsistent’ to ‘6 = completely consistent’. For each dimension, the scores of individual items were summed to obtain a total score. The minimum possible score for each dimension was 8 (1 × 8), and the maximum possible score was 48 (6 × 8). This questionnaire was a well-validated self-report tool, and the Cronbach’s α of each dimension was 0.732–0.861. It had good reliability and validity in various populations in China [17]. The CBF-PI was selected for two critical reasons: (1) cultural specificity – its development for Chinese populations ensures alignment with local cultural norms, minimising biases associated with direct translations of Western instruments (e.g. the Revised Neuroticism, Extraversion, Openness Personality Inventory [NEO PI-R]); (2) practicality – the short version reduces respondent burden, a priority for ICU nurses with limited time for surveys. Longer alternatives, such as the NEO PI-R (240 items), were excluded due to impracticality.
Death-Coping Self-efficacy Questionnaire: this was developed by Bugen et al. in 1980 and applied the constructivist developmental self-efficacy framework to assess the ability to cope with death and their expertise in death preparation. It had been widely used by scholars to assess the ability of caregivers to cope with the death of patients [18]. This study used the Chinese version of the Death-Coping Self-Efficacy Questionnaire modified by Lin et al. [19]. The Bugen scale was adopted instead of general self-efficacy tools (e.g. the General Self-Efficacy Scale) for its domain-specific focus on death-related stressors, aligning with the study’s theoretical basis. Cultural adaptations by Lin et al. [19] were critical to address linguistic nuances (e.g. Chinese death taboos) and ensure measurement validity. The questionnaire included 29 items, divided into three dimensions: end-of-life care (specifically designed for patients with a terminal illness and a life expectancy of ≤ 6 months. It focuses on providing comfort and support to patients and their families, including symptom control, emotional support and spiritual care), grief coping and death preparation. Each item used the Likert 5-point scoring method, with scores ranging from 1 to 5 from ‘definitely not’ to ‘pretty sure’, and the total score ranged from 29 to 145 points. The higher the score is, the stronger the self-efficacy in coping with the patient’s death. Its Cronbach’s α was 0.905, with good reliability and validity [19]. Attitudes toward death were assessed using a single item, including the three options of ‘fear of death’, ‘thinking that talking about death is unlucky’ and ‘accepting death calmly’. The participants selected the attitude category that best matched their participative feelings.
Data collection
All data were collected through electronic questionnaires, which were distributed anonymously by investigators through the Sojump platform. The beginning of the questionnaire detailed the purpose, significance and precautions for answering the questions. The participants were deemed to have agreed to take part in this study by filling out the questionnaire. To further protect participant confidentiality, all responses were anonymised, and no personally identifiable information was collected. The investigators involved in the questionnaire collection were nurses who had received special training from the research team. The training content included the use of the scale, answering guidelines and data confidentiality requirements to ensure the consistency and reliability of data collection. To ensure data quality, the research team checked each submitted questionnaire and excluded those with missing data or inconsistent answers. Double-checking was performed before and after data import to reduce data entry errors.
Statistical analysis
Statistical processing was performed using EpiData3.1 and SPSS 26.0 software. The measurement data conforming to a normal distribution were described as mean ± standard deviation, and enumeration data were expressed as frequency or percentage. The independent sample t-test and one-way analysis of variance were used to compare whether there were differences in the self-efficacy of ICU nurses in coping with death based on different demographic and sociological basic data. The correlation was used to examine the relationship between personality traits and death-coping self-efficacy. Finally, multiple linear regression was adopted to analyse the influencing factors of ICU nurses’ death-coping self-efficacy. A test level of α = 0.05 and a p-value of < 0.05 indicated that the difference was considered statistically significant. Multicollinearity was assessed using variance inflation factors (VIFs), with a threshold of VIF < 5 indicating acceptable collinearity. Residual diagnostics confirmed the validity of regression assumptions.
Results
General information
A total of 350 questionnaires were distributed, and 301 valid questionnaires were collected, with an effective recovery rate of 86.0%. The questionnaires were distributed and collected between August 2022 and September 2022. The reasons for excluding 49 questionnaires were incomplete answers to all items (34 questionnaires) and obvious inconsistencies in the answers to the questionnaires (15 questionnaires). Finally, the participants included in the analysis were 301 ICU nurses, and their general information is detailed in Table 1.
Table 1.
General information of ICU nurses (N = 301)
| Variable | Category | n(%) |
|---|---|---|
| Gender | Male | 47(15.6) |
| Female | 254(84.4) | |
| Marital status | Married | 177(58.8) |
| Single/divorced/widowed | 124(41.2) | |
| Education | Specialist | 54(17.9) |
| Undergraduate | 214(71.1) | |
| Postgraduate | 33(11.0) | |
| Religious beliefs | Have | 12(4.0) |
| None | 289(96.0) | |
| Years of working experience | ≤ 10 years | 202(67.1) |
| > 10 years | 99(32.9) | |
| Attend a palliative care education course within one year | Have | 192 (63.8) |
| None | 109 (36.2) | |
| The experience of accompanying a family member who has passed away | Have | 87 (28.9) |
| None | 214 (71.1) | |
| Attitude towards death | Fear | 68(22.6) |
| Unlucky, unwilling to talk about | 61(20.3) | |
| Accept it calmly | 172(57.1) |
Among the ICU nurses participating in the study, 84.4% (254) were women, with an average age of 31.18 ± 6.78 years. More than half of the nurses had < 10 years of clinical experience (202, accounting for 67.1%). In addition, 71.1% of the nurses had a bachelor’s degree or above, and 96.0% of the nurses had no religious beliefs. Regarding palliative care-related experience, 63.8% of the nurses reported that they had participated in palliative care education courses in the past year, 28.9% had the experience of accompanying family members to death and 57.1% said they could accept death calmly.
Death-coping self-efficacy and big five personality trait scores of intensive care unit nurses
The overall score of ICU nurses’ death-coping self-efficacy was 98.52 ± 18.18, and the item scores of each dimension were hospice care, death preparation and grief coping, from high to low (Table 2). Among the Big Five Personality Traits, ICU nurses had the highest score for conscientiousness and the lowest score for neuroticism (Table 3).
Table 2.
Total score and scores of each dimension of ICU nurses’ self-efficacy in coping with death
| Project | Number of entries | Scores of each dimension | Item score | Sorting |
|---|---|---|---|---|
| Hospice | 12 | 44.70 ± 8.25 | 3.73 ± 0.69 | 1 |
| Preparation for Death | 8 | 25.62 ± 6.01 | 3.20 ± 0.75 | 2 |
| Grief Coping | 9 | 28.21 ± 6.76 | 3.13 ± 0.75 | 3 |
| Total score | 29 | 98.52 ± 18.18 | 3.40 ± 0.63 |
Table 3.
Total scores and scores of each dimension of personality traits of ICU nurses
| Project | Number of entries | Dimension score | Item score | Sorting |
|---|---|---|---|---|
| Rigorousness | 8 | 33.81 ± 5.40 | 4.23 ± 0.68 | 1 |
| Agreeableness | 8 | 32.89 ± 6.07 | 4.11 ± 0.76 | 2 |
| Openness | 8 | 31.92 ± 4.83 | 3.99 ± 0.60 | 3 |
| Extraversion | 8 | 29.80 ± 5.28 | 3.73 ± 0.66 | 4 |
| Neuroticism | 8 | 27.80 ± 6.04 | 3.48 ± 0.76 | 5 |
| Total score | 40 | 156.22 ± 20.78 | 19.53 ± 2.60 |
Factors influencing intensive care unit nurses’ death-coping self-efficacy
The results of the univariate analysis showed that whether ICU nurses participated in palliative care education courses within 1 year, whether they had the experience of accompanying family members to death, their attitude towards death and their years of clinical work had a significant impact on their death-coping self-efficacy (p < 0.05), whereas there was no statistically significant difference in the scores of variables such as gender, marital status, education level or religious beliefs (p > 0.05). See Table 4 for details.
Table 4.
Analysis of influencing factors of ICU nurses’ death coping self-efficacy scores
| Variable | Category | Death coping self-efficacy | F/t | P |
|---|---|---|---|---|
| Gender | Male | 103.02 ± 19.16 | 1.769 | 0.082 |
| Female | 97.69 ± 17.91 | |||
| Marital status | Married | 99.33 ± 17.38 | -0.905 | 0.366 |
| Single/divorced/widowed | 97.37 ± 19.28 | |||
| Education | Specialist | 98.11 ± 22.72 | 0.202 | 0.817 |
| Undergraduate | 98.89 ± 18.05 | |||
| Postgraduate | 96.82 ± 8.35 | |||
| Religious beliefs | Have | 103.83 ± 20.88 | 0.904 | 0.384 |
| None | 98.30 ± 18.06 | |||
| Years of working experience | ≤ 10 years | 96.53 ± 17.28 | -2.646 | 0.009 |
| > 10 years | 102.60 ± 19.33 | |||
| Attend a palliative care education class | Have | 101.81 ± 19.45 | 4.276 | < 0.001 |
| None | 92.74 ± 14.00 | |||
| The experience of accompanying a family member who has passed away | Have | 113.47 ± 21.72 | 10.670 | < 0.001 |
| None | 92.45 ± 12.10 | |||
| Attitude towards death | Fear | 90.63 ± 20.91 | 20.917 | < 0.001 |
| Unlucky, unwilling to talk about | 91.80 ± 12.19 | |||
| Accept it calmly | 104.03 ± 16.88 |
The results of the Pearson correlation analysis showed that agreeableness, conscientiousness, extraversion and openness in personality traits were positively correlated with the total score and each dimension of death-coping self-efficacy, whereas neuroticism was negatively correlated with it. There was no statistically significant correlation between nurses’ age and death-coping self-efficacy (Table 5).
Table 5.
Correlation analysis between death coping self-efficacy and personality traits of ICU nurses
| Project | Five personality | Extraversion | Neuroticism | Rigorousness | Agreeableness | Openness |
|---|---|---|---|---|---|---|
| Hospice | 0.338* | 0.339* | -0.249* | 0.511* | 0.422* | 0.293* |
| Grief Coping | 0.292* | 0.331* | -0.240* | 0.430* | 0.338* | 0.289* |
| Preparation for Death | 0.349* | 0.363* | -0.117* | 0.389* | 0.358* | 0.366* |
| Death coping self-efficacy | 0.377* | 0.398* | -0.240* | 0.520* | 0.436* | 0.361* |
Note: *p<0.05
The statistically significant variables in the univariate analysis (such as participation in palliative care education courses, experience of accompanying family members to death and attitude towards death) and the five dimensions of personality traits were included in the multiple linear regression analysis to explore the main factors affecting death-coping self-efficacy further. The goodness of fit of the multiple linear regression model was high, and the coefficient of determination R2 of the model was 0.373; the adjusted R2 was 0.364, indicating that the included variables could explain 36.4% of the variation in ICU nurses’ death-coping self-efficacy. The model results are shown in Table 6. The results showed that whether or not they had participated in palliative care education courses within 1 year, the experience of accompanying family members to death, attitude towards death and the rigour, agreeableness and openness of personality traits had a significant effect on death-coping self-efficacy (p < 0.05).
Table 6.
Multivariate linear stepwise regression analysis of factors affecting ICU nurses’ death coping self-efficacy
| Variable | Partial regression coefficient | Standard error | Standardized partial regression coefficients | t-value | P-value |
|---|---|---|---|---|---|
| Constant term | 76.378 | 7.994 | 9.555 | < 0.001 | |
| Rigorousness | 0.674 | 0.218 | 0.200 | 3.092 | 0.002 |
| Openness | 0.813 | 0.128 | 0.270 | 6.335 | < 0.001 |
| Agreeableness | 0.649 | 0.225 | 0.130 | 3.993 | < 0.001 |
| Attend a palliative care education class | -3.482 | 1.508 | -0.092 | -2.309 | 0.022 |
| The experience of accompanying a family member who has passed away | -12.738 | 1.712 | -0.318 | -7.438 | < 0.001 |
| Attitude towards death | 4.323 | 0.881 | 0.196 | 4.909 | < 0.001 |
Discussion
Current status of intensive care unit nurses’ death-coping self-efficacy
In this study, the overall score of ICU nurses’ death-coping self-efficacy was 98.52 ± 18.18. The average score of the death-coping self-efficacy items was 3.40 ± 0.63, with an average score of 3 as the middle standard, indicating that the overall score of death-coping self-efficacy was medium. In contrast, a study of intern nurses in Shijiazhuang by Zhao et al. [2] showed that their death-coping self-efficacy scores were significantly lower (77.32 ± 12.50), which may be related to the intern nurses’ lack of experience in dealing with patient death and less training in end-of-life care. This is also consistent with Bandura’s self-efficacy theory, which proposes that self-efficacy increases with experience and expertise [20].
The specific analysis found that the hospice care dimension had the highest score (44.70 ± 8.25), indicating that nurses performed well. They pay more attention to understanding and respecting patients’ needs, attach importance to psychological care and internalise the results of professional training [21]. One of the goals of a nurse’s job is to create a caring treatment environment, which requires nurses to have qualities such as respect, focus and care to meet the needs of patients and their families and to help alleviate their negative emotional reactions [22].
However, in this study, the average score for the grief coping dimension was the lowest at 28.21 ± 6.76, suggesting that ICU nurses have room for improvement in managing emotions and psychological stress related to death. This finding aligns with those of previous studies [23], which indicate that ICU nurses often struggle with coping with death, are susceptible to negative emotional responses and have difficulty maintaining composure in the face of death. In addition, nurses are always expected to help others, while their own grief and loss are often ignored [24]. The nurse’s social support system, including colleagues, team members, leaders and family members, can alleviate the pain of facing death through channels of emotional expression [25]. Nursing managers should pay attention to strengthening training, which can include discussing near-death treatment, talking about death, accepting death, the meaning of life and the funeral process to improve the general ability of ICU nurses to cope with expected death and sudden death, thereby improving the quality and efficiency of nursing management.
Analysis of personality traits of intensive care unit nurses
Personality traits are relatively stable factors that have a significant impact on individual behaviour [26]. According to the Big Five Personality Traits theory, high conscientiousness reflects a higher degree of self-discipline; high agreeableness reflects that the individual is more willing to help and trust others; high openness reflects that the individual has a more active imagination and is willing to think about new ideas [27]. The frequency of neuroticism in the personality traits of ICU nurses was low, whereas the frequency of conscientiousness, agreeableness and openness was high, which was broadly consistent with previous studies [28]. This means that ICU nurses tend to take a more positive, feasible and constructive approach to deal with emergencies; they are also more likely to be willing to help and trust patients, better communicate and empathise with dying patients and help them think about death, thereby reducing anxiety when facing death. They are more likely to explore multiple ways to solve nursing problems, improve the efficiency and quality of nursing work and help improve patients’ medical experience.
This study found that the personality traits of ICU nurses, namely conscientiousness, agreeableness and openness, were significantly positively correlated with death-coping self-efficacy, whereas neuroticism was negatively correlated with it (p < 0.05). Nurses with higher conscientiousness and agreeableness may show a higher sense of responsibility and teamwork ability when facing complex and emotional work situations, which is consistent with the results of previous studies. For example, Farčić et al. [29] found that nurses with high conscientiousness and high agreeableness performed better in clinical decision-making and patient communication. Conscientiousness and agreeableness are associated with a strong sense of responsibility and empathy, which are crucial in the context of death-coping. These traits enable nurses to engage in proactive behaviours, such as seeking additional training and support, which can enhance their self-efficacy in dealing with death. Additionally, their empathetic nature helps in building trust and rapport with patients and their families, facilitating better communication and support during end-of-life care [30].
In contrast, individuals with high neuroticism tend to be emotionally unstable and more inclined to use emotional coping strategies, resulting in lower self-efficacy in death-coping. This result was also supported by Schlyter et al. [31]. The relationship between personality traits and self-efficacy is consistent across studies; conscientiousness is generally positively correlated with problem-solving ability and self-discipline, whereas neuroticism is associated with negative emotions and a reduced ability to cope with difficulties.
Factors influencing intensive care unit nurses’ death-coping self-efficacy
The results showed that whether or not they had participated in palliative care education courses in the past year was one of the factors affecting ICU nurses’ death-coping self-efficacy, which was consistent with the results of previous studies [32, 33]. This finding suggests that palliative care education courses may be an effective strategy to improve ICU nurses’ death-coping self-efficacy [34]. The study found that the more actively nurses participated in hospice education courses, the better they understood the process and stages of death, the better they were able to identify the emotions and needs of dying patients and the more they actively thought about facts related to death. In addition, ICU nurses who had experience accompanying relatives to die had higher death-coping self-efficacy, which was consistent with Ma et al. [35]. The view is consistent, which may be because nurses with hospice care experience are more able to show their care with empathy. The results of this study show that attitudes towards death will also affect ICU nurses’ death-coping self-efficacy, among which those who accept death calmly score the highest, and those who fear death score the lowest. Studies have shown that nurses who accept death calmly have a more positive attitude towards the care of dying patients and are more dedicated to their work [36], whereas fear of death can easily trigger negative emotions in nursing staff [37, 38]; that is, a positive attitude towards death will affect ICU nurses in solving end-of-life care problems to a certain extent.
Comparison between this study and previous studies
Compared with previous studies, this study is the first to systematically analyse the specific relationship between personality traits and death-coping self-efficacy in ICU nurses. Existing studies have mostly focused on general nurses or nursing students, whereas this study focused on ICU nurses who are under greater pressure, indicating that their personality traits may have a more significant impact on self-efficacy [39, 40]. In addition, this study found that whether or not they had participated in palliative care education courses within 1 year, the experience of accompanying family members to death and different attitudes towards death are important factors affecting death-coping self-efficacy. This is consistent with the results of Kim et al. [32], who pointed out that palliative care-related training can significantly improve nurses’ acceptance and self-efficacy of death.
Clinical significance of the study
The results of this study have important practical guiding significance for nursing managers. First, for nurses with high rigour, agreeableness and openness, their death-coping self-efficacy can be further improved by strengthening personalised training and psychological support measures. Second, special attention should be paid to nurses with high neuroticism, and emotional management and psychological adjustment courses should be introduced to help them relieve negative emotions and improve coping strategies. Finally, by optimising palliative care education courses and creating opportunities to share experiences of accompanying relatives to die, nurses’ acceptance and coping ability of death can be improved, thereby improving the mental health level of ICU nurses and improving the quality of hospice care services.
This study has some limitations. First, the research samples were derived from three tertiary-level A hospitals in Beijing, which may be subject to geographical restrictions and sample selection bias. The use of convenience sampling introduces potential selection bias, as the participants may not represent the broader population of nurses. Future studies should expand the sample size and include nurses from more regions to enhance the generalizability of the findings. Second, the study used a cross-sectional design, which can only reflect the correlation between variables and cannot reveal causal relationships. In the future, longitudinal studies can further verify the dynamic relationship between personality traits and death-coping self-efficacy. Additionally, although the scale used in this study has high reliability and validity, it may still be affected by self-report bias inherent in questionnaire-based assessments. Furthermore, while high self-efficacy in coping with death is associated with certain personality traits, it is important to note that having negative feelings toward death is a natural response. Emotional coping can be necessary, and nurses who experience such feelings may be more attuned to the emotions of patients and their families. Therefore, it cannot be concluded that high self-efficacy directly correlates with an improvement in the quality of palliative and end-of-life care. Finally, the relatively low R² value of 37.373% suggests that there are additional factors influencing the outcome that were not captured in our model. This highlights the need for further research to explore other potential variables that may contribute to the understanding of death-coping self-efficacy.
Conclusion
The personality traits of ICU nurses are correlated with their self-efficacy in coping with death. This study found that the personality traits of rigour, agreeableness and openness were positively correlated with the self-efficacy of ICU nurses in coping with death. However, it is important to note that personality alone does not determine nursing ability, as clinical competence also depends on professional training, experience and contextual factors. Managers should pay attention to the differences in personality traits of nurses, understand the self-efficacy characteristics of nurses with different personalities and use this knowledge to carry out targeted professional training. Personality assessments should be integrated with ongoing skill development, rather than treated as standalone predictors of performance, helping ICU nurses deal with emotions in the face of death and adopt better coping methods through clinical education. Ultimately, a holistic approach combining personality awareness, emotional regulation strategies and evidence-based practice is essential for enhancing nurses’ adaptive capacities in critical care environments.
Acknowledgements
Not applicable.
Author contributions
Study design: Zhang WW, Zhong LX, Yang LN, Fu L. Data acquisition: Zhang WW, Zhong LX, Yang LN, Fu L. Data analysis and interpretation: Zhang WW, Zhong LX, Yang LN, Fu L. Manuscript preparation: Zhang WW, Zhong LX, Yang LN, Fu L. Critical revision of the manuscript for intellectual content: Zhang WW. Manuscript review: Zhang WW, Zhong LX, Yang LN, Fu L. Obtaining financing: None.
Funding
Not applicable.
Data availability
Data will be available upon request.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of Beijing Friendship Hospital, and written informed consent was obtained from all participants. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
Data will be available upon request.