The impact of death attitudes on death anxiety among nursing interns: a multicenter cross-sectional study

Background: This multi-center, cross-sectional study investigated death attitudes and death anxiety among nursing interns in China, explored their internal correlations, and identified independent predictors of high death anxiety to provide an empirical basis for enhancing death education and end-of-life care quality. Methods: A survey was conducted among 400 nursing interns from four medical institutions using an online platform. Validated instruments included the Death Attitude Profile–Revised (DAP-R) and the Chinese Version of the Templer Death Anxiety Scale (CT-DAS). High death anxiety was defined as a CT-DAS score > 35. Multivariate logistic regression was employed to identify factors significantly associated with death anxiety. Results: Of the participants, 27.5% were classified as having high death anxiety. Correlation analysis revealed that natural acceptance was negatively associated with death anxiety (r = -0.252, P < 0.001), while fear of death (r = 0.508), death avoidance (r = 0.274), approach acceptance (r = 0.200), and escape acceptance (r = 0.225) showed significant positive correlations (all P < 0.001). Multivariate analysis identified female gender as a significant risk factor (OR = 4.17, 95% CI: 1.45–12.02, P = 0.008). Fear of death (OR = 1.39, 95% CI: 1.26–1.54, P < 0.001), approach acceptance (OR = 0.90, 95% CI: 0.84–0.96, P = 0.002)and escape acceptance (OR = 1.16, 95% CI: 1.05–1.28, P = 0.003) were associated with death anxiety. Conclusions: Nursing interns in China exhibit a relatively high prevalence of death anxiety, which is closely linked to gender, clinical knowledge, and cognitive orientations toward death. Higher levels of fear of death and escape acceptance are associated with increased death anxiety, whereas approach acceptance appears to be protective. It is imperative to integrate structured, experiential death education into nursing curricula to enhance interns’ psychological resilience and improve the delivery of end-of-life care. Clinical trial number: Not applicable.