Sense of coherence,resilience,and end-of-life attitudes in critical care

Abstract

Background

Critical care nurses frequently encounter end-of-life care situations without adequate preparation, which can intensify emotional burden. Psychological resources such as sense of coherence and resilience may shape coping and attitudes toward dying patients, while cultural background may also play a role.

Aim

To examine associations among sense of coherence, resilience, and end-of-life care attitudes in critical care nurses, and to explore cultural factors related to these attitudes.

Research design

Cross-sectional, correlational design.

Participants and research context

Between June 2022 and September 2023, data were collected via the American Association of Critical Care Nurses website and seven intensive care units in a U.S. academic medical center. Participants (N = 131) completed demographic data, Connor–Davidson Resilience Scale, Frommelt Attitude Toward Care of Dying Scale Form B, and Orientation to Life Questionnaire (sense of coherence). Structural equation modeling was used to examine associations among variables.

Ethical Considerations

This study was approved by the ethics committees of the University (#2022-0555) and the Medical Center (STU-2022-0419) in accordance with the Declaration of Helsinki. All participants provided informed consent for the anonymous survey.

Results

Sense of coherence was positively associated with resilience (β = 0.424, p < .001), which in turn predicted more positive attitudes toward caring for dying patients (β = 0.251, p < .001). Asian-identifying nurses reported significantly lower scores on end-of-life care attitudes than other ethnic groups (β = −0.246, p = .001). Religious affiliation was not significantly associated with attitudes. Positive attitudes were linked to peer support and greater experience with patient death. Higher sense of coherence correlated with workplace satisfaction and graduate-level education.

Conclusion

Attitudes toward end-of-life care reflect interactions among sense of coherence, resilience, racial identification, and workplace context. Strengthening sense of coherence and resilience through education, peer support, and culturally informed training may enhance nurses’ preparedness for end-of-life care.