# Coping with Death Among Nurses in Ecuador: A Mixed-Methods Study

## TL;DR

Ecuadorian nurses face emotional challenges when coping with death, and communication with dying patients and families is a major professional difficulty.

## Contribution

This mixed-methods study explores Ecuadorian nurses' coping with death, revealing emotional challenges and the role of spirituality in resilience.

## Key findings

- Nurses showed moderate coping levels with death despite frequent clinical exposure.
- Communication with dying patients and families was identified as a major professional challenge.
- Spirituality was found to be a key coping resource for nurses.

## Abstract

What are the main findings?
Ecuadorian nurses showed moderate coping levels with death, despite frequent exposure in clinical settings.Communication with dying patients and families was identified as a major professional challenge.

Ecuadorian nurses showed moderate coping levels with death, despite frequent exposure in clinical settings.

Communication with dying patients and families was identified as a major professional challenge.

What are the implications of the main findings?
Nurses in Ecuador experience significant emotional challenges when coping with death, implying a need for healthcare systems to recognise and address the psychological impact on staff.Providing ongoing education, emotional support, and training in spiritual and psychological care can strengthen nurses’ resilience, suggesting that investment in these areas may improve both nurse wellbeing and patient care quality.

Nurses in Ecuador experience significant emotional challenges when coping with death, implying a need for healthcare systems to recognise and address the psychological impact on staff.

Providing ongoing education, emotional support, and training in spiritual and psychological care can strengthen nurses’ resilience, suggesting that investment in these areas may improve both nurse wellbeing and patient care quality.

Background/Objectives: Coping with death is an essential yet challenging aspect of nursing. In Ecuador, limited training and cultural factors may influence how nurses face the process of death and dying. This study aimed to explore nurses’ perspectives and highlight the degree of congruence between the numerical and discursive data provided by participants. Methods: A sequential explanatory mixed-methods design (QUAN → qual) using questionnaires and qualitative interviews was employed. The quantitative phase included 497 nurses who completed the Bugen Coping with Death Scale and the qualitative phase involved semi-structured interviews with 18 nurses. Quantitative data were analysed descriptively, while qualitative data underwent thematic analysis. Integration occurred at the methodological level—through the building of the qualitative data collection instrument—and at the levels of analysis and interpretation. Results: Nurses demonstrated moderate coping levels on the Bugen Coping with Death Scale. Although many reported being comfortable discussing death, qualitative data revealed substantial emotional distress and limited preparedness—particularly when facing their own mortality or the death of loved ones. Nurses expressed fear of suffering, sadness, and helplessness, especially when caring for dying children or young mothers. Communication with patients and families at the end of life emerged as a major challenge. Spirituality was identified as a key coping resource. Conclusions: Coping with death remains a complex and emotionally demanding process for nurses in Ecuador. Continuous education, emotional support, and training in spiritual and psychological dimensions of care are essential to strengthen nurses’ resilience and enhance the quality of care.