Attitudes Towards End-of-Life Care Among Nursing Students: A Cross-Sectional Descriptive Study in a Southern European Undergraduate Nursing Program

Abstract

Background/Objectives: Attitudes toward end-of-life care (EOLC) are a key component of nursing practice. This study aimed to assess nursing students’ attitudes toward EOLC and their perceived preparedness to manage end-of-life situations. Methods: A cross-sectional descriptive study was conducted with 593 undergraduate nursing students from a public Spanish university. Data were collected using an online questionnaire, including the validated Spanish version of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-S). Descriptive and inferential analyses were performed. Results: The median reverse-coded FATCOD-S total score was 125.0 (IQR 119.0–131.0), and 99.7% of students were classified as having positive or very positive attitudes when the descriptive cut-offs were applied. In the exploratory adjusted model, fourth-year status and previous EOLC training were associated with higher FATCOD-S total scores. However, 59.5% of respondents reported feeling unprepared to provide EOLC, and 59.0% perceived EOLC as a significant source of stress for nurses. Additionally, 62.0% of students with positive attitudes reported not feeling prepared to provide such care. Responses related to emotional involvement, communication about death, and ethical aspects showed greater variability. Conclusions: Although most nursing students display favorable attitudes toward EOLC, these coexist with a low perceived level of preparedness, with more than half of students reporting that they do not feel prepared to provide EOLC. Positive attitudes alone may not ensure confidence in clinical practice. Strengthening undergraduate education—particularly in emotional preparation, communication skills, and coping strategies—is essential to better prepare future nurses for the complexities of EOLC. These findings should be interpreted in light of the study’s cross-sectional design and single-university setting.