Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Adult, Career and Higher Education

Major Professor

Victor Hernandez, Ph.D.

Committee Member

Edward C. Fletcher, Ph.D.

Committee Member

Rosemary Closson, Ph.D.

Committee Member

Yi-Hsin Chen, Ph.D.


Palliative Care, End-of-Life, Attitudes Toward Death, Registered Nurses, Emotional Labor


The purpose of this study was to describe Registered Nurses’ attitudes toward death and their perspectives on education and training related to death and end-of-life patient care. A complementary goal was to determine whether nurses’ attitudes and perspectives are associated with background variables. The three attitudes toward death included anxiety, escape, and neutral attitudes. The background variables of the nurses included formal educational level, age, gender, ethnicity, years of nursing practice, state of residence, and area of nursing practice.

A survey including four sections was used for data collection. The first section of the survey utilized an established 32-item survey based on the Death Attitude Profile Revised survey developed by Wong, Reker, and Gesser in 1994. The questions asked how nurses felt about the topic of death. The second section of the survey was about the extent of palliative care education and training, while the third section was concerned with the demographics of the respondents. Part four of the survey included two open-ended questions regarding attitudes toward death and how prepared respondents felt in meeting their patients’ end-of-life needs.

The survey was sent to state nurses’ associations across the United States in 2015. Survey Monkey was the link for the survey and it was opened for a three-week period. The original responses totaled 248 participants. Responses with any missing values were excluded. The final dataset included 167 total responses. Data was analyzed using descriptive statistics and regression analysis to determine the association between the variables of interest.

The results of the study were most significant in relation to anxiety toward death. Nurses who were more experienced on the job, female, and with more formal education had lower anxiety levels, as did nurses with a higher confidence level in dealing with death. For the neutral attitudes, the best predictor was the rating of the nurses’ end-of-life preparation. The best predictor of the escape attitude was years of nursing experience. The results supported the need for college level end-of-life education and the significance role of nursing experience in relation to less anxiety towards death. The surprising result was that post-college end-of-life education actually increased the anxiety attitude toward death. More research is needed to ascertain if these results could be replicated. There is a need to determine what type of post-collegiate education would decrease death anxiety in nurses.