Death competence profiles and influencing factors among novice oncology nurses: a latent profile analysis

BMC Nursing Guo et al. BMC Nursing (2024) 23:939 https://doi.org/10.1186/s12912-024-02641-1 Open Access RESEARCH Death competence profiles and influencing factors among novice oncology nurses: a latent profile analysis Qing Guo1, Yanhui Wang1, Ruishuang Zheng1*, Jun Wang2, Ping Zhu3, Li Wang4 and Fengqi Dong5 Abstract Background Preparing novice oncology nurses to competently care for dying cancer patients is challenging, particularly in cultures where death and dying are taboo subjects. This study aims to explore the various profiles of death competence among novice oncology nurses through latent profile analysis, identifies distinguishing characteristics, and examines influential factors within these subgroups. Methods A multisite cross-sectional study was conducted from August 2021 to July 2022, involving 506 novice oncology nurses from six tertiary cancer hospitals and centers across mainland China. Participants completed a questionnaire that included the Chinese version of the Coping with Death Scale, the Big Five Personality Traits Scale, and general demographic information. Latent profile analysis, univariate analysis, and multinomial logistic regression were utilized to identify death competence profiles and interindividual variability. Results Three latent profiles were identified: ‘Low Death Competence with Attitude Change toward Living’ group (21.5%, Profile 1), ‘Moderate Death Competence’ group (52.0%, Profile 2), and ‘High Death Competence with No Attitude Change toward Living’ group (26.5%, Profile 3). Specifically, for Profile 2, being male and having a conscientious personality were facilitating factors for death competence. Conversely, an agreeable personality and frequent exposure to patient death emerged as hindering factors. In Profile 3, working in Intensive Care Units and Palliative Care Units, along with personality traits of conscientiousness, openness, or extraversion, were associated with higher death competence, although frequent exposure to patient death was identified as a potential hindering factor even for this highly competent group. Conclusion Significant variability in death competence exists among the three groups of novice oncology nurses, reflecting the complexity of their experiences. These findings underscore the necessity for tailored, culturally sensitive death education and training programs. This study also provides vital insights for developing such programs, customized to meet the unique characteristics and needs of different subgroups of novice oncology nurses, ultimately enhancing their death competence and improving end-of-life cancer care. Keywords Novice oncology nurses, Death competence, China, Personality trait, Latent profile analysis *Correspondence: Ruishuang Zheng Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Guo et al. BMC Nursing (2024) 23:939 Background Novice oncology nurses are a vital part of the clinical nursing workforce, and preparing them to competently provide critical care to cancer patients is a significant challenge [1–3]. Their competence is crucial for their transition into skilled healthcare professionals and making significant contribution [3]. However, evidence suggests that these nurses often find it stressful and challenging to provide care for patients, particularly those who are dying [2, 4]. Caring for dying cancer patients and handling their deaths is a daunting and distressing experience even for experienced oncology nurses [5, 6], let al.one those new to the field. These challenges can lead to reduced patient interactions and a lower level of care provided by novice oncology nurses [7, 8]. Moreover, such experiences can contribute to emotional and psychological withdrawal, job dissatisfaction, increased burnout, decreased professional quality of life [9, 10], and symptoms of poor health [2]. Hence, developing death competence is essential for ensuring both the quality of professional healthcare and the well-being of novice oncology nurses. Currently, there is no internationally accepted term for death competence, also used as death competency, coping with death competence, coping with death, or death coping ability. However, it generally refers to the skills and attitudes necessary for managing one’s own and others’ deaths [11, 12], commonly measured by the Coping with Death Scale developed by Bugen [13]. In this study, we define death competence of oncology nurses as their ability to cope with cancer patients’ deaths, including handling death-related events, communicating with bereaved families, managing negative emotions caused by death, and providing hospice care [14]. Existing evidence highlights that various demographic and psychological factors influence oncology nurses’ ability to cope with patient death or end-of-life care [15, 16]. For instance, male nurses, those over the age of 31, those employed in cancer hospitals, those with positive attitudes toward death, and those who have received sufficient death education and training typically exhibit higher levels of death competence [16]. However, novice oncology nurses who may lack these advantages, often struggle the most, highlighting the need for targeted support and training to enhance their death competence. Further to this, the role of social or work-related factors that might predict these nurses’ death competence in a culture where death is a taboo subject, remain underexplored. Personality traits also play a significant role in coping with complex situations, such as death, serving as buffers against stress [16]. These traits, which influence emotional expression, thinking styles, and behavioral patterns, affect nurses’ work engagement, the quality of nursing care, and patient outcomes. For example, nurses Page 2 of 12 with a psychotic personality, marked by a tendency for risk-taking and antisocial or non-conformist behavior, may find it challenging to cope (...truncated)