New graduate nurses’ experience of coping with patient dying and death in the Chinese cultural context: A mixed methods study

Categories: Education and Uncategorized.

There is increasing emphasis on improving the quality of end-of-life care to promote and achieve a good death for dying patients. Nurses, who have the most contact with dying patients, play a vital role in facilitating high-quality end-of-life care. Globally, there is evidence that new graduate nurses find it challenging and demanding to care for dying patients and deal with patient death. New graduate nurses report feeling inadequately prepared to meet dying patients’ physical, emotional and spiritual needs [1]. They described difficulty with demonstrating appropriate caring behaviours for patients during the dying process, and in supporting bereaved family members after patient death [1]. Their discomfort and reluctance for end-of-life care, and in particular for communicating with dying patients impacted their provision of end-of-life care [2].

The Chinese culture has its own unique rituals and traditions associated with dying and death, which have greatly influenced Chinese peoples’ attitudes towards dying and death. In mainland China, death is a taboo topic and discussing it is usually thought to be unlucky and sacrilegious [3]. This may make providing end-of-life care for dying patients more challenging for new graduate nurses. However, little is known about new graduate nurses’ experience of coping with patient dying and death in the Chinese cultural context.

A study was undertaken to understand new graduate nurses’ coping with patient dying and death in the Chinese cultural context. A theoretical framework which integrated the Comprehensive Occupational Stress Model [4] and Lazarus and Folkman’s Coping Theory [5] was used to direct concept development, research questions and data analysis. Specifically, a convergent parallel mixed methods design was adopted, which included a questionnaire and semi-structured individual interviews with new graduate nurses.

The study was conducted in Tianjin, a municipality and a coastal metropolitan region in the northeast part of China’s mainland. Nearly 300 hundred new graduate nurses from five tertiary hospitals participated in the survey to explore Chinese new graduate nurses’ death self-efficacy, death anxiety and their coping mechanisms with patient death, which were measured by the Death Self-efficacy Scale [6], the Death Anxiety Scale [7] and the Coping with Death Scale [8], respectively. Subsequently, 12 new graduate nurses who had experienced caring for dying patients and patient death in their practice participated in semi-structured individual interviews, to explore their perceptions of caring for dying patients and coping with patient death, and to elucidate how the experience impact them personally and professionally.

The results of this study indicated that Chinese new graduate nurses were at a disadvantage in terms of death self-efficacy, less well prepared in coping with death and were more anxious about death compared to those in Western countries. They found it challenging to care for dying patients and experience patient death. Although feeling inadequate, new graduate nurses did their best to facilitate a good death for dying patients. They seldom communicated with dying patients and reported not knowing how to talk with them about dying and death. They grieved over the death of their patients but tried to be act as a professional. The experience of coping with patient dying and death inevitably impacted new graduate nurses personally and professionally. New graduate nurses adopted several strategies to aid their coping, for instance, distancing, and talking with others to cope with patient death. However, few resources or training available for Chinese new graduate nurses to cope with patient death.

A number of significant recommendations arose from this study. New graduate nurses in the Chinese cultural context should be provided more opportunities to be exposed to patient dying and death. Chinese mentors and preceptors are advised to share and openly discuss with new graduate nurses how death is experienced in their clinical environments, which may provide them valuable experience and lessons to strengthen their death self-efficacy and competency of coping with death and decrease their death anxiety. It is imperative to develop and implement cultural-sensitive communication models or patterns in the Chinese death taboo cultural context. New graduate nurses should be provided education on how to manage their own responses to dying and death and how to take care of themselves after experiencing patient dying and death. Finally, it is also necessary for other parts of the world that are culturally similar with mainland China to further validate the findings of this study.

Many more Chinese-born new graduates choose to work outside China, and are assumed to be confident providing end-of-life care and coping with patient dying and death within the new country, where cultural beliefs, attitudes, and values towards dying and death may differ from their own. Therefore, it is also essential to consider the influence of Chinese culture on these nurses’ confidence and preparedness for end-of-life care, especially for coping with patient dying and death when they work in the new countries who receive them as migrants.

This article is a summary of a PhD project recently completed by Ruishuang Zheng at Monash University, Australia. Ruishuang pursued her PhD study under the supervision of Susan Lee from Monash University, Melissa Bloomer from Deakin University, Australia, and Qiaohong Guo from Capital Medical University, China.

Ruishuang can be reached at


  1. Kent, B., Anderson, N. E., & Owens, R. G. (2012). Nurses’ early experiences with patient death: the results of an on-line survey of Registered Nurses in New Zealand. International Journal of Nursing Studies, 49(10), 1255-1265.
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