Construction and implementation of a death education program for nursing interns: an action research study

BACKGROUND: Nursing interns frequently encounter patient death but are often inadequately prepared for end-of-life care, leading to distress and reduced efficacy. Existing death education programs rarely address their specific needs. OBJECTIVE: To develop and evaluate a tailored death education program for nursing interns. METHODS: The study was conducted in two phases: development and refinement of a preliminary program through literature review, interviews, Delphi method, and the first action research cycle; followed by evaluation via a second action research cycle with 48 interns (24 per cycle). Quantitative outcomes were assessed using the Death Attitude Profile-Revised (DAP-R), Frommelt Attitude Toward Care of the Dying scale (FATCOD-B), and Coping with Death Scale (CDS) scales, while qualitative data were collected through semi-structured interviews and participatory observation. RESULTS: After the second cycle, significant improvements (P < 0.05) were observed across all DAP-R dimensions, FATCOD-B total score, and CDS total score. The second cycle yielded significantly greater improvements in most outcomes compared to the first (P < 0.05), except for Escape Acceptance (P = 0.073). Qualitative analysis identified three themes: reflections and recommendations on death education workshops; development of end-of-life communication skills and deepening death awareness and Internalized development of life care and empathy capacity. CONCLUSION: The action research-based program effectively improved nursing interns’ death coping, end-of-life care attitudes, and communication skills, supporting the integration of experiential and reflective pedagogies into palliative care education.