Latent class analysis of death coping ability among palliative care nurses and its association with their emotional labor

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This study aimed to identify subgroups of death coping ability among Chinese palliative care nurses based on their assessments using the Death Coping Ability Scale, and to analyze the relationship between these subgroups and their emotional labor. Method: Convenient sampling was employed to survey 868 palliative care nurses from medical institutions in Beijing, Jiangsu Province, Anhui Province, and Hunan Province. Data was collected using a general information questionnaire, the Chinese version of the Death Coping Ability Scale, and the Emotional Labor Scale. Latent profile analysis was conducted to categorize the nurses' death coping abilities, and differences in emotional labor among these categories were compared. Results: The death coping ability of palliative care nurses was categorized into three groups: "low death coping ability group" (11.5%), "medium death coping ability group" (52.0%), and "high death coping ability group" (36.5%). Factors influencing these categories included specialization in palliative care, opportunities for interaction with the bereaved, participation in grief counseling training, and personal bereavement experiences, all statistically significant ( p < 0.05 ). Notably, there were significant differences in emotional labor scores among the three groups ( F=33.006, p < 0.001 ). Conclusions: The death coping ability of palliative care nurses can be classified into three distinct categories, each associated with different levels of emotional labor. Nursing managers should recognize these differences and implement targeted, personalized interventions to enhance the death coping abilities of palliative care nurses. palliative care nurse death coping ability emotional labor latent category analysis Figures Figure 1 Introduction With the increasing prevalence of an aging population and a rising annual mortality rate, palliative care has emerged as a critical modality for enhancing the quality of life for patients in end-stage conditions [ 1 ]. Palliative care provides comprehensive physical, psychological, spiritual and social care for dying patients with life-limiting illness [ 2 ]. This holistic approach not only helps patients with life-limiting illness ends with death comfortably, peacefully, and with dignity but also improves the quality of life, reduces medical costs, and optimizes the utilization of medical resources [ 3 ]. As the main practitioners of palliative care, nurses play a vital role in supporting communication among doctors, patients and families [ 4 ]. They serve as coordinators within multidisciplinary care teams, and their comprehensive caregiving capacities significantly influence the quality of palliative services. The concept of 'death coping ability' refers to the capacity and skills to manage one's own or another's death, incorporating relevant attitudes and beliefs [ 5 ]. It involves strategies employed by individuals to mitigate stress when confronted with death [ 6 ]. This comprehensive ability to handle death events is an indispensable professional skill for palliative care nurses and an important indicator of their overall competency [ 7 ]. Due to the nature of their work, palliative nurses inevitably face death events, which can pose significant challenges, especially for those with limited experience and preparation [ 8 ]. Previous studies have indicated that in palliative care practice, nurses may experience a range of emotions including calm acceptance, overwhelming emotional dietress such as fear of death, and sadness, which can lead to depression following the death of patients [ 9 ]. When regulating emotions, palliative care nurses expend considerable emotional labor, managing their emotional expressions and interactions with patients [ 10 ]. Emotional labor involves adjusting and expressing emotions according to professional role requirements, empathizing genuinely with patients, and addressing negative emotions with a rational and professional attitude [ 11 ]. The strategies of emotional labor mainly include surface acting, deep acting and the expression of natural emotions. Surface acting involves passively repressing one's true emotions to display expressions that conform to norms, without altering the inner emotions. Deep acting, on the other hand, involves actively regulating and transforming one's internal emotional experience to align both internal and external emotions with the norms. Natural emotional expression refers to employees expressing their genuine emotions at work, unaffected by the organization's emotional rules. The process of emotional labor goes beyond merely regulating emotions; it also involves understanding and conceptualizing death[ 12 ]. Nurses with varying levels of death coping ability may exhibit different outcomes in managing death events, potentially leading to differences in their levels of emotional labor. However, current research primarily focuses on one of these aspects, with minimal information on the relationship between death coping ability and emotional labor. To address this gap, we conducted this cross-sectional survey. Several factors correlate with a high ability to cope with death among palliative care nurses, including age, educational background, attitudes towards death, palliative experience, and personal bereavement experiences [ 13 – 14 ]. Research underscores a significant association between palliative experience and the ability to manage death effectively [ 15 ]. Nurses with extensive palliative care experience generally exhibit a more robust ability to cope with death, likely due to their enhanced understanding of death and familiarity with effective coping strategies, enabling them to accept and manage death events more calmly [ 16 ]. Additionally, research has indicated that attitudes towards death are predictors of death coping ability; a negative attitude may affect the level of death coping ability [ 17 – 18 ]. Conversely, nurses with limited palliative experience or those new to the field often demonstrate a reduced ability to cope with death. This may be attributed to traditional Chinese cultural perspectives that view death as a taboo, fostering negative emotional responses such as avoidance and fear. This cultural influence can lead to inadequate preparation for handling palliative -related matters, including death, thereby hampering nurses’ emotional regulation. Previous studies have found that death coping ability is positively correlated with care performance and tends to increase with age and accumulated palliative care experience [ 15 ]. Such experiences enrich nurses' perceptions and reflections on life, which in turn enhances their emotional regulation and ability to cope with death events effectively [ 19 ]. Prior studies on the ability to cope with death primarily assessed the level of research tools available, failing to classify and refine the group characteristics related to the death coping ability of palliative care nurses. To address this gap, this study employed latent class analysis (LCA) to identify different potential categories of death coping ability among palliative nurses and to explore the correlation between these categories and emotional labor. This approach is potentially beneficial for nursing managers to better understand the emotional labor process that palliative nurses undergo when coping with death events. LCA is a person-centered statistical method designed to reveal hidden clusters within data by considering correlations between variables [ 20 ]. It categorizes individuals marked by multiple variables into mutually exclusive groups, ensuring minimal variation of observed variables within each category while maximizing the differences between categories. Currently, LCA is widely utilized to explore the heterogeneity within nurse groups. In this study, LCA was used to delineate the characteristics of different categories of palliative nurses' death coping abilities and to investigate their relationship with emotional labor. This analysis can inform the development of targeted educational and training strategies, ultimately enhancing the quality of palliative care services. Methods Design, Participants, and Setting This multicenter, cross-sectional study was conducted through an online survey from July to October 2023, in collaboration with the Jiangsu Nursing Association. It targeted palliative care nurses across medical facilities in four provinces in China. Convenience sampling was employed to recruit participants. The inclusion criteria were: (1) possession of a valid nursing license and current registration as a nurse; (2) a minimum of six months of experience in a palliative care ward or oncology department; and (3) provision of informed consent and voluntary agreement to participate in the research. Exclusion criteria included: (1) nurses who were currently receiving standardized training or were engaged in routine practice; (2) nurses who were unable to participate due to external study, advanced training, or vacation leave. The survey was conducted using an electronic questionnaire developed with Questionnaire Star and distributed online. The objective and importance of the survey were clearly articulated in the title of the questionnaire to ensure the respondents were well-informed. To ensure reliability and accuracy of the responses, several measures were implemented: (1) completion of all questions was compulsory to prevent omissions; (2) each respondent was restricted to one questionnaire submission to prevent multiple entries; (3) two researchers rigorously screened the responses to exclude any questionnaires that contained logical errors, patterned answers, incomplete fields, or were completed in less than five minutes. Out of 930 palliative nurses initially invited, 868 provided valid responses after data cleansing, yielding an effective response rate of 93.3%. Instruments The online questionnaire is composed of three sections: basic demographic and professional data, the Chinese version of the Death Coping Ability Scale, and Emotional Labor Scale. The Chinese Version of the Death Coping Ability Scale The Death Coping Ability Scale, developed by American scholar Bugen in 1980, is the first instrument designed to assess an individual's capacity to cope with death [ 21 – 22 ]. The Chinese version of the death coping ability scale was introduced and translated by Tseng Huantang [ 23 ]. The scale consists of 30 items across eight dimensions: self-acceptance of death, ability to cope with death, ability to perceive and express oneself about death, ability to deal with the aftermath of death, ability to perceive life, ability to manage loss, ability to discuss other’s death and ability to discuss one’s own death. It employs a Likert 7-point scoring system, where scores range from 1 (least ability) to 7 (greatest ability), with a total possible score ranging from 30 to 210. Scores below 105 indicate inadequate coping abilities, while scores above 157 denote strong coping capacities. The Cronbach's alpha coefficient of the scale is 0.92. Emotional Labor Scale This scale was developed by scholar Grandey in 2003 and later adapted into a Chinese version by Luo Hong [ 24 – 25 ]. The scale includes three dimensions: surface acting (7 items), deep acting (3 items), and emotion display (4 items). It uses a Likert 6-point scoring method, with scores ranging from 1 to 6, and a total score ranging from 14 to 84. A higher score indicates a higher level of emotional labor. The Cronbach's alpha coefficients for the scale’s dimensions range from 0.71 to 0.87. Emotional labor levels are categorized based on the average score per item: low level (≤ 1), slightly below average (> 1 to ≤ 2), average (> 2 to ≤ 4), slightly above average (> 4 to ≤ 5), and high level (> 5). Ethical Considerations This study received ethical approval from the First Affiliated Hospital of Nanjing Medical University (approval number: 2022-SR-732). All participants provided their informed consent electronically prior to participating. The consent form was displayed on the first page of the survey, with options "Yes" and "No." Only those who selected "Yes" proceeded to the questionnaire. Participants were also free to withdraw from the study at any point. Data analysis Latent class analysis was conducted using Mplus 7.0. The primary model fit indices include the Log likelihood (LL) test, and informational criteria such as the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), sample-size adjusted BIC (aBIC), and the Entropy index. The likelihood ratio tests, Lo-Mendell-Rubin (LMR) and the Bootstrap Likelihood Ratio Test (BLRT), were also utilized. Lower values of LL, AIC, BIC, and aBIC indicate a better model fit, while an Entropy index close to 1.0 suggests better predictiveness. An Entropy index approximately equal to 0.8 indicates that the accuracy of classification exceeds 90%. If the p-values for the LMR and BLRT are significant, it indicates that a model with k classes is significantly better than a model with k-1 classes. Data analysis was performed using SPSS 26.0, employing the chi-square test for between-group comparisons and multinomial logistic regression for multifactorial analysis, with a significance level of α = 0.05. Results Latent Class Analysis Results of Palliative Care Nurses' Death Coping Ability Table 1 shows the model fit indices of the latent profile analysis of palliative care nurses' death coping ability potential categories. As the number of categories increased, the Log Likelihood (LL), Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and adjusted BIC (aBIC) gradually decreased, with a notable reduction in the rate of decline after three categories. The Entropy index, indicative of classification accuracy, remained above 0.80 for 2–4 categories, peaking at three categories. The Lo-Mendell-Rubin (LMR) test suggested that three categories were preferable to two, with no significant improvement when expanding to four categories. Categories with probabilities below 8% in models with four and five categories were deemed non-representative. Thus, three categories were selected. Based on the scores in eight dimensions—acceptance of death, handling of dying, expression of death-related thoughts, funeral handling, life conservation, coping with loss, discussing others' deaths, and discussing one's own death—Category 1 was labeled "Low Death Coping Ability Group" (11.5%), Category 2 as "Medium Death Coping Ability Group" (52.0%), and Category 3 as "High Death Coping Ability Group" (36.5%). Conditional probability graphs for each category across these dimensions are presented in Fig. 1 . Table 1 The fitting indexes of each model of potential categories of palliative care nurses' death coping ability Category LL AIC BIC aBIC Entropy LMR(p) BLRT(p) Classified probability 1 -11751.773 23535.547 23611.806 23560.994 2 -10321.417 20692.834 20811.989 20732.595 0.872 < 0.001 < 0.001 0.493/0.507 3 -9733.945 19535.890 19697.941 19589.965 0.920 0.010 < 0.001 0.115/0.520/0.365 4 -9430.022 18946.044 19150.991 19014.433 0.899 0.317 < 0.001 0.073/0.412/0.391/0.124 5 -9250.594 18605.188 18853.030 18687.891 0.885 0.020 < 0.001 0.055/0.248/0.325/0.260/0.112 Note: LL (Log likelihood),AIC (Akaike Information Criterion);BIC (Bayesian information criterion)༛LMR (Lo-Mendell-Rubin); BLRT (bootstrapped likelihood ratio test) General Information Distribution among Palliative Care Nurses' Death Coping Ability Categories An analysis of single-factor variables, including years of palliative experience, professional title, specialization in palliative care nursing, palliative care training course attendance, opportunities to interact with the bereaved, participation in grief counseling training courses, and personal bereavement experiences, revealed significant statistical differences (p < 0.05). Detailed data can be found in Table 2 . Table 2 The characteristics of potential categories of coping ability to death Characteristic C1 C2 C3 χ 2 /F P Gender, No. (%) 1.370 0.504 Male 1 (1.0) 0 (0.2) 2 (0.6) Female 101 (99.0) 450 (99.8) 313 (99.4) Marital status, No. (%) 3.926 0.140 Single or divorced 29 (28.4) 135 (29.9) 74 (23.5) Married 73 (71.6) 316 (70.1) 241 (76.5) Hospital classification, No. (%) 5.607 0.231 Tertiary hospital 65 (63.7) 305 (67.6) 227 (72.1) Secondary hospital 23 (22.5) 75 (16.6) 53 (16.8) Other 14 (13.7) 71 (15.7) 35 (11.1) Years of clinical experience, median (IQR), years 9 (6, 13) 10 (5.75, 15) 11 (6, 17) 4.867 0.088 Years of hospice experience median (IQR), years 4 (2, 6) 3 (1, 5) 3 (2, 5) 2.121 0.038 Education level, No. (%) 4.313 0.116 College and below 20 (19.6) 86 (19.1) 43 (13.7) Bachelor degree or above 82 (80.4) 365 (80.9) 272 (86.3) Professional title, No. (%) 10.344 0.035 Junior RN 56 (54.9) 245 (54.3) 153 (48.6) Middle RN 42 (41.2) 158 (35.0) 116 (36.8) Senior RN 4 (3.9) 48 (10.6) 46 (14.6) Professional position, No. (%) 1.937 0.380 Staff nurse 86 (84.3) 371 (82.3) 249 (79.0) Charge Nurse or Nurse manager 16 (15.7) 80 (17.7) 66 (21.0) Palliative Care Nursing Specialist, No. (%) 5.982 0.050 Yes 3 (2.9) 58 (12.9) 26 (8.3) No 99 (97.1) 393 (87.1) 289 (91.7) Palliative Care Training Course Attendance, No. (%) 3.863 0.145 Yes 52 (51.0) 254 (56.3) 193 (61.3) No 50 (49.0) 197 (43.7) 122 (38.7) Opportunities to interact with the bereaved (per month), No. (%) 162 < 0.001 ≥ 10 times 13 (12.7) 137 (30.4) 141 (44.8) 5–10 times 16 (15.7) 62 (13.7) 56 (17.8) <5 times 73 (71.6) 252 (55.9) 118 (37.5) Participate in grief counseling training course, No. (%) 24.154 < 0.001 Yes 20 (19.6) 166 (36.8) 146 (46.3) No 82 (80.4) 285 (63.2) 169 (53.7) Personal Bereavement Experience, No. (%) 22.008 < 0.001 Yes 33 (32.4) 195 (43.2) 177 (56.2) No 69 (67.6) 256 (56.8) 138 (43.8) Multivariate Logistic Regression Analysis of Influencing Factors on Death Coping Ability The multivariate logistic regression analysis utilized a stepwise variable selection method to examine the factors influencing palliative care nurses' death coping ability. Independent variables selected from significant results in single-factor analyses included nursing experience, professional title, tenure in palliative care, specialization in palliative care nursing, interaction with bereaved individuals, participation in grief counseling training, and personal bereavement experiences. The model employed criteria of α ≤ 0.05 for inclusion and α ≥ 0.10 for exclusion. The analysis found that specialization in palliative care nursing, frequency of interactions with bereaved individuals, participation in grief counseling programs, and personal bereavement experiences significantly influenced the nurses' death coping strategies (p < 0.05). For detailed information on the influencing factors and their statistical significance, refer to Table 3 . Table 3 Multivariable logistic regression analysis of potential factors affecting death coping ability (n = 868) Model Variable B SE Wald df P OR 95%CI Lower Upper Moderate Death Coping Ability Group Intercept 1.026 0.315 10.617 1 0.001 Palliative Care Specialist Nurse 1.221 0.616 3.935 1 0.047 3.391 1.015 11.331 Non-Palliative Care Specialist Nurse Has Attended Grief Counseling Training 0.555 0.279 3.96 1 0.047 1.742 1.008 3.008 Has Not Attended Grief Counseling Training Frequent Contact with the Bereaved 0.805 0.412 3.822 1 0.051 2.236 0.998 5.012 Less Contact with the Bereaved -0.054 0.321 0.028 1 0.866 0.947 0.505 1.779 Average Contact with the Bereaved Has Bereavement Experience 0.252 0.246 1.047 1 0.306 1.286 0.794 2.083 No Bereavement Experience High Death Coping Ability Group Intercept 0.683 0.325 4.414 1 0.036 Palliative Care Specialist Nurse 0.407 0.641 0.403 1 0.525 1.503 0.428 5.281 Non-Palliative Care Specialist Nurse Has Attended Grief Counseling Training 0.962 0.288 11.139 1 0.001 2.616 1.487 4.602 Has Not Attended Grief Counseling Training Frequent Contact with the Bereaved 0.842 0.415 4.117 1 0.042 2.321 1.029 5.235 Less Contact with the Bereaved -0.665 0.333 3.982 1 0.046 0.514 0.267 0.988 Average Contact with the Bereaved Has Bereavement Experience 0.594 0.257 5.324 1 0.021 1.811 1.094 2.999 No Bereavement Experience Note: The group with low death coping ability was used as the reference group. Comparison of Emotional Labor among Different Death Coping Ability Categories There were statistically significant differences in surface acting, emotional display, and deep acting among different categories of death coping ability potential categories (p < 0.001). Multiple comparisons revealed that the scores for total emotional labor and its three dimensions were higher in the High Death Coping Ability Group than in the Medium Death Coping Ability Group. See Table 4 . Table 4 Testing Differences in Emotional Labor by Potential Categories of Death Coping Ability (n = 868) Group N Surface Acting Emotion Display Deep Acting Total Score Low death coping ability group 102 3.11 ± 1.10 3.09 ± 1.21 4.01 ± 1.42 3.30 ± 1.04 Moderate death coping ability group 451 3.50 ± 0.85 3.52 ± 0.99 4.48 ± 0.84 3.71 ± 0.67 High death coping ability group 315 3.78 ± 1.40 3.85 ± 1.45 5.06 ± 0.88 4.08 ± 1.11 F 15.655 16.950 60.391 33.006 P < 0.001 < 0.001 < 0.001 < 0.001 LSD Low < Moderate < High Low < Moderate < High Low < Moderate < High Low < Moderate < High Discussion This study identified three latent categories of death coping abilities among palliative care nurses through latent class analysis, revealing significant intergroup heterogeneity. Over half of the nurses fall into the medium death coping ability group, aligning with findings by Wang et al[ 26 ], which suggests that most most palliative care nurses have a medium to high level of death coping abilities. The latent profile analysis reveals that nurses in the Low Death Coping Group score lower across all eight dimensions of death coping ability, with particularly low scores in death acceptance and discussing death. However, they score relatively higher in expressing thoughts about death, indicating that patient death events stimulate their contemplation on life and death. Nonetheless, their understanding and cognitive approach to death make it challenging for them to handle patient death events effectively. To address this, thematic seminars focusing on death cognition and grief could be organized, enhancing nurses' existential understanding and thereby facilitating more empathetic care [ 27 ]. In addition, developing educational initiatives like palliative care training modules could strengthen nurses' capabilities in managing terminal illnesses [ 28 ]. In the Medium Death Coping Ability Group, lower scores in death acceptance, funeral handling, and discussing death indicate a tendency to avoid these topics. Targeted interventions for this group could include hosting death experience workshops with experiential learning and role-playing to acclimate nurses to death coping strategies[ 29 ] and organizing screenings of educational documentaries on death followed by guided discussions to foster a structured approach to understanding and managing death [ 30 ]. The High Death Coping Ability Group shows proficiency across all dimensions of death coping ability but scores particularly lower in accepting death. This may reflect a traditional medical focus on life preservation, which complicates emotional response to patient mortality. To support these nurses, a hybrid approach of theoretical instruction and practical experience in palliative care education could bridge the gap between understanding and accepting death [ 31 ]. Furthermore, enhancing the range and accessibility of educational resources through innovative methods such as Massive Open Online Courses (MOOCs) and mobile learning platforms could ensure comprehensive knowledge dissemination and skill development [ 32 ]. Factors Influencing Death Coping Ability Nurses specialized in palliative care demonstrated a higher capability to cope with death (OR = 1.503), consistent with related research [ 33 ]. One plausible explanation is that in China, palliative care specialists are subjected to comprehensive, structured training programs and must clear a stringent certification procedure to earn their qualifications. These programs not only broaden knowledge but also develop cognitive frameworks and problem-solving skills, enabling these specialists to adeptly handle death-related scenarios. In contrast to their general nursing counterparts, palliative care specialists demonstrate superior learning abilities and insights, possessing a profound comprehension of their field and the capacity to swiftly and effectively translate theoretical knowledge into practical applications in clinical settings. In this study, palliative care nurses who had more frequent interactions with the bereaved exhibited higher levels of death coping capabilities (OR = 2.321), which aligns with the findings of related research [ 34 ]. This may be attributed to the fact that frequent encounters with the bereaved help these nurses to accept and recognize death as an integral part of life's completeness, enabling them to address death-related events with a proactive and positive attitude. Further research has indicated that regular engagement with the bereaved and involvement in the care of terminally ill patients enhances capabilities in aspects such as articulating thoughts on death and reflecting on life, which are critical components of death coping skills [ 35 ]. The extensive experience accumulated through practical exposure also fosters a substantial sense of self-efficacy, supporting their ability to manage death-related situations effectively. Grief counseling equips nurses with strategies to handle their emotions effectively, such as understanding and managing sorrow, anger, guilt, and helplessness which commonly arise following patient deaths. This emotional management is crucial for maintaining professionalism and providing high-quality care. Furthermore, it's noted that engaging in physical activities, mindfulness, and hobbies are part of effective self-care strategies that help nurses cope with the emotional toll of their duties [ 36 ]. Additionally, nurses with personal bereavement experiences also showed higher levels of death coping abilities (OR = 1.811), aligning with findings from related research [ 37 ]. This may be because nurses who have experienced the loss of a loved one understand the process of death events more profoundly. They possess a deeper comprehension of the meaning of life and death, are better able to empathize with grieving families, and can adopt coping strategies to handle death-related situations calmly and competently. Emotional Labor Among Palliative Care Nurses Based on Their Death Coping Abilities Emotional labor involves three types of labor strategies: surface acting, emotional display, and deep acting, representing a form of non-material labor [ 38 ]. This study explores the variations in total scores and individual dimensions of emotional labor among palliative care nurses, categorized by their different latent death coping abilities. The results indicate that there are differences in emotional labor scors across various categories of death coping abilities among palliative care nurses. especially, stronger death coping abilities correlate with higher levels of emotional labor. This suggests that nurses who are better equipped to handle death are also more engaged in emotional labor, potentially indicating a more profound engagement with their roles, which involves managing personal emotions to fulfill the job requirements effectively. In this study, Group C3 showed an overall emotional labor score of 4.08 (SD = 1.11). Within this group, the scores for surface acting were 3.78 (SD = 1.40), deep acting scored the highest at 5.06 (SD = 0.88), and emotional display were 3.85 (SD = 1.45). Across all dimensions and the total score, Group C3 consistently outperformed Groups C2 and C1. The highest scores in the deep acting dimension indicate that palliative care nurses with strong death coping abilities tend to utilize deep acting strategies to regulate their emotions, adopting a proactive attitude when interacting with patients. In palliative care, nurses engaging with terminally ill patients need to invest significant emotional effort to recognize the psychological and emotional needs of their patients, inevitably leading to emotional labor [ 39 ]. Deep acting in emotional labor enables nurses to self-regulate their inner emotional state, thus improving their ability to recognize and understand the emotional needs of terminally ill patients. This facilitates deeper communication and interaction, playing a positive role [ 40 ]. Palliative care nurses with strong death coping abilities exhibit a more mature emotional mindset when dealing with terminally ill patients, enabling them to more effectively and rapidly leverage the positive effects of deep acting. They can regulate their emotional expressions in response to death both behaviorally and cognitively [ 41 ]. Therefore, nursing managers could focus on this aspect by conducting advanced communications skills alongside enhancing death coping abilities in palliative care nurses. This would encourage the development of effective emotional labor strategies and maximize the benefits of deep acting. In this study, the scores for surface acting in Groups C1 to C3 were 3.11 (SD = 1.10), 3.50 (SD = 0.85), and 3.50 (SD = 0.85) respectively. All three groups of palliative care nurses exhibited a moderate level of surface acting. Especially, Group C1, apart from deep acting, showed a preference for surface acting strategies. This tendency may be attributed to the fact that nurses in Group C1 are generally less experienced, with limited life experience and less exposure to life-and-death situations, making them less capable of regulating emotions effectively at work. Surface acting is an emotional labor strategy, characterized by a disconnect between external emotional expressions and genuine internal feelings. This approach may lead to the suppression of negative emotions, potentially causing emotional dissonance, which can then evolve into job burnout and compassion fatigue, thus harming an individual's mental and physical health [ 38 ]. Nursing managers should pay attention to the emotional labor experiences of palliative care nurses, especially those with less experience. There is a need to support nurses well-being by good support if they are to become effective in emotional labour. Efforts should focus on enhancing their emotional regulation capabilities through humanistic management and education, flexible scheduling, and tailored career development planning. It is also crucial to stay attuned to nurses internal states and sense of well-being to help alleviate negative emotions and reduce the use of surface acting strategies. Conclusion This study identifies three categories of death coping ability among palliative care nurses, highlighting the necessity for targeted interventions to bolster their abilities in emotional labor. Specialization in palliative care, frequent interactions with the bereaved, participation in grief counseling, and personal bereavement experiences significantly influence death coping abilities. Addressing this heterogeneity through comprehensive education, support and training can empower nurses to effectively manage death events and manage emotions, ultimately improving patient care outcomes. Abbreviations LCA latent class analysis LL Log likelihood test AIC Akaike Information Criterion BIC Bayesian Information Criterion aBIC adjusted BIC LMR Lo-Mendell-Rubin BLRT Bootstrap Likelihood Ratio Test Declarations Ethics approval and consent to participate The ethical approval was obtained from the First affiliated hospital of Nanjing Medical University (approval number: 2022-SR-732). All study participants were provided with informed consent electronically prior to participating in the study. The informed consent page presented two options (Yes/No). Only subjects who chose “Yes” were guided to the questionnaire pages, and participants could quit the process at any time. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due the restriction from the Ethical Committee of the First affiliated hospital of Nanjing Medical University but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was no funding support. Authors' contributions JL: Methodology and manuscript preparation, Writing-Original draft preparation. A A: Methodology, Supervision, Reviewing and Editing. XYC: Investigation, performed the data analysis, editing. YC: performed the data analyses, Methodology. CS: Investigation and advice. XC and JFW: Supervision, Reviewing and Editing, manuscript preparation. All authors provided critical comments on drafts of the manuscript and approved the final manuscript. Acknowledgements The authors thank all nurses who responded to the questionnaire and people who distributed the questionnaire to the nurses. References Currow DC, Agar MR, Phillips JL. Role of Palliative Care at the End of Life for People With Cancer. J Clin oncology: official J Am Soc Clin Oncol. 2020;38(9):937–43. Sansó N, Galiana L, Oliver A, Pascual A, Sinclair S, Benito E. Palliative Care Professionals' Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death. J Pain Symptom Manag. 2015;50(2):200–7. Frasca M, Galvin A, Raherison C, Soubeyran P, Burucoa B, Bellera C, Mathoulin-Pelissier S. 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Cancer Nurs. 2020;43(5):E283–90. Wang YL, Yang ZW, Tang YZ, Li HL, Zhou LS. A qualitative exploration of empathic labor in Chinese palliative nurses. BMC Palliat care. 2022;21(1):23. Gabriel AS, Diefendorff JM. Emotional labor dynamics: A momentary approach. Acad Manag J. 2015;58:1804–25. Olson RE, Smith A, Good P, Neate E, Hughes C, Hardy J. Emotionally reflexive labour in end-of-life communication. Social science & medicine (1982). 2021; 291:112928. Peters L, Cant R, Payne S, O'Connor M, McDermott F, Hood K, Morphet J, Shimoinaba K. Emergency and palliative care nurses' levels of anxiety about death and coping with death: a questionnaire survey. Australasian Emerg Nurs journal: AENJ. 2013;16(4):152–9. Tjernberg J, Bo¨kberg C. Older persons’ thoughts about death and dying and their experiences of care in end-of-life: a qualitative study. BMC Nurs. 2020;19:123. Cheung J, Au D, Chan W, Chan J, Ng K, Woo J. Self-competence in death work among health and social care workers: a region-wide survey in Hong Kong. BMC Palliat Care. 2018;17:65. Lin X, Li X, Bai Y, Liu Q, Xiang W. Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study. PLoS ONE. 2022;17(9):e0274540. Safari Malak-Kolaei F, Sanagoo A, Pahlavanzadeh B, Akrami F, Jouybari L. The Relationship Between. Death and Do Not Resuscitation Attitudes Among Intensive Care Nurses. Omega (Westport). 2020: 30222820959235. Zheng R, Guo Q, Dong F, Gao L. Death Self-efficacy, Attitudes Toward Death and Burnout Among Oncology Nurses: A Multicenter Cross-sectional Study. Cancer Nurs. 2022;45(2):E388–96. Mori M, Krumh Olz HM, Allore HG. Using Latent class analysis to identify hidden clinical phenotypes. JAMA. 2020;324(7):700–1. Bugen LA. Coping–effects of death education. Omega4 Death Dying. 1980;11(2):175–83. Chen WL, Ma HM, Wang X, Chen JJ. Research progress of nurses' death coping ability. Chin J Nurs. 2019;54(12):1795–9. (in chinese). Zeng HT. A study on the effect of death education on nursing graduate students' behavior in caring for terminally ill patients (E87092)(raw data). Database of Academic Investigation and Research, Research Center for Humanities and Social Sciences, Taiwan National Institute of China; 2000. (in Chinese). Grandey AA. When the show must must go on: Surface and deep acting as determinants of emotional exhaustion and peer-rated service delivery. Manage J. 2003;46:86–96. Luo H, SUN QL, Gu LH. Study on the influence of emotional work ability on job burnout in nurses. Chin J Nurs. 2008;43(11):969–71. (in Chinese). Wang Y, Huang Y, Zheng R, Xu J, Zhang L, Zhu P, Lu Z, Wang L, Xie J, Zhao J, Dong F. The contribution of perceived death competence in determining the professional quality of life of novice oncology nurses: A multicentre study. Eur J Oncol nursing: official J Eur Oncol Nurs Soc. 2023;62:102273. Li YP, Huang DD. The mediating effect of psychological capital on moral courage and death coping ability of nurses in ICU. J Adv Nurs. 2019;38(3):204–8. (in Chinese). Camarneiro A, Gomes S. Translation and Validation of the Coping with Death Scale: A Study with Nurses. Revista de Enfermagem Referência 2015; IV Série(7): 113–22. Chan WCH, Tin AF, Karen Lok Yi Wong. Effectiveness of an experiential workshop for enhancing helping professionals’ self-competence in death work in Hong Kong: a randomised controlled trial. Health Soc Care Commun. 2017;25(3):1070–9. Schreiner L, Wolf Bordonaro GP. Using Nontraditional Curricular Tools to Address Death and Dying in Nurse Education. J Hospice Palliat Nurs. 2019;21(3):229–36. Liu Y, Zhang XH, Wang S, et al. Impact of death education training based on Thousand Chat live on nurses' attitude towards hospice care and death in emergency department. J Nurs Res. 2019;37(5):922–5. (in Chinese). Luo L, Zhang HF, Li F, et al. Investigation and analysis of death education contents and training methods of hospice nurses. Chin J Mod Nurs. 2012;7(17):2269–73. (in Chinese). Lin X, Li X, Bai Y, et al. Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study. PLoS ONE. 2022;17(9):e0274540. Ay MA, O¨z F. Nurses attitudes towards death, dying patients and euthanasia: A descriptive study. Nurs Ethics. 2019;26:1442–57. Kim S, Lee K, Kim S. Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study. BMC Palliat Care. 2020;19:105. Delgado C, Upton D, Ranse K, Furness T, Foster K. Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature. Int J Nurs Stud. 2017;70:71–88. Miller-Lewis L, Tieman J, Rawlings D, et al. Correlates of perceived death competence: What role does meaning-in-life and quality-of-life play? Palliat Supportive Care. 2019;17(5):550–60. Kwak Y, Han Y, Song J, et al. Impact of emotional labour and workplace violence on professional quality of life among clinical nurses. Int J Nurs Pract. 2020;26(1):e12792. Olson RE, Smith A, Good P, et al. Emotionally reflexive labour in end-of-life communication. Soc Sci Med. 2021;291:112928. Liu H, Zou H, Wang H, et al. Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses. J Adv Nurs. 2020;76(2):577–87. Harder N, Lemoine J, Harwood R. Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review. J Clin Nurs. 2020;29(3–4):330–46. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Mar, 2025 Read the published version in BMC Palliative Care → Version 1 posted Editorial decision: Revision requested 22 May, 2024 Submission checks completed at journal 21 May, 2024 Editor assigned by journal 21 May, 2024 First submitted to journal 19 May, 2024 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-4445010","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":305389844,"identity":"f088f1e2-851a-41f2-b917-dd83af31476d","order_by":0,"name":"Jie Li","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Li","suffix":""},{"id":305389845,"identity":"b67c481e-3423-4e82-ab12-825ee67b5bc7","order_by":1,"name":"Anne Arber","email":"","orcid":"","institution":"The University of Surrey","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"Arber","suffix":""},{"id":305389846,"identity":"8c66e925-8dbc-4801-91be-b9d60039be2d","order_by":2,"name":"Xiaoyan Chen","email":"","orcid":"","institution":"Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Chen","suffix":""},{"id":305389847,"identity":"dd18b6f6-5aac-4458-8a5b-8df7de432e14","order_by":3,"name":"Yanzi Chen","email":"","orcid":"","institution":"Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Yanzi","middleName":"","lastName":"Chen","suffix":""},{"id":305389848,"identity":"27cb5a00-45f5-4264-9d57-705d511158aa","order_by":4,"name":"Cuihua Sun","email":"","orcid":"","institution":"Jiangsu Nursing Association","correspondingAuthor":false,"prefix":"","firstName":"Cuihua","middleName":"","lastName":"Sun","suffix":""},{"id":305389849,"identity":"cd6c367d-0c7f-47a4-b260-710a69e7e14b","order_by":5,"name":"Jinfeng Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jinfeng","middleName":"","lastName":"Wu","suffix":""},{"id":305389850,"identity":"ded6a67c-66d6-4709-9299-a0d6c7834540","order_by":6,"name":"Xian Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDACZiBmbGBg4GdgSGCAsonUItlAtBaYMoMDCDZ+YHCc+dmDnzts8oxvNzzdzMNgI7vhAFAEnxbJZjZzw94zacVmdw6k3eZhSDPecIDN3ACfFn5mBjNpxrbDidtuJIC0HE7ccICHTQKfFjZm9m9ALf8TN88Aa/lPWAs/Mw/IlgOJGyTAWg4Q1iLZzFMm2duWnDgD6LCbcwySjWceZjPDq8Xg/PFtEj/b7BL7Z+Sk3XhTYSfbd7z5GV4tSIAnAWgCAyRyiQTsB4hXOwpGwSgYBSMKAABH3UkKi2637QAAAABJRU5ErkJggg==","orcid":"","institution":"Nanjing Women and Children’s Hospital (Women’s Hospital of Nanjing Medical University)","correspondingAuthor":true,"prefix":"","firstName":"Xian","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-05-19 16:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4445010/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4445010/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12904-025-01708-3","type":"published","date":"2025-03-13T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57620783,"identity":"20bbf2a5-304d-4bc9-b17c-114d338dfbba","added_by":"auto","created_at":"2024-06-03 12:57:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32219,"visible":true,"origin":"","legend":"\u003cp\u003eLatent Profile Diagram of Death Coping Ability\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4445010/v1/bbfe29e3f3c9d8726229f9d1.png"},{"id":78689766,"identity":"f251bc72-8c3c-4c4b-8ce8-04f994d979dd","added_by":"auto","created_at":"2025-03-17 16:13:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1189638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4445010/v1/41b0cc1c-5b2b-4876-be4b-05b7c99b2cb4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Latent class analysis of death coping ability among palliative care nurses and its association with their emotional labor","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the increasing prevalence of an aging population and a rising annual mortality rate, palliative care has emerged as a critical modality for enhancing the quality of life for patients in end-stage conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Palliative care provides comprehensive physical, psychological, spiritual and social care for dying patients with life-limiting illness [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This holistic approach not only helps patients with life-limiting illness ends with death comfortably, peacefully, and with dignity but also improves the quality of life, reduces medical costs, and optimizes the utilization of medical resources [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs the main practitioners of palliative care, nurses play a vital role in supporting communication among doctors, patients and families [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. They serve as coordinators within multidisciplinary care teams, and their comprehensive caregiving capacities significantly influence the quality of palliative services.\u003c/p\u003e \u003cp\u003eThe concept of 'death coping ability' refers to the capacity and skills to manage one's own or another's death, incorporating relevant attitudes and beliefs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It involves strategies employed by individuals to mitigate stress when confronted with death [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This comprehensive ability to handle death events is an indispensable professional skill for palliative care nurses and an important indicator of their overall competency [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to the nature of their work, palliative nurses inevitably face death events, which can pose significant challenges, especially for those with limited experience and preparation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Previous studies have indicated that in palliative care practice, nurses may experience a range of emotions including calm acceptance, overwhelming emotional dietress such as fear of death, and sadness, which can lead to depression following the death of patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. When regulating emotions, palliative care nurses expend considerable emotional labor, managing their emotional expressions and interactions with patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Emotional labor involves adjusting and expressing emotions according to professional role requirements, empathizing genuinely with patients, and addressing negative emotions with a rational and professional attitude [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The strategies of emotional labor mainly include surface acting, deep acting and the expression of natural emotions. Surface acting involves passively repressing one's true emotions to display expressions that conform to norms, without altering the inner emotions. Deep acting, on the other hand, involves actively regulating and transforming one's internal emotional experience to align both internal and external emotions with the norms. Natural emotional expression refers to employees expressing their genuine emotions at work, unaffected by the organization's emotional rules. The process of emotional labor goes beyond merely regulating emotions; it also involves understanding and conceptualizing death[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nurses with varying levels of death coping ability may exhibit different outcomes in managing death events, potentially leading to differences in their levels of emotional labor. However, current research primarily focuses on one of these aspects, with minimal information on the relationship between death coping ability and emotional labor. To address this gap, we conducted this cross-sectional survey.\u003c/p\u003e \u003cp\u003eSeveral factors correlate with a high ability to cope with death among palliative care nurses, including age, educational background, attitudes towards death, palliative experience, and personal bereavement experiences [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research underscores a significant association between palliative experience and the ability to manage death effectively [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Nurses with extensive palliative care experience generally exhibit a more robust ability to cope with death, likely due to their enhanced understanding of death and familiarity with effective coping strategies, enabling them to accept and manage death events more calmly [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, research has indicated that attitudes towards death are predictors of death coping ability; a negative attitude may affect the level of death coping ability [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Conversely, nurses with limited palliative experience or those new to the field often demonstrate a reduced ability to cope with death. This may be attributed to traditional Chinese cultural perspectives that view death as a taboo, fostering negative emotional responses such as avoidance and fear. This cultural influence can lead to inadequate preparation for handling palliative -related matters, including death, thereby hampering nurses\u0026rsquo; emotional regulation. Previous studies have found that death coping ability is positively correlated with care performance and tends to increase with age and accumulated palliative care experience [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Such experiences enrich nurses' perceptions and reflections on life, which in turn enhances their emotional regulation and ability to cope with death events effectively [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrior studies on the ability to cope with death primarily assessed the level of research tools available, failing to classify and refine the group characteristics related to the death coping ability of palliative care nurses. To address this gap, this study employed latent class analysis (LCA) to identify different potential categories of death coping ability among palliative nurses and to explore the correlation between these categories and emotional labor. This approach is potentially beneficial for nursing managers to better understand the emotional labor process that palliative nurses undergo when coping with death events.\u003c/p\u003e \u003cp\u003eLCA is a person-centered statistical method designed to reveal hidden clusters within data by considering correlations between variables [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It categorizes individuals marked by multiple variables into mutually exclusive groups, ensuring minimal variation of observed variables within each category while maximizing the differences between categories. Currently, LCA is widely utilized to explore the heterogeneity within nurse groups. In this study, LCA was used to delineate the characteristics of different categories of palliative nurses' death coping abilities and to investigate their relationship with emotional labor. This analysis can inform the development of targeted educational and training strategies, ultimately enhancing the quality of palliative care services.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign, Participants, and Setting\u003c/h2\u003e \u003cp\u003eThis multicenter, cross-sectional study was conducted through an online survey from July to October 2023, in collaboration with the Jiangsu Nursing Association. It targeted palliative care nurses across medical facilities in four provinces in China. Convenience sampling was employed to recruit participants. The inclusion criteria were: (1) possession of a valid nursing license and current registration as a nurse; (2) a minimum of six months of experience in a palliative care ward or oncology department; and (3) provision of informed consent and voluntary agreement to participate in the research. Exclusion criteria included: (1) nurses who were currently receiving standardized training or were engaged in routine practice; (2) nurses who were unable to participate due to external study, advanced training, or vacation leave.\u003c/p\u003e \u003cp\u003eThe survey was conducted using an electronic questionnaire developed with Questionnaire Star and distributed online. The objective and importance of the survey were clearly articulated in the title of the questionnaire to ensure the respondents were well-informed. To ensure reliability and accuracy of the responses, several measures were implemented: (1) completion of all questions was compulsory to prevent omissions; (2) each respondent was restricted to one questionnaire submission to prevent multiple entries; (3) two researchers rigorously screened the responses to exclude any questionnaires that contained logical errors, patterned answers, incomplete fields, or were completed in less than five minutes. Out of 930 palliative nurses initially invited, 868 provided valid responses after data cleansing, yielding an effective response rate of 93.3%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cp\u003eThe online questionnaire is composed of three sections: basic demographic and professional data, the Chinese version of the Death Coping Ability Scale, and Emotional Labor Scale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eThe Chinese Version of the Death Coping Ability Scale\u003c/h2\u003e \u003cp\u003eThe Death Coping Ability Scale, developed by American scholar Bugen in 1980, is the first instrument designed to assess an individual's capacity to cope with death [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The Chinese version of the death coping ability scale was introduced and translated by Tseng Huantang [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The scale consists of 30 items across eight dimensions: self-acceptance of death, ability to cope with death, ability to perceive and express oneself about death, ability to deal with the aftermath of death, ability to perceive life, ability to manage loss, ability to discuss other\u0026rsquo;s death and ability to discuss one\u0026rsquo;s own death. It employs a Likert 7-point scoring system, where scores range from 1 (least ability) to 7 (greatest ability), with a total possible score ranging from 30 to 210. Scores below 105 indicate inadequate coping abilities, while scores above 157 denote strong coping capacities. The Cronbach's alpha coefficient of the scale is 0.92.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eEmotional Labor Scale\u003c/h2\u003e \u003cp\u003eThis scale was developed by scholar Grandey in 2003 and later adapted into a Chinese version by Luo Hong [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The scale includes three dimensions: surface acting (7 items), deep acting (3 items), and emotion display (4 items). It uses a Likert 6-point scoring method, with scores ranging from 1 to 6, and a total score ranging from 14 to 84. A higher score indicates a higher level of emotional labor. The Cronbach's alpha coefficients for the scale\u0026rsquo;s dimensions range from 0.71 to 0.87. Emotional labor levels are categorized based on the average score per item: low level (\u0026le;\u0026thinsp;1), slightly below average (\u0026gt;\u0026thinsp;1 to \u0026le;\u0026thinsp;2), average (\u0026gt;\u0026thinsp;2 to \u0026le;\u0026thinsp;4), slightly above average (\u0026gt;\u0026thinsp;4 to \u0026le;\u0026thinsp;5), and high level (\u0026gt;\u0026thinsp;5).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e This study received ethical approval from the First Affiliated Hospital of Nanjing Medical University (approval number: 2022-SR-732). All participants provided their informed consent electronically prior to participating. The consent form was displayed on the first page of the survey, with options \"Yes\" and \"No.\" Only those who selected \"Yes\" proceeded to the questionnaire. Participants were also free to withdraw from the study at any point.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eLatent class analysis was conducted using Mplus 7.0. The primary model fit indices include the Log likelihood (LL) test, and informational criteria such as the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), sample-size adjusted BIC (aBIC), and the Entropy index. The likelihood ratio tests, Lo-Mendell-Rubin (LMR) and the Bootstrap Likelihood Ratio Test (BLRT), were also utilized. Lower values of LL, AIC, BIC, and aBIC indicate a better model fit, while an Entropy index close to 1.0 suggests better predictiveness. An Entropy index approximately equal to 0.8 indicates that the accuracy of classification exceeds 90%. If the p-values for the LMR and BLRT are significant, it indicates that a model with k classes is significantly better than a model with k-1 classes. Data analysis was performed using SPSS 26.0, employing the chi-square test for between-group comparisons and multinomial logistic regression for multifactorial analysis, with a significance level of α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLatent Class Analysis Results of Palliative Care Nurses' Death Coping Ability\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the model fit indices of the latent profile analysis of palliative care nurses' death coping ability potential categories. As the number of categories increased, the Log Likelihood (LL), Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and adjusted BIC (aBIC) gradually decreased, with a notable reduction in the rate of decline after three categories. The Entropy index, indicative of classification accuracy, remained above 0.80 for 2\u0026ndash;4 categories, peaking at three categories. The Lo-Mendell-Rubin (LMR) test suggested that three categories were preferable to two, with no significant improvement when expanding to four categories. Categories with probabilities below 8% in models with four and five categories were deemed non-representative. Thus, three categories were selected. Based on the scores in eight dimensions\u0026mdash;acceptance of death, handling of dying, expression of death-related thoughts, funeral handling, life conservation, coping with loss, discussing others' deaths, and discussing one's own death\u0026mdash;Category 1 was labeled \"Low Death Coping Ability Group\" (11.5%), Category 2 as \"Medium Death Coping Ability Group\" (52.0%), and Category 3 as \"High Death Coping Ability Group\" (36.5%). Conditional probability graphs for each category across these dimensions are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe fitting indexes of each model of potential categories of palliative care nurses' death coping ability\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaBIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEntropy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLMR(p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBLRT(p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eClassified probability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-11751.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23535.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23611.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23560.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-10321.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20692.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20811.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20732.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.493/0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-9733.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19535.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19697.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19589.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.115/0.520/0.365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-9430.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18946.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19150.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19014.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.073/0.412/0.391/0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-9250.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18605.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18853.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18687.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.055/0.248/0.325/0.260/0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: LL (Log likelihood),AIC (Akaike Information Criterion);BIC (Bayesian information criterion)༛LMR (Lo-Mendell-Rubin); BLRT (bootstrapped likelihood ratio test)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information Distribution among Palliative Care Nurses' Death Coping Ability Categories\u003c/h2\u003e \u003cp\u003eAn analysis of single-factor variables, including years of palliative experience, professional title, specialization in palliative care nursing, palliative care training course attendance, opportunities to interact with the bereaved, participation in grief counseling training courses, and personal bereavement experiences, revealed significant statistical differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed data can be found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe characteristics of potential categories of coping ability to death\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eC2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e450 (99.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e313 (99.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMarital status, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle or divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (71.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e316 (70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e241 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHospital classification, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (63.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e227 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of clinical experience, median (IQR), years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (6, 13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (5.75, 15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (6, 17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of hospice experience median (IQR), years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation level, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e365 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e272 (86.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProfessional title, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior RN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e245 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle RN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior RN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProfessional position, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e371 (82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e249 (79.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharge Nurse or Nurse manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePalliative Care Nursing Specialist, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (97.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393 (87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e289 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePalliative Care Training Course Attendance, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eOpportunities to interact with the bereaved (per month), No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (71.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e252 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eParticipate in grief counseling training course, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePersonal Bereavement Experience, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e177 (56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Logistic Regression Analysis of Influencing Factors on Death Coping Ability\u003c/h2\u003e \u003cp\u003eThe multivariate logistic regression analysis utilized a stepwise variable selection method to examine the factors influencing palliative care nurses' death coping ability. Independent variables selected from significant results in single-factor analyses included nursing experience, professional title, tenure in palliative care, specialization in palliative care nursing, interaction with bereaved individuals, participation in grief counseling training, and personal bereavement experiences. The model employed criteria of α\u0026thinsp;\u0026le;\u0026thinsp;0.05 for inclusion and α\u0026thinsp;\u0026ge;\u0026thinsp;0.10 for exclusion. The analysis found that specialization in palliative care nursing, frequency of interactions with bereaved individuals, participation in grief counseling programs, and personal bereavement experiences significantly influenced the nurses' death coping strategies (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For detailed information on the influencing factors and their statistical significance, refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression analysis of potential factors affecting death coping ability (n\u0026thinsp;=\u0026thinsp;868)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate Death Coping Ability Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalliative Care Specialist Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e11.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Palliative Care Specialist Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Attended Grief Counseling Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Not Attended Grief Counseling Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent Contact with the Bereaved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess Contact with the Bereaved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage Contact with the Bereaved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Bereavement Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Bereavement Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Death Coping Ability Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalliative Care Specialist Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Palliative Care Specialist Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Attended Grief Counseling Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Not Attended Grief Counseling Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent Contact with the Bereaved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess Contact with the Bereaved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage Contact with the Bereaved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Bereavement Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Bereavement Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eNote: The group with low death coping ability was used as the reference group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Emotional Labor among Different Death Coping Ability Categories\u003c/h2\u003e \u003cp\u003eThere were statistically significant differences in surface acting, emotional display, and deep acting among different categories of death coping ability potential categories (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Multiple comparisons revealed that the scores for total emotional labor and its three dimensions were higher in the High Death Coping Ability Group than in the Medium Death Coping Ability Group. See Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTesting Differences in Emotional Labor by Potential Categories of Death Coping Ability (n\u0026thinsp;=\u0026thinsp;868)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurface Acting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmotion Display\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDeep Acting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow death coping ability group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate death coping ability group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh death coping ability group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u0026thinsp;\u0026lt;\u0026thinsp;Moderate\u0026thinsp;\u0026lt;\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow\u0026thinsp;\u0026lt;\u0026thinsp;Moderate\u0026thinsp;\u0026lt;\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow\u0026thinsp;\u0026lt;\u0026thinsp;Moderate\u0026thinsp;\u0026lt;\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLow\u0026thinsp;\u0026lt;\u0026thinsp;Moderate\u0026thinsp;\u0026lt;\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study identified three latent categories of death coping abilities among palliative care nurses through latent class analysis, revealing significant intergroup heterogeneity. Over half of the nurses fall into the medium death coping ability group, aligning with findings by Wang et al[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], which suggests that most most palliative care nurses have a medium to high level of death coping abilities.\u003c/p\u003e \u003cp\u003eThe latent profile analysis reveals that nurses in the Low Death Coping Group score lower across all eight dimensions of death coping ability, with particularly low scores in death acceptance and discussing death. However, they score relatively higher in expressing thoughts about death, indicating that patient death events stimulate their contemplation on life and death. Nonetheless, their understanding and cognitive approach to death make it challenging for them to handle patient death events effectively. To address this, thematic seminars focusing on death cognition and grief could be organized, enhancing nurses' existential understanding and thereby facilitating more empathetic care [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In addition, developing educational initiatives like palliative care training modules could strengthen nurses' capabilities in managing terminal illnesses [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Medium Death Coping Ability Group, lower scores in death acceptance, funeral handling, and discussing death indicate a tendency to avoid these topics. Targeted interventions for this group could include hosting death experience workshops with experiential learning and role-playing to acclimate nurses to death coping strategies[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and organizing screenings of educational documentaries on death followed by guided discussions to foster a structured approach to understanding and managing death [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe High Death Coping Ability Group shows proficiency across all dimensions of death coping ability but scores particularly lower in accepting death. This may reflect a traditional medical focus on life preservation, which complicates emotional response to patient mortality. To support these nurses, a hybrid approach of theoretical instruction and practical experience in palliative care education could bridge the gap between understanding and accepting death [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Furthermore, enhancing the range and accessibility of educational resources through innovative methods such as Massive Open Online Courses (MOOCs) and mobile learning platforms could ensure comprehensive knowledge dissemination and skill development [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Death Coping Ability\u003c/h2\u003e \u003cp\u003eNurses specialized in palliative care demonstrated a higher capability to cope with death (OR\u0026thinsp;=\u0026thinsp;1.503), consistent with related research [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. One plausible explanation is that in China, palliative care specialists are subjected to comprehensive, structured training programs and must clear a stringent certification procedure to earn their qualifications. These programs not only broaden knowledge but also develop cognitive frameworks and problem-solving skills, enabling these specialists to adeptly handle death-related scenarios. In contrast to their general nursing counterparts, palliative care specialists demonstrate superior learning abilities and insights, possessing a profound comprehension of their field and the capacity to swiftly and effectively translate theoretical knowledge into practical applications in clinical settings. In this study, palliative care nurses who had more frequent interactions with the bereaved exhibited higher levels of death coping capabilities (OR\u0026thinsp;=\u0026thinsp;2.321), which aligns with the findings of related research [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This may be attributed to the fact that frequent encounters with the bereaved help these nurses to accept and recognize death as an integral part of life's completeness, enabling them to address death-related events with a proactive and positive attitude. Further research has indicated that regular engagement with the bereaved and involvement in the care of terminally ill patients enhances capabilities in aspects such as articulating thoughts on death and reflecting on life, which are critical components of death coping skills [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The extensive experience accumulated through practical exposure also fosters a substantial sense of self-efficacy, supporting their ability to manage death-related situations effectively. Grief counseling equips nurses with strategies to handle their emotions effectively, such as understanding and managing sorrow, anger, guilt, and helplessness which commonly arise following patient deaths. This emotional management is crucial for maintaining professionalism and providing high-quality care. Furthermore, it's noted that engaging in physical activities, mindfulness, and hobbies are part of effective self-care strategies that help nurses cope with the emotional toll of their duties [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Additionally, nurses with personal bereavement experiences also showed higher levels of death coping abilities (OR\u0026thinsp;=\u0026thinsp;1.811), aligning with findings from related research [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This may be because nurses who have experienced the loss of a loved one understand the process of death events more profoundly. They possess a deeper comprehension of the meaning of life and death, are better able to empathize with grieving families, and can adopt coping strategies to handle death-related situations calmly and competently.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEmotional Labor Among Palliative Care Nurses Based on Their Death Coping Abilities\u003c/h2\u003e \u003cp\u003eEmotional labor involves three types of labor strategies: surface acting, emotional display, and deep acting, representing a form of non-material labor [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. This study explores the variations in total scores and individual dimensions of emotional labor among palliative care nurses, categorized by their different latent death coping abilities. The results indicate that there are differences in emotional labor scors across various categories of death coping abilities among palliative care nurses. especially, stronger death coping abilities correlate with higher levels of emotional labor. This suggests that nurses who are better equipped to handle death are also more engaged in emotional labor, potentially indicating a more profound engagement with their roles, which involves managing personal emotions to fulfill the job requirements effectively.\u003c/p\u003e \u003cp\u003eIn this study, Group C3 showed an overall emotional labor score of 4.08 (SD\u0026thinsp;=\u0026thinsp;1.11). Within this group, the scores for surface acting were 3.78 (SD\u0026thinsp;=\u0026thinsp;1.40), deep acting scored the highest at 5.06 (SD\u0026thinsp;=\u0026thinsp;0.88), and emotional display were 3.85 (SD\u0026thinsp;=\u0026thinsp;1.45). Across all dimensions and the total score, Group C3 consistently outperformed Groups C2 and C1. The highest scores in the deep acting dimension indicate that palliative care nurses with strong death coping abilities tend to utilize deep acting strategies to regulate their emotions, adopting a proactive attitude when interacting with patients. In palliative care, nurses engaging with terminally ill patients need to invest significant emotional effort to recognize the psychological and emotional needs of their patients, inevitably leading to emotional labor [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Deep acting in emotional labor enables nurses to self-regulate their inner emotional state, thus improving their ability to recognize and understand the emotional needs of terminally ill patients. This facilitates deeper communication and interaction, playing a positive role [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Palliative care nurses with strong death coping abilities exhibit a more mature emotional mindset when dealing with terminally ill patients, enabling them to more effectively and rapidly leverage the positive effects of deep acting. They can regulate their emotional expressions in response to death both behaviorally and cognitively [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Therefore, nursing managers could focus on this aspect by conducting advanced communications skills alongside enhancing death coping abilities in palliative care nurses. This would encourage the development of effective emotional labor strategies and maximize the benefits of deep acting. In this study, the scores for surface acting in Groups C1 to C3 were 3.11 (SD\u0026thinsp;=\u0026thinsp;1.10), 3.50 (SD\u0026thinsp;=\u0026thinsp;0.85), and 3.50 (SD\u0026thinsp;=\u0026thinsp;0.85) respectively. All three groups of palliative care nurses exhibited a moderate level of surface acting. Especially, Group C1, apart from deep acting, showed a preference for surface acting strategies. This tendency may be attributed to the fact that nurses in Group C1 are generally less experienced, with limited life experience and less exposure to life-and-death situations, making them less capable of regulating emotions effectively at work. Surface acting is an emotional labor strategy, characterized by a disconnect between external emotional expressions and genuine internal feelings. This approach may lead to the suppression of negative emotions, potentially causing emotional dissonance, which can then evolve into job burnout and compassion fatigue, thus harming an individual's mental and physical health [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Nursing managers should pay attention to the emotional labor experiences of palliative care nurses, especially those with less experience. There is a need to support nurses well-being by good support if they are to become effective in emotional labour. Efforts should focus on enhancing their emotional regulation capabilities through humanistic management and education, flexible scheduling, and tailored career development planning. It is also crucial to stay attuned to nurses internal states and sense of well-being to help alleviate negative emotions and reduce the use of surface acting strategies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identifies three categories of death coping ability among palliative care nurses, highlighting the necessity for targeted interventions to bolster their abilities in emotional labor. Specialization in palliative care, frequent interactions with the bereaved, participation in grief counseling, and personal bereavement experiences significantly influence death coping abilities. Addressing this heterogeneity through comprehensive education, support and training can empower nurses to effectively manage death events and manage emotions, ultimately improving patient care outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elatent class analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLog likelihood test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAkaike Information Criterion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBayesian Information Criterion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eaBIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eadjusted BIC\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLo-Mendell-Rubin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBLRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBootstrap Likelihood Ratio Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical approval was obtained from the First affiliated hospital of Nanjing Medical University (approval number: 2022-SR-732).\u003c/p\u003e\n\u003cp\u003eAll study participants were provided with informed consent electronically prior to participating in the study. The informed consent page presented two options (Yes/No). Only subjects who chose \u0026ldquo;Yes\u0026rdquo; were guided to the questionnaire pages, and participants could quit the process at any time.\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 and/or analysed during the current study are not publicly available due the restriction from the Ethical Committee of the First affiliated hospital of Nanjing Medical University but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJL: Methodology and manuscript preparation, Writing-Original draft preparation. A A: Methodology, Supervision, Reviewing and Editing. XYC: Investigation, performed the data analysis, editing. YC: performed the data analyses, Methodology.\u003c/p\u003e\n\u003cp\u003eCS: Investigation and advice. XC and JFW: Supervision, Reviewing and Editing, manuscript preparation. All authors provided critical comments on drafts of the manuscript and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all nurses who responded to the questionnaire and people who distributed the questionnaire to the nurses.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCurrow DC, Agar MR, Phillips JL. Role of Palliative Care at the End of Life for People With Cancer. 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Soc Sci Med. 2021;291:112928.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu H, Zou H, Wang H, et al. Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses. J Adv Nurs. 2020;76(2):577\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarder N, Lemoine J, Harwood R. Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review. J Clin Nurs. 2020;29(3\u0026ndash;4):330\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"palliative care, nurse, death coping ability, emotional labor, latent category analysis","lastPublishedDoi":"10.21203/rs.3.rs-4445010/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4445010/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eDeath coping ability is a critical professional skill for palliative care nurses. This study aimed to identify subgroups of death coping ability among Chinese palliative care nurses based on their assessments using the Death Coping Ability Scale, and to analyze the relationship between these subgroups and their emotional labor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003eConvenient sampling was employed to survey 868 palliative care nurses from medical institutions in Beijing, Jiangsu Province, Anhui Province, and Hunan Province. Data was collected using a general information questionnaire, the Chinese version of the Death Coping Ability Scale, and the Emotional Labor Scale. Latent profile analysis was conducted to categorize the nurses' death coping abilities, and differences in emotional labor among these categories were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe death coping ability of palliative care nurses was categorized into three groups: \"low death coping ability group\" (11.5%), \"medium death coping ability group\" (52.0%), and \"high death coping ability group\" (36.5%). Factors influencing these categories included specialization in palliative care, opportunities for interaction with the bereaved, participation in grief counseling training, and personal bereavement experiences, all statistically significant (\u003cem\u003ep \u0026lt; 0.05\u003c/em\u003e). Notably, there were significant differences in emotional labor scores among the three groups (\u003cem\u003eF=33.006, p \u0026lt; 0.001\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe death coping ability of palliative care nurses can be classified into three distinct categories, each associated with different levels of emotional labor. Nursing managers should recognize these differences and implement targeted, personalized interventions to enhance the death coping abilities of palliative care nurses.\u003c/p\u003e","manuscriptTitle":"Latent class analysis of death coping ability among palliative care nurses and its association with their emotional labor","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-03 12:57:05","doi":"10.21203/rs.3.rs-4445010/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-22T08:49:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-21T14:16:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-21T14:16:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2024-05-19T16:00:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4fad52aa-b913-479e-b8dc-cad43360cab4","owner":[],"postedDate":"June 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-17T16:10:01+00:00","versionOfRecord":{"articleIdentity":"rs-4445010","link":"https://doi.org/10.1186/s12904-025-01708-3","journal":{"identity":"bmc-palliative-care","isVorOnly":false,"title":"BMC Palliative Care"},"publishedOn":"2025-03-13 15:57:58","publishedOnDateReadable":"March 13th, 2025"},"versionCreatedAt":"2024-06-03 12:57:05","video":"","vorDoi":"10.1186/s12904-025-01708-3","vorDoiUrl":"https://doi.org/10.1186/s12904-025-01708-3","workflowStages":[]},"version":"v1","identity":"rs-4445010","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4445010","identity":"rs-4445010","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}