# Construction and implementation of a death education program for nursing interns: an action research study

## TL;DR

This study created and tested a death education program for nursing interns to improve their end-of-life care skills and attitudes.

## Contribution

A tailored death education program for nursing interns was developed and validated using action research.

## Key findings

- Significant improvements were observed in death attitudes, care of the dying, and coping with death after the program.
- The second action research cycle showed greater improvements than the first in most outcomes.
- Qualitative analysis revealed enhanced communication skills and empathy in interns.

## Abstract

Nursing interns frequently encounter patient death but are often inadequately prepared for end-of-life care, leading to distress and reduced efficacy. Existing death education programs rarely address their specific needs.

To develop and evaluate a tailored death education program for nursing interns.

The study was conducted in two phases: development and refinement of a preliminary program through literature review, interviews, Delphi method, and the first action research cycle; followed by evaluation via a second action research cycle with 48 interns (24 per cycle). Quantitative outcomes were assessed using the Death Attitude Profile-Revised (DAP-R), Frommelt Attitude Toward Care of the Dying scale (FATCOD-B), and Coping with Death Scale (CDS) scales, while qualitative data were collected through semi-structured interviews and participatory observation.

After the second cycle, significant improvements (P < 0.05) were observed across all DAP-R dimensions, FATCOD-B total score, and CDS total score. The second cycle yielded significantly greater improvements in most outcomes compared to the first (P < 0.05), except for Escape Acceptance (P = 0.073). Qualitative analysis identified three themes: reflections and recommendations on death education workshops; development of end-of-life communication skills and deepening death awareness and Internalized development of life care and empathy capacity.

The action research-based program effectively improved nursing interns’ death coping, end-of-life care attitudes, and communication skills, supporting the integration of experiential and reflective pedagogies into palliative care education.

The online version contains supplementary material available at 10.1186/s12909-025-08495-8.