Self-competence in death work and psychological empowerment: A methodological study

Self-competence in death work and psychological empowerment: A methodological study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-competence in death work and psychological empowerment: A methodological study Elif Sarac, Esra Yıldız This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8712906/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Improving the death-coping self-competence would provide more confidence for better care to dying patients and assist their family members.This study aimed to test factor structure and construct validity of a Turkish version of Chan’s Self-Competence in Death Work Scale. Methods This methodological study included 56 nurses and 38 physicians.The Self-Competence in Death Work Scale,Psychological Empowerment Scale, and demographic characteristics were used to collect data.Exploratory and confirmatory factor analyses, internal consistency reliability, and Spearman’s correlation analysis were used. Results The findings identified both a single factor and two factors as key components of self-competence in death work:(1)existential and (2)emotional coping. The factor structure explained 43% of the variance.The findings revealed a strong positive correlation between self-competence and psychological empowerment. Conclusions The research addresses the pressing need for research that investigates the self-competence and empowerment in practice among healthcare professionals for better care Self-competence Coping with death Empowerment Nurse Physician Validity INTRODUCTION Healthcare professionals are frequently exposed to dying patients and play key roles in providing end-of-life care [1]. While working, they can struggle with the psychological aspects of providing care of this type, such as by being overwhelmed by emotion, particularly when patient deaths occur [2]. It is thus essential for healthcare professionals to have self-competency to cope with this psychological burden. Such professionals with lower self-competence who are involved in the care of dying patients may exhibit higher levels of anxiety [3]. For the successful care of dying patients, healthcare staff should reduce suffering while also meeting all patient needs, such as physical, social, psychological, cultural, and spiritual needs [4]. However, this can be impeded if healthcare professionals are anxious and overwhelmed Competence has been defined as knowing what to do and doing it with confidence when performing a particular role [5]. For healthcare professionals working with dying patients, competence is manifested by exhibiting the necessary healthcare skills and behaviors and possessing and applying the appropriate medical knowledge. In addition, among healthcare professionals who perform death work, self-efficacy is critical for performing the job effectively, for increasing productivity and being promoted to more senior roles, as well as for having better mental health and becoming psychologically empowered. Many studies have revealed that self-competence in death work is associated with lower stress and improved well-being [6,7]. Psychological empowerment is defined as a motivational concept related to self-efficacy, which includes the ability to perform effective and innovative behaviors [8]. It provides a personal orientation to the work. When we consider doctors and nurses, it is clear that feeling psychologically strong in death-related tasks is related to self-competence. Self-competence has been classified into two main categories: existential coping and emotional coping skills [9,10,11]. Existential coping refers to the ability to cope with life-and-death issues and the dread associated with the end of life, while emotional coping refers to the capacity to endure the emotional turbulence of being in the proximity of death [10,12]. In the literature, there are descriptions of different tools for measuring competence in providing care to dying patients [13-16] however, no such tools have been tested in Turkiye. Against this background, the present study was implemented to test the factor structure and construct validity of the Self-Competence in Death Work Scale and to analyze the association of this construct with psychological empowerment. Background and Conceptual Framework Statements of Significance What is already known about this study *The Self-Competence in Death Work Scale (SC-DWS), developed by Chan et al. (2015) in Hong Kong, is an established tool for assessing the self-competence of healthcare professionals in dealing with end-of-life care and death-related responsibilities[13]. *The original SC-DWS has demonstrated good psychometric properties in its context of development and is used to support professionals’ abilities facing death work. *Self-competence in death work has been identified as a critical aspect for healthcare professionals, particularly in palliative and end-of-life care settings, but relevant measurement tools are culture-specific. *There currently exists no validated scale in Türkiye that specifically measures self-competence in death work among healthcare providers. What this paper adds *This paper presents the first Turkish adaptation and validation of the SC-DWS, filling a significant gap in available assessment tools for Turkish healthcare professionals working with dying patients. *It systematically examines the factor structure and construct validity of the Turkish SC-DWS, providing evidence for its suitability in the Turkish healthcare context. *The study explores the association between self-competence in death work and psychological empowerment, offering new insights into how these constructs are related among Turkish healthcare professionals. *The results contribute to improved educational and support interventions tailored for end-of-life care providers in Türkiye, enhancing their psychological resources and professional competencies. Methods Sampling This study included 94 participants (56 nurses and 38 physicians) working in the cardiology department, emergency department, intensive care unit, oncology department, or chemotherapy unit of a public hospital in Turkey. Any healthcare professionals working in these hospital departments who voluntarily agreed to participate in our research were included, with no specific sampling method being applied. The inclusion criteria were that they needed to be aged 18–59 and perform death work as part of their role as a nurse or physician. Setting This methodological study was conducted between 12/1/2025 and 3/30/2025 to test the construct validity and reliability of the Self-Competence in Death Work Scale (SC-DWS) and to analyze the association of this construct with psychological empowerment. Data Collection The data were collected using a face-to-face questionnaire with questions about the participants’ demographic characteristics, as well as using the Self-Competence in Death Work Scale and Psychological Empowerment Scale. Measures Self-Competence in Death Work Scale (SC-DWS) The Self-Competence in Death Work Scale (SC-DWS) was developed in Hong Kong by Chan et al. (2015). It measures the self-competence for application to healthcare professionals. The scale includes 16 items with both one-factor and two-factor structure. In the two-factor structure, two items 13 and 15 were excluded. Explanatory factors for self-competence in death work are categorized into the subscales: (1) existential coping and (2) emotional coping. Rating is performed on a five-point Likert scale, ranging from 1 (“This does not describe me”) to 5 (“This describes me very well”). No items are reverse-coded. The total test score is calculated as an indicator of overall self-competence. Higher scores reflect greater self-competence. The internal consistency coefficient of the original scale in English was 0.85 for the one-factor solution and 0.88 for the two-factor solution. However, in our study, it was 0.82 for the one-factor solution and 0.81 for the two-factor solution. The value of Cronbach’s a for the Self-Competence in Death Work Scale was 0.92. Spreitzer’s Psychological Empowerment Scale The Psychological Empowerment Scale was first developed by Spreitzer (1995) [17]. It was translated into Turkish and validated in a Turkish context by Uner and Turan (2010) [18]. It involves a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree It has four main components of psychological empowerment; “meaning,” “competence,” “self-determination,” and “impact.” Higher scores represent the perception of being more psychologically empowered. Procedure Two bilingual translators who are experts in nursing, medicine, and methodological research worked to translate the SC-DWS from English into Turkish. This included translation and back-translation processes to prevent any conceptual or terminological misunderstandings. Besides translation, no other modifications were made to the instrument. Items from the scale were assessed via questions arranged in a questionnaire. The estimated time required to complete the questionnaire was 10 min. Data Analyses SPSS version 27® (SPSS Statistics, Armonk, NY; IBM Corp.) was used for statistical analyses. The KMO (Kaiser Mayer Olkin) and Bartlett tests, exploratory and confirmatory factor analyses with promax rotation, Cronbach’s a, and descriptive statistics were employed. The analyses included Spearman’s correlation analysis to clarify the relationships among the instruments. Based on the assertion that a KMO value >0.70 indicates that data are optimal for an exploratory factor analysis (EFA), we conducted EFA [19,20]. The Kolmogorov–Smirnov (KS) test showed that the data were normally distributed (p<0.001). The total scores for the overall scale and its subscales were calculated. Categorical data were described using frequencies and percentages. Results Demographic Characteristics of the Participants A total of 94 healthcare professionals—56 nurses and 38 physicians—were recruited in this study. Their mean (±SD) age was 38.08±7.6. Overall, 52.1% of the participants were female, and 54.2% had experienced bereavement due to the death of a family member or close friend at least once in their lifetime. Further details of the demographic characteristics of the subjects are presented in Table 1. Table 1. Demographic Characteristics of the Participants (N= 120 ) m sd Age [Min-Ma x = 24 - 60 ] 38.08 7.60 n % Sex Female Male 62 58 51.7 48.3 M arital Status Married Single 68 52 56.7 43.3 E ducation Graduate Masters Degree 57 63 47.5 52.5 Profession Nurse Physician 248 8 83.8 16.2 Grief Experience Yes No 65 55 54.2 45.8 Duration of work 0-5 years 6-10 years 11 and above 36 16 68 30.0 13.3 56.7 Psychological Diagnosis Yes No 24 96 20.0 80.0 Total 120 %100 Item Characteristics and Reliability of Self-Competence in Death Work Scale In our study, each item in the SC-DWS had rating responses ranging from 1 to 5. Coefficients in the EFA findings were found to be satisfactory in one- and two-factor solutions as in the original English version of the scale. Items 13 and 15 were removed from the two-factor structure due to them being considered to represent very similar concepts. Overall, healthcare professionals displayed a high level of self-competence, with a mean score of 53.87±7.02. While the mean score for physicians was 55.09±6.88, for nurses it was 52.94±7.04. The scores of items, means, and corrected item/total correlations are presented in Table 2 . Table 2. Items’ Corrected Item-Total Correlation and Cronbach’s Alpha of the Turkish Version of SCDW Scale Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item-Total Correlation Squared Multiple Correlation Cronbach's Alpha if Item Deleted s1 49,72 45,600 ,270 ,397 ,803 s2 49,59 42,966 ,519 ,504 ,786 s3 50,58 36,835 ,590 ,515 ,778 s4 50,34 40,193 ,544 ,516 ,781 s5 49,82 43,546 ,450 ,404 ,791 s6 49,90 41,587 ,580 ,571 ,780 s7 50,00 44,387 ,300 ,292 ,803 s8 50,09 42,992 ,490 ,500 ,788 s9 50,03 42,949 ,482 ,316 ,788 s10 49,97 41,562 ,632 ,504 ,777 s11 49,91 44,521 ,473 ,353 ,791 s12 49,94 47,786 ,100 ,359 ,813 s14 50,28 44,423 ,319 ,378 ,801 s16 50,22 46,020 ,242 ,198 ,805 The total score for existential coping was 38.74±5.25, while the total score for Emotional Coping was 15.13±2.66. The internal consistency was good for the Turkish version of SC-DWS, with a Cronbach’s a of 0.81. Meanwhile, Cronbach’s values were 0.74 and 0.72 for the Existential Coping and Emotional Coping subscales. These findings demonstrate that our version of the scale is reliable and homogeneous. Principal Component Analysis The KMO value of the study was 0.77, and Bartlett’s test of sphericity showed a significant p value (χ 2 = 611.878, P<0.001). Both of these findings indicate that the data were appropriate for the EFA. This principal component analysis with promax rotation demonstrated both one- and two-factor solutions that explained 43% of the total variance, as in the original English version of the scale. Item-factor loadings varied from 0.166 to 0.802. The factors included Factor 1 (Existential Coping, items: 1, 2, 3, 4, 5, 6, 7, 11, 12, 16) and Factor 2 (Emotional Coping, items: 8, 9, 10, 14), as shown in Table 3 . The correlation coefficients between each item and the total score ranged from 0.37 to 0.76. Table 3. F actor loading and components of items Items Component Emotional Coping Existential Coping s8 ,711 s10 ,761 s14 ,600 s9 ,590 s6 ,222 s5 ,166 s11 ,450 s2 ,802 s1 ,626 s3 ,600 s4 ,580 s7 ,550 s16 ,513 s12 ,301 Extraction Method: Principal Component Analysis. Rotation Method: Promax with Kaiser Normalization. Given that our aim in this work was to construct a valid and reliable instrument, we conducted confirmatory factor analysis (CFA). From the results of this, maximum likelihood estimation indicated a good model fit in CFA, with χ²/df = 1.548, RMSEA = 0.065, GFI = 0.903, CFI = 0.928, and TLI = 0.900, confirming the scale’s stability (Table 4) . Table 4. Fit Indices in Confirmatory Factor Analysis (CFA) Recommended Criterion Perceived Disability Scale χ2/sd 0.90 0,903 AGFI >0.90 0,850 CFI >0.90 0,928 TLI>0.90 0,901 RMSEA <0.08 0,065 RMR <0.08 0,063 *GFI: Goodness of fit AGFI = Adjusted Goodness of Fit; CFI=comparative fit index; TLI, Tucker–Lewis Index; RMSEA = root mean square error of approximation; SRMR = standardized root means square residual According to the findings, the item with the highest average score (4.28±0.84) was item 2: “I can fully accept that suffering is inevitable, for example, the suffering of a patient/service user during the dying process.” (Table 5). In the original study, this item ranked second-highest in terms of the score. This shows that our findings are similar to those in the literature. Table 5. Mean (SD) Scores of the Self-Competence in Death Work Scale m±sd 1 I can fully accept that I cannot completely control life, for example, the life and death of patient/service user 4.16±0.85 2 I can fully accept that suffering is inevitable, for example, the suffering of patient/service user during the dying process 4.28±0.84 3 I am prepared for my death and that of my family, for example, being open to discuss death with my family, or think about my funeral. 3.30±1.46 4 I have finished most of my business, which has reduced my life regrets. 3.53±1.14 5 Confronted by uncertainties in life, I take things less for granted and apply this to my life. 4.08±0.86 6 Confronted by uncertainties in life, I live my life more positively and have found my meaning in life. 3.98±0.93 7 I can fully accept that my emotions are aroused during work. 3.88±1.00 8 I can effectively cope with my emotions induced by work 3.78±0.88 9 I have coped with my bereavement experience or experience related to death 3.85±0.89 10 When I feel stressed by work, I can take care of my needs properly. 3.91±0.87 11 I can fully accept the nature of death work, including pity or depressed feelings 3.97±0.69 12 Even though death is inevitable, I admire my contribution to work 3.93±0.76 13 When I feel stressed by work, I can find meaning in work. 3.54±0.81 14 I do not bring work-induced emotions into life and do not bring life-induced emotions into work 3.59±0.95 15 I admit that helping professionals are challenged by life and death like ordinary people, so I can accept my limitations in work. 3.62±0.76 16 I can fully accept that, even though I am a helping professional, I feel helpless about life and death. 3.66±0.82 The Mean Score of SCDW Scale 53.87±7.02 The Mean Score of Existential Coping 38.74±5.25 The Mean Score of Emotional Coping 15.13±2.66 The Mean Score of Psychological Empowerment Scale 6.04±0.67 The Mean Score of Meaning 6.40±0.65 The Mean Score of Competence 6.36±0.71 The Mean Score of Self-determination 6.02±0.91 The Mean Score of Impact 5.37±0.99 *Potential score range of each item of Self-Competence in Death Work Scale is 1-5 *Potential score range of the Self-competence in Death Work Scale is 16-80. *Potential score range of the Emotional Coping is 4-20 *Potential score range of the Existential Coping is 10-50 *Potential score range of the Pyschological Empowerment Scale is 1-7 The Findings of the Psychological Empowerment Scale The Psychological Empowerment Scale featured a four-factor structure. The total score of the 94 healthcare professionals in this instrument was 6.04±0.67. The highest score of a subscale of the Psychological Empowerment Scale was 6.40±0.65 for “Meaning.” Further details regarding the subscale scores are presented in Table 5. The findings showed good internal consistency of the Psychological Empowerment Scale, with Cronbach’s alpha of 0.90 for the nurse sample and 0.94 for the physicians. This study also identified a strong positive correlation between self-competence in death work and psychological empowerment (r = 0.203, p = 0.026). DISCUSSION Working on the frontline of healthcare, nurses and physicians play essential roles in end-of-life care, that is, supporting patients until their death. The present study evaluated the psychometric properties of a Turkish version of the Self-Competence in Death Work Scale. Several analyses have been conducted to validate this instrument, which have revealed its adequate psychometric properties, including good internal consistency and construct validity [21, 22]. A study by Chan et al. (2017) provided evidence of its good internal consistency, with Cronbach’s a of 0.86 for the total scale and 0.81 and 0.77 for the existential and emotional subscales. Meanwhile, another paper clarified that the original English version of SC-DWS is internally consistent, with a value of 0.90 for the whole scale, 0.87 for the existential subscale, and 0.79 for the emotional subscale [10]. Our findings on the Turkish version of SC-DWS are similar to those in the literature with respect to the psychometric properties of the instrument, namely, its reliability and construct validity. The results identified both a single factor and two factors as key components of self-competence in death work: “Existential and Emotional Coping.” Instrument validity and reliability were analyzed by conventional methods [20]. First, linguistic validity was ensured, after which EFA, CFA, and reliability analyses were performed to determine content validity and reliability. In the original study, after conducting EFA, correlation analyses were carried out with different tools to determine construct validity [13]. Building on this previous work, our study was conducted on nurses and physicians to investigate their self-competence in death work, similar to other studies reported in the literature [1,4,10]. This target group was selected because clarifying the self-competence of healthcare workers is essential for both their mental health and the quality of contemporary healthcare [15]. If the self-competence of Turkish nurses and physicians in providing healthcare for dying patients can be accurately and consistently determined, this will aid in the identification of those in need of a boost in their psychological empowerment via appropriate interventions. The factor loading ranged from 0.166 to 0.862 in this study. Factor loading represents the extent to which a specific item contributes to the structure [23]. The lowest loading was associated with item 5: “Confronted by uncertainties in life, I take things less for granted and apply this to my life.” The low level to which item 5 contributed to Existential Coping might have derived from a failure to clearly understand the statement. Meanwhile, the highest factor loading was identified for item 2: “I can fully accept that suffering is inevitable, for example, the suffering of a patient/service user during the dying process.” This item (item 2) also had the highest average score, indicating that this statement described the subject relatively well in our study. In the original, this item ranked second in terms of the Chan et al. (2015). Our findings are thus similar to those reported in the literature for the English version of the scale. The findings of our study determined that the participants’ self-competence scores were generally high, similar to the results of previous studies [10,13]. Those previous studies featured analyses of the correlations of the construct validity of SC-DWS with different tools measuring depression levels, death anxiety, and spiritual well-being, such as “Presence of Meaning,” “Personal Burnout,” and “Death Anxiety.” They identified a significant relationship between SC-DWS score and the presence/intensity of depression. Meanwhile, our study included an analysis of the correlation between SC-DWS and Psychological Empowerment Scale scores. The findings revealed that high self-competence was associated with greater psychological empowerment when performing death work. This finding could be important in efforts to reduce the burnout experienced by doctors and nurses, minimizing dispatch fatigue and improving their performance [24–28]. Limitations When discussing the results of this study, it is important to acknowledge certain limitations of our research. For example, the participants were drawn from the cardiology department, emergency department, intensive care unit, oncology department, and chemotherapy unit of a public hospital in Turkey which could have been a source of bias. In addition, considering that the instrument involves a self-reported questionnaire, nurses and doctors may not have fully reflected their deepest feelings and thoughts in their responses as they might have thought that to do so would cast doubt on their professionalism Conclusion In our study, we validated the Turkish version of the Self-Competence in Death Work Scale and verified its reliability. We also identified the existence of a positive relationship between self-competence and psychological empowerment. We recommend further analyses of this scale on larger samples of Turkish healthcare professionals. Nonetheless, this study shows that competency assessment can help us identify those who are competent in terms of clinical decision-making when performing death work, but who need improvements in knowledge or skills when suffering compassion fatigue or emotional burnout. Further validation studies may also be conducted to explore the reasons for the discrepancies associated with self-competence and mental empowerment among professionals working in palliative care units or morgues. Declarations Ethics Approval and consent to participate This study was permitted by the management of the hospital, and ethics committee approval (29.11.2024-28) from Ataturk University ethical board was also obtained. Informed consent forms were received from the respondents, who were told that participation was voluntary. This study was conducted in accordance with the Declaration of Helsinki and its amendments. Additionally, Chan and Uner granted permission for the use of their instruments in our sample. Consent for publication Not applicable Availability of data and materials The datasets generated during and/or analyzed during the current study are not publicly available due to the confidentiality of the data used, the sensitive nature of the questions asked in the research, and the assurance given to the participants that the raw data would remain confidential and would not be shared but are available from the corresponding author on reasonable request. Competing interest The authors have no potential conflicts of interest to disclosure. Funding No funding source(s) was involved in this study. Acknowledgements We present our thanks to all consulting experts and participants included in the study. Additionally, our gratitude goes to the authors for their contribution in developing the instrument and granted permission to test it in Turkish context. We also thank Tom Buckle from Scribendi (www.scribendi.com) for editing a draft of this manuscript. References Herber OR, Johnston BM. 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Psychological empowerment, work addiction, and burnout among mental health professionals. Curr Psychol, 2023; 42, 25602-25613 https://doi.org/10.1007/s12144-022-03663-1 Gu, L., Wang, L., & Pan, B. Psychological empowerment and job satisfaction in nurses: A systematic review and meta-analysis. Frontiers in public health, 2022; 10, 1022823. https://doi.org/10.3389/fpubh.2022.102282327 Bergeron, D. M. Time heals all wounds? HRM and bereavement in the workplace. Human Resource Management Review, 2023;33(2), 100931. https://doi.org/10.1016/j.hrmr.2022.100931 Wilson, D. M., Punjani, S., Song, Q., & Low, G. A study to understand the impact of bereavement grief on the workplace. OMEGA-Journal of Death and Dying, 2021;83(2),187-197. https://doi.org/10.1177/0030222819846419 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 02 Apr, 2026 Editor invited by journal 05 Mar, 2026 Editor assigned by journal 30 Jan, 2026 Submission checks completed at journal 30 Jan, 2026 First submitted to journal 27 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8712906","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618915834,"identity":"913a0caf-40d0-45bf-8905-bd31ea5da3a3","order_by":0,"name":"Elif Sarac","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIie2PsWrDMBCGTwQ8GbIVGQ1+hUBAtGCcB+liY5Cn7hlMURZ7CeRJsnYWGDyp9SrIEi+ePQoCJXLcQhY76VaIvuU4+D/+OwCL5f/yPAdAHEAEZkEbcYeCPT4orFf4vUqPKIcxlfWLz6bTa4zhqcwbLetwX5SmJQtex5SFTJfeVhqFxMXSVYfkQ8ZGqdgbH1OAAUE5fjdKTqA7JFQYBfFyVPF37eyEvi8tuae7r4TWzbQCijkE8UHBrhIhVTdaFqp1XrYVxk5/mCuTiCrTEk384u/YTOkswHOStp6uwhWt0+bYZcH4Yb84PzO+JKNb8WtWfwlbLBbLY3AG6pxfljn80FQAAAAASUVORK5CYII=","orcid":"","institution":"Ministry of Defense","correspondingAuthor":true,"prefix":"","firstName":"Elif","middleName":"","lastName":"Sarac","suffix":""},{"id":618915836,"identity":"567bcdda-1021-4321-9248-0ad8a74fe05b","order_by":1,"name":"Esra Yıldız","email":"","orcid":"","institution":"Atatürk University","correspondingAuthor":false,"prefix":"","firstName":"Esra","middleName":"","lastName":"Yıldız","suffix":""}],"badges":[],"createdAt":"2026-01-27 16:54:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8712906/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8712906/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108005845,"identity":"a6abc711-f2e3-41bf-9ba5-636a9974e040","added_by":"auto","created_at":"2026-04-28 12:49:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":367604,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8712906/v1/36a89c2b-c218-4c9d-864b-0d2f7e5e84b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-competence in death work and psychological empowerment: A methodological study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHealthcare professionals are frequently exposed to dying patients and play key roles in providing end-of-life care [1]. While working, they can struggle with the psychological aspects of providing care of this type, such as by being overwhelmed by emotion, particularly when patient deaths occur [2]. It is thus essential for healthcare professionals to have self-competency to cope with this psychological burden. Such professionals with lower self-competence who are involved in the care of dying patients may exhibit higher levels of anxiety [3]. For the successful care of dying patients, healthcare staff should reduce suffering while also meeting all patient needs, such as physical, social, psychological, cultural, and spiritual needs [4]. However, this can be impeded if healthcare professionals are anxious and overwhelmed\u003c/p\u003e\n\u003cp\u003eCompetence has been defined as knowing what to do and doing it with confidence when performing a particular role [5]. For healthcare professionals working with dying patients, competence is manifested by exhibiting the necessary healthcare skills and behaviors and possessing and applying the appropriate medical knowledge. In addition, among healthcare professionals who perform death work, self-efficacy is critical for performing the job effectively, for increasing productivity and being promoted to more senior roles, as well as for having better mental health and becoming psychologically empowered. Many studies have revealed that self-competence in death work is associated with lower stress and improved well-being [6,7]. Psychological empowerment is defined as a motivational concept related to self-efficacy, which includes the ability to perform effective and innovative behaviors [8]. It provides a personal orientation to the work. \u0026nbsp;When we consider doctors and nurses, it is clear that feeling psychologically strong in death-related tasks is related to self-competence.\u003c/p\u003e\n\u003cp\u003eSelf-competence has been classified into two main categories: existential coping and emotional coping skills [9,10,11]. Existential coping refers to the ability to cope with life-and-death issues and the dread associated with the end of life, while emotional coping refers to the capacity to endure the emotional turbulence of being in the proximity of death [10,12]. In the literature, there are descriptions of different tools for measuring competence in providing care to dying patients [13-16] however, no such tools have been tested in Turkiye. Against this background, the present study was implemented to test the factor structure and construct validity of the Self-Competence in Death Work Scale and to analyze the association of this construct with psychological empowerment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground and Conceptual Framework\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements of Significance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is already known about this study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e*The Self-Competence in Death Work Scale (SC-DWS), developed by Chan et al. (2015) in Hong Kong, is an established tool for assessing the self-competence of healthcare professionals in dealing with end-of-life care and death-related responsibilities[13].\u003c/p\u003e\n\u003cp\u003e*The original SC-DWS has demonstrated good psychometric properties in its context of development and is used to support professionals\u0026rsquo; abilities facing death work.\u003c/p\u003e\n\u003cp\u003e*Self-competence in death work has been identified as a critical aspect for healthcare professionals, particularly in palliative and end-of-life care settings, but relevant measurement tools are culture-specific.\u003c/p\u003e\n\u003cp\u003e*There currently exists no validated scale in T\u0026uuml;rkiye that specifically measures self-competence in death work among healthcare providers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this paper adds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e*This paper presents the first Turkish adaptation and validation of the SC-DWS, filling a significant gap in available assessment tools for Turkish healthcare professionals working with dying patients.\u003c/p\u003e\n\u003cp\u003e*It systematically examines the factor structure and construct validity of the Turkish SC-DWS, providing evidence for its suitability in the Turkish healthcare context.\u003c/p\u003e\n\u003cp\u003e*The study explores the association between self-competence in death work and psychological empowerment, offering new insights into how these constructs are related among Turkish healthcare professionals.\u003c/p\u003e\n\u003cp\u003e*The results contribute to improved educational and support interventions tailored for end-of-life care providers in T\u0026uuml;rkiye, enhancing their psychological resources and professional competencies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 94 participants (56 nurses and 38 physicians) working in the cardiology department, emergency department, intensive care unit, oncology department, or chemotherapy unit of a public hospital in Turkey. Any healthcare professionals working in these hospital departments who voluntarily agreed to participate in our research were included, with no specific sampling method being applied. The inclusion criteria were that they needed to be aged 18\u0026ndash;59 and perform death work as part of their role as a nurse or physician.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis methodological study was conducted between 12/1/2025 and 3/30/2025 to test the construct validity and reliability of the Self-Competence in Death Work Scale (SC-DWS) and to analyze the association of this construct with psychological empowerment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were collected using a face-to-face questionnaire with questions about the participants\u0026rsquo; demographic characteristics, as well as using the Self-Competence in Death Work Scale and Psychological Empowerment Scale.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Competence in Death Work Scale (SC-DWS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Self-Competence in Death Work Scale (SC-DWS) was developed in Hong Kong by Chan et al. (2015). It measures the self-competence for application to healthcare professionals. The scale includes 16 items with both one-factor and two-factor structure. In the two-factor structure, two items 13 and 15 were excluded. Explanatory factors for self-competence in death work are categorized into the subscales: (1) existential coping and (2) emotional coping. Rating is performed on a five-point Likert scale, ranging from 1 (\u0026ldquo;This does not describe me\u0026rdquo;) to 5 (\u0026ldquo;This describes me very well\u0026rdquo;). No items are reverse-coded. The total test score is calculated as an indicator of overall self-competence. Higher scores reflect greater self-competence. \u003c/p\u003e\n\u003cp\u003eThe internal consistency coefficient of the original scale in English was 0.85 for the one-factor solution and 0.88 for the two-factor solution. However, in our study, it was 0.82 for the one-factor solution and 0.81 for the two-factor solution. The value of Cronbach\u0026rsquo;s a for the Self-Competence in Death Work Scale was 0.92.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpreitzer\u0026rsquo;s Psychological Empowerment Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Psychological Empowerment Scale was first developed by Spreitzer (1995) [17]. It was translated into Turkish and validated in a Turkish context by Uner and Turan (2010) [18]. It involves a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree It has four main components of psychological empowerment; \u0026ldquo;meaning,\u0026rdquo; \u0026ldquo;competence,\u0026rdquo; \u0026ldquo;self-determination,\u0026rdquo; and \u0026ldquo;impact.\u0026rdquo; Higher scores represent the perception of being more psychologically empowered.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eProcedure \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo bilingual translators who are experts in nursing, medicine, and methodological research worked to translate the SC-DWS from English into Turkish. This included translation and back-translation processes to prevent any conceptual or terminological misunderstandings. Besides translation, no other modifications were made to the instrument. Items from the scale were assessed via questions arranged in a questionnaire. The estimated time required to complete the questionnaire was 10 min.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eData Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS version 27\u0026reg; (SPSS Statistics, Armonk, NY; IBM Corp.) was used for statistical analyses. The KMO (Kaiser Mayer Olkin) and Bartlett tests, exploratory and confirmatory factor analyses with promax rotation, Cronbach\u0026rsquo;s a, and descriptive statistics were employed. The analyses included Spearman\u0026rsquo;s correlation analysis to clarify the relationships among the instruments. Based on the assertion that a KMO value \u0026gt;0.70 indicates that data are optimal for an exploratory factor analysis (EFA), we conducted EFA [19,20]. The Kolmogorov\u0026ndash;Smirnov (KS) test showed that the data were normally distributed (p\u0026lt;0.001). The total scores for the overall scale and its subscales were calculated. Categorical data were described using frequencies and percentages.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic Characteristics of the Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 94 healthcare professionals\u0026mdash;56 nurses and 38 physicians\u0026mdash;were recruited in this study. Their mean (\u0026plusmn;SD) age was 38.08\u0026plusmn;7.6. Overall, 52.1% of the participants were female, and 54.2% had experienced bereavement due to the death of a family member or close friend at least once in their lifetime. Further details of the demographic characteristics of the subjects are presented in \u003cstrong\u003eTable 1.\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic Characteristics of the Participants (N=\u003c/strong\u003e\u003cstrong\u003e120\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003em\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esd\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e \u003cem\u003e[Min-Ma\u003c/em\u003e\u003cem\u003ex\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e24\u003c/em\u003e\u003cem\u003e-\u003c/em\u003e\u003cem\u003e60\u003c/em\u003e\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e38.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003cstrong\u003earital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003cstrong\u003education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003cp\u003eMasters Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003cp\u003ePhysician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.8\u003c/p\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrief Experience\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of work\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0-5 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;6-10 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;11 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e120\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eItem Characteristics and Reliability of Self-Competence in Death Work Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, each item in the SC-DWS had rating responses ranging from 1 to 5. Coefficients in the EFA findings were found to be satisfactory in one- and two-factor solutions as in the original English version of the scale. Items 13 and 15 were removed from the two-factor structure due to them being considered to represent very similar concepts. Overall, healthcare professionals displayed a high level of self-competence, with a mean score of 53.87\u0026plusmn;7.02. While the mean score for physicians was 55.09\u0026plusmn;6.88, for nurses it was 52.94\u0026plusmn;7.04. The scores of items, means, and corrected item/total correlations are presented in \u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Items\u0026rsquo; Corrected Item-Total Correlation and Cronbach\u0026rsquo;s Alpha of the Turkish Version of SCDW Scale\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"541\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003eScale Mean if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003eScale Variance if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003eSquared Multiple Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003eCronbach\u0026apos;s Alpha if Item Deleted\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e45,600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,803\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e42,966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e36,835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,778\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e40,193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e43,546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,791\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e41,587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e44,387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,803\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e42,992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,788\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e42,949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,788\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e41,562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e44,521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,791\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e49,94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e47,786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,813\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e44,423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,801\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003es16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e50,22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e46,020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e,805\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe total score for existential coping was 38.74\u0026plusmn;5.25, while the total score for Emotional Coping was 15.13\u0026plusmn;2.66. The internal consistency was good for the Turkish version of SC-DWS, with a Cronbach\u0026rsquo;s a of 0.81. Meanwhile, Cronbach\u0026rsquo;s values were 0.74 and 0.72 for the Existential Coping and Emotional Coping subscales. These findings demonstrate that our version of the scale is reliable and homogeneous. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrincipal Component Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe KMO value of the study was 0.77, and Bartlett\u0026rsquo;s test of sphericity showed a significant p value (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 611.878, P\u0026lt;0.001). Both of these findings indicate that the data were appropriate for the EFA. This principal component analysis with promax rotation demonstrated both one- and two-factor solutions that explained 43% of the total variance, as in the original English version of the scale. Item-factor loadings varied from 0.166 to 0.802. The factors included Factor 1 (Existential Coping, items: 1, 2, 3, 4, 5, 6, 7, 11, 12, 16) and Factor 2 (Emotional Coping, items: 8, 9, 10, 14), as shown in \u003cstrong\u003eTable 3\u003c/strong\u003e. The correlation coefficients between each item and the total score ranged from 0.37 to 0.76.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. F\u003c/strong\u003e\u003cstrong\u003eactor loading and components\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of items\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"373\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 275px;\"\u003e\n \u003cp\u003eComponent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003eEmotional Coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003eExistential Coping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e,711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e,761\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e,600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e,590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,450\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,802\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,580\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003es12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e,301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eExtraction Method: Principal Component Analysis.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRotation Method: Promax with Kaiser Normalization.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGiven that our aim in this work was to construct a valid and reliable instrument, we conducted confirmatory factor analysis (CFA). From the results of this, maximum likelihood estimation indicated a good model fit in CFA, with \u0026chi;\u0026sup2;/df = 1.548, RMSEA = 0.065, GFI = 0.903, CFI = 0.928, and TLI = 0.900, confirming the scale\u0026rsquo;s stability \u003cstrong\u003e(Table 4)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Fit Indices in Confirmatory Factor Analysis (CFA)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"66%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecommended Criterion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Disability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026chi;2/sd \u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1,548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eGFI \u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,903\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eAGFI \u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,850\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eCFI \u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,928\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eTLI\u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,901\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eRMSEA \u0026lt;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eRMR \u0026lt;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0,063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*GFI: Goodness of fit AGFI = Adjusted Goodness of Fit; CFI=comparative fit index;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTLI, Tucker\u0026ndash;Lewis Index; RMSEA = root mean square error of approximation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSRMR = standardized root means square residual\u003c/p\u003e\n\u003cp\u003eAccording to the findings, the item with the highest average score (4.28\u0026plusmn;0.84) was item 2: \u0026ldquo;I can fully accept that suffering is inevitable, for example, the suffering of a patient/service user during the dying process.\u0026rdquo; \u003cstrong\u003e(Table 5).\u003c/strong\u003e In the original study, this item ranked second-highest in terms of the score. This shows that our findings are similar to those in the literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Mean (SD) Scores of the Self-Competence in Death Work Scale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"646\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 646px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; m\u0026plusmn;sd\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI can fully accept that I cannot completely control life, for example, the life and death of patient/service user\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e4.16\u0026plusmn;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI can fully accept that suffering is inevitable, for example, the suffering of patient/service user during the dying process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e4.28\u0026plusmn;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI am prepared for my death and that of my family, for example, being open to discuss death with my family, or think\u003c/p\u003e\n \u003cp\u003eabout my funeral.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.30\u0026plusmn;1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI have finished most of my business, which has reduced my life regrets.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.53\u0026plusmn;1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eConfronted by uncertainties in life, I take things less for granted and apply this to my life.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e4.08\u0026plusmn;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eConfronted by uncertainties in life, I live my life more positively and have found my meaning in life.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.98\u0026plusmn;0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI can fully accept that my emotions are aroused during work.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.88\u0026plusmn;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI can effectively cope with my emotions induced by work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.78\u0026plusmn;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI have coped with my bereavement experience or experience related to death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.85\u0026plusmn;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eWhen I feel stressed by work, I can take care of my needs properly.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.91\u0026plusmn;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI can fully accept the nature of death work, including pity or depressed feelings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.97\u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eEven though death is inevitable, I admire my contribution to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.93\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eWhen I feel stressed by work, I can find meaning in work.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.54\u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI do not bring work-induced emotions into life and do not bring life-induced emotions into work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.59\u0026plusmn;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI admit that helping professionals are challenged by life and death like ordinary people, so I can accept my limitations in work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.62\u0026plusmn;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 552px;\"\u003e\n \u003cp\u003eI can fully accept that, even though I am a helping professional, I feel helpless about life and death.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e3.66\u0026plusmn;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of SCDW Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e53.87\u0026plusmn;7.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Existential Coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e38.74\u0026plusmn;5.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Emotional Coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e15.13\u0026plusmn;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Psychological Empowerment Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e6.04\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Meaning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e6.40\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Competence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e6.36\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Self-determination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e6.02\u0026plusmn;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 552px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Mean Score of Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e5.37\u0026plusmn;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Potential score range of each item of Self-Competence in Death Work Scale is 1-5\u003c/p\u003e\n\u003cp\u003e*Potential score range of the Self-competence in Death Work Scale is 16-80.\u003c/p\u003e\n\u003cp\u003e*Potential score range of the Emotional Coping is 4-20\u003c/p\u003e\n\u003cp\u003e*Potential score range of the Existential Coping is 10-50\u003c/p\u003e\n\u003cp\u003e*Potential score range of the Pyschological Empowerment Scale is 1-7\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Findings of the Psychological Empowerment Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Psychological Empowerment Scale featured a four-factor structure. The total score of the 94 healthcare professionals in this instrument was 6.04\u0026plusmn;0.67. The highest score of a subscale of the Psychological Empowerment Scale was 6.40\u0026plusmn;0.65 for \u0026ldquo;Meaning.\u0026rdquo; Further details regarding the subscale scores are presented in \u003cstrong\u003eTable 5.\u003c/strong\u003e The findings showed good internal consistency of the Psychological Empowerment Scale, with Cronbach\u0026rsquo;s alpha of 0.90 for the nurse sample and 0.94 for the physicians. This study also identified a strong positive correlation between self-competence in death work and psychological empowerment (r = 0.203, p = 0.026).\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWorking on the frontline of healthcare, nurses and physicians play essential roles in end-of-life care, that is, supporting patients until their death. The present study evaluated the psychometric properties of a Turkish version of the Self-Competence in Death Work Scale. Several analyses have been conducted to validate this instrument, which have revealed its adequate psychometric properties, including good internal consistency and construct validity [21, 22]. A study by Chan et al. (2017) provided evidence of its good internal consistency, with Cronbach\u0026rsquo;s a of 0.86 for the total scale and 0.81 and 0.77 for the existential and emotional subscales. Meanwhile, another paper clarified that the original English version of SC-DWS is internally consistent, with a value of 0.90 for the whole scale, 0.87 for the existential subscale, and 0.79 for the emotional subscale [10]. Our findings on the Turkish version of SC-DWS are similar to those in the literature with respect to the psychometric properties of the instrument, namely, its reliability and construct validity.\u003c/p\u003e \u003cp\u003eThe results identified both a single factor and two factors as key components of self-competence in death work: \u0026ldquo;Existential and Emotional Coping.\u0026rdquo; Instrument validity and reliability were analyzed by conventional methods [20]. First, linguistic validity was ensured, after which EFA, CFA, and reliability analyses were performed to determine content validity and reliability. In the original study, after conducting EFA, correlation analyses were carried out with different tools to determine construct validity [13]. Building on this previous work, our study was conducted on nurses and physicians to investigate their self-competence in death work, similar to other studies reported in the literature [1,4,10]. This target group was selected because clarifying the self-competence of healthcare workers is essential for both their mental health and the quality of contemporary healthcare [15]. If the self-competence of Turkish nurses and physicians in providing healthcare for dying patients can be accurately and consistently determined, this will aid in the identification of those in need of a boost in their psychological empowerment via appropriate interventions.\u003c/p\u003e \u003cp\u003eThe factor loading ranged from 0.166 to 0.862 in this study. Factor loading represents the extent to which a specific item contributes to the structure [23]. The lowest loading was associated with item 5: \u0026ldquo;Confronted by uncertainties in life, I take things less for granted and apply this to my life.\u0026rdquo; The low level to which item 5 contributed to Existential Coping might have derived from a failure to clearly understand the statement. Meanwhile, the highest factor loading was identified for item 2: \u0026ldquo;I can fully accept that suffering is inevitable, for example, the suffering of a patient/service user during the dying process.\u0026rdquo; This item (item 2) also had the highest average score, indicating that this statement described the subject relatively well in our study. In the original, this item ranked second in terms of the Chan et al. (2015). Our findings are thus similar to those reported in the literature for the English version of the scale.\u003c/p\u003e \u003cp\u003eThe findings of our study determined that the participants\u0026rsquo; self-competence scores were generally high, similar to the results of previous studies [10,13]. Those previous studies featured analyses of the correlations of the construct validity of SC-DWS with different tools measuring depression levels, death anxiety, and spiritual well-being, such as \u0026ldquo;Presence of Meaning,\u0026rdquo; \u0026ldquo;Personal Burnout,\u0026rdquo; and \u0026ldquo;Death Anxiety.\u0026rdquo; They identified a significant relationship between SC-DWS score and the presence/intensity of depression. Meanwhile, our study included an analysis of the correlation between SC-DWS and Psychological Empowerment Scale scores. The findings revealed that high self-competence was associated with greater psychological empowerment when performing death work. This finding could be important in efforts to reduce the burnout experienced by doctors and nurses, minimizing dispatch fatigue and improving their performance [24\u0026ndash;28].\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWhen discussing the results of this study, it is important to acknowledge certain limitations of our research. For example, the participants were drawn from the cardiology department, emergency department, intensive care unit, oncology department, and chemotherapy unit of a public hospital in Turkey which could have been a source of bias. In addition, considering that the instrument involves a self-reported questionnaire, nurses and doctors may not have fully reflected their deepest feelings and thoughts in their responses as they might have thought that to do so would cast doubt on their professionalism\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn our study, we validated the Turkish version of the Self-Competence in Death Work Scale and verified its reliability. We also identified the existence of a positive relationship between self-competence and psychological empowerment.\u003c/p\u003e \u003cp\u003eWe recommend further analyses of this scale on larger samples of Turkish healthcare professionals. Nonetheless, this study shows that competency assessment can help us identify those who are competent in terms of clinical decision-making when performing death work, but who need improvements in knowledge or skills when suffering compassion fatigue or emotional burnout. Further validation studies may also be conducted to explore the reasons for the discrepancies associated with self-competence and mental empowerment among professionals working in palliative care units or morgues.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was permitted by the management of the hospital, and ethics committee approval (29.11.2024-28) from Ataturk University ethical board was also obtained. Informed consent forms were received from the respondents, who were told that participation was voluntary. This study was conducted in accordance with the Declaration of Helsinki and its amendments. Additionally, Chan and Uner granted permission for the use of their instruments in our sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available due to the confidentiality of the data used, the sensitive nature of the questions asked in the research, and the assurance given to the participants that the raw data would remain confidential and would not be shared but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no potential conflicts of interest to disclosure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding source(s) was involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe present our thanks to all consulting experts and participants included in the study. Additionally, our gratitude goes to the authors for their contribution in developing the instrument and granted permission to test it in Turkish context. We also thank Tom Buckle from Scribendi (www.scribendi.com) for editing a draft of this manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHerber OR, Johnston BM. The role of healthcare support workers in providing palliative and end‐of‐life care in the community: a systematic literature review. Health and Social Care in the Community, 2013; 21(3): 225-235. https://doi.org/10.1111/j.1365-2524.2012.01092.x2.\u003c/li\u003e\n\u003cli\u003eThreapleton DE, Chung RY, Wong SYS, Wong ELY, Kiang N, Chau PYK, Woo J, Chung VCH, Yeoh EK. Care toward the end of life in older populations and its implementation facilitators and barriers: a scoping review. J Am Med Dir Assoc, 2017; 18(12):1000-1009.e4. https://doi.org/10.1016/j.jamda.2017.04.0103.\u003c/li\u003e\n\u003cli\u003ePeters L, Cant R, Payne S, O\u0026apos;Connor M, McDermott F, Hood K, Morphet J, Shimoinaba K. How death anxiety impacts nurses\u0026apos; caring for patients at the end of life: a review of literature. Open Nurs J,2013; 7:14-21. https://doi.org/10.2174/18744346013070100144.\u003c/li\u003e\n\u003cli\u003eCheng, P. Y., \u0026amp; Fang, L. Applying the Concept of Grief Counseling in Caring for an Elderly Dialysis Patient with Bereavement Due to the Death of Spouse: A Nursing Care Experience. Hu Li Za Zhi, 2018; 65(5), 98-104. DOI:10.6224/JN.201810_65(5).12.\u003c/li\u003e\n\u003cli\u003eHirtz U, Tyropoulou E, Cecilie, Traberg CS, Bahrami B. Self-competence increases the willingness to pay for social influence. Scientific Reports, 2020;10(1):17813. https://doi.org/10.1038/s41598-020-74857-5\u003c/li\u003e\n\u003cli\u003eChan, W. C. H., Tin, A. F., \u0026amp; Yu, T. K. Professional quality of life, depression, and meaning in life among helping professionals: The moderating role of self-competence in death work. Death Studies, 2020;46(4), 958-968. https://doi.org/10.1080/07481187.2020.17934317.\u003c/li\u003e\n\u003cli\u003eStaci M. Zavattaro, Clayton Schuneman \u0026amp; Sharon H. Mastracci. \u0026quot;Every day of your life you deal with death:\u0026quot; Incorporating dirty work into the MPA curriculum. Journal of Public Affairs Education, 2024;30:2, pages 194-215. https://doi.org/10.1080/15236803.2024.23358708.\u003c/li\u003e\n\u003cli\u003eLlorente-Alonso, M., Garc\u0026iacute;a-Ael, C. \u0026amp; Topa, G. A meta-analysis of psychological empowerment: Antecedents, organizational outcomes, and moderating variables. Curr Psychol. 2024; 43, 1759-1784 https://doi.org/10.1007/s12144-023-04369-89.\u003c/li\u003e\n\u003cli\u003eHo Chan, W. C. and Tin, A. F. 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American Journal of Applied Mathematics and Statistics, 2021;9(1):4-11. https://doi.org/10.12691/ajams-9-1-224\u003c/li\u003e\n\u003cli\u003eŞenol \u0026Ccedil;elik, S., Sarikose, S., \u0026amp; \u0026Ccedil;elik, Y. Structural and psychological empowerment and burnout among nurses: A systematic review and meta‐analysis. International Nursing Review, 2024;71(1), 189-201. https://doi.org/10.1111/inr.1287825.\u003c/li\u003e\n\u003cli\u003eSun, R., Yang, H.M., Chau, C.T.J. et al. Psychological empowerment, work addiction, and burnout among mental health professionals. Curr Psychol, 2023; 42, 25602-25613 https://doi.org/10.1007/s12144-022-03663-1\u003c/li\u003e\n\u003cli\u003eGu, L., Wang, L., \u0026amp; Pan, B. Psychological empowerment and job satisfaction in nurses: A systematic review and meta-analysis. Frontiers in public health, 2022; 10, 1022823. https://doi.org/10.3389/fpubh.2022.102282327\u003c/li\u003e\n\u003cli\u003eBergeron, D. M. Time heals all wounds? HRM and bereavement in the workplace. Human Resource Management Review, 2023;33(2), 100931. https://doi.org/10.1016/j.hrmr.2022.100931\u003c/li\u003e\n\u003cli\u003eWilson, D. M., Punjani, S., Song, Q., \u0026amp; Low, G. A study to understand the impact of bereavement grief on the workplace. OMEGA-Journal of Death and Dying, 2021;83(2),187-197. https://doi.org/10.1177/0030222819846419\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Self-competence, Coping with death, Empowerment, Nurse, Physician, Validity","lastPublishedDoi":"10.21203/rs.3.rs-8712906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8712906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Improving the death-coping self-competence would provide more confidence for better care to dying patients and assist their family members.This study aimed to test factor structure and construct validity of a Turkish version of Chan\u0026rsquo;s Self-Competence in Death Work Scale.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis methodological study included 56 nurses and 38 physicians.The Self-Competence in Death Work Scale,Psychological Empowerment Scale, and demographic characteristics were used to collect data.Exploratory and confirmatory factor analyses, internal consistency reliability, and Spearman\u0026rsquo;s correlation analysis were used.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings identified both a single factor and two factors as key components of self-competence in death work:(1)existential and (2)emotional coping. The factor structure explained 43% of the variance.The findings revealed a strong positive correlation between self-competence and psychological empowerment.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe research addresses the pressing need for research that investigates the self-competence and empowerment in practice among healthcare professionals for better care\u003c/p\u003e","manuscriptTitle":"Self-competence in death work and psychological empowerment: A methodological study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 16:55:38","doi":"10.21203/rs.3.rs-8712906/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-02T10:36:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-05T08:08:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T10:02:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T09:58:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-01-27T16:35:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f68353f9-2e41-4557-9678-e59e99e98b9f","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T16:55:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 16:55:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8712906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8712906","identity":"rs-8712906","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}