Examining the Relationship Between Nursing Students’ Belief in a Just World and Their Attitudes Towards Death

Abstract

The belief in a just world is a mindset that facilitates our ability to cope with life events by fostering a sense of control. Nursing students' beliefs in a just world and their attitudes towards death can influence how they will care for their patients. The intent of this descriptive and cross-sectional study was to examine the relationship between nursing students and their beliefs in a just world and their attitudes towards death. Quantitative data was collected using the Descriptive Characteristics Questionnaire, the Belief in a Just World Scale, and the Attitude towards Death Scale. The sample included 270 participants. It was determined that as nursing students’ beliefs in a just world increased, they developed positive attitudes towards death. It is recommended that discussions on the subject should be included in the education curriculum to increase nursing students' beliefs in a just world and their awareness about death.

Keywords

belief belief in a just world death death attitudes nursing students

Introduction

The belief in a just world, in its simplest form, is the belief that the world is just, that good things will happen to good people and that bad things will happen to bad people. Individuals generally tend to believe that they live in a just world where they reap what they deserve including what may be happening to them. Religious books include many examples that illustrate the idea that trueness will reach victory and that sinners will ultimately be punished. Religions that advocate a doctrine that just rewards may not be immediate but will inevitably result also support a belief in a just world. (Lerner, 1980; Rubin & ve Peplau, 1975). This belief allows individuals to perceive that their physical and social environments are more stable and organized (Lerner & Miller, 1978; Yu et al., 2018). Therefore, the belief in a just world provides an individual with important adaptive functions and so s/he tends to maintain this belief. The strength of the belief in a just world changes with one’s negative life experiences. The belief in a just world plays a key role in regulating the reactions of an individual facing negative events throughout his/her lifetime and in preventing negative consequences that may jeopardize his/her well-being. (Dalbert, 1999, 2002).

Wanting to be treated justly in the world that we live in is as realistic an expectation as the concept of death. In Islamic teaching, the fact that every living organism will die 1 day is defined as an awakening (Yigit, 2020). The human being, who is always intertwined with death, has developed an attitude towards death by thinking about its concept. The concept of death in people’s minds determines their behaviors and lifestyles in many religious, philosophical, moral, and legal areas. People are afraid of dying and losing loved ones. The level of this type of fear will vary according to the meaning one attaches to death. Although thinking about death is universal, one’s perception of and attitude towards death can change due to many variables, including one’s values, beliefs, certain life experiences, and characteristics of the society in which s/he lives (Byeon & Park, 2017; Robinson & Epps, 2017).

Nurses are a helping professional group who provide uninterrupted and direct health care, and who will frequently encounter death while providing this care (Zheng et al., 2016). To manage the death process effectively, the concept of death and the factors affecting attitudes towards death should be included in the nursing education process and curriculum. The belief in God and an afterlife is associated with a more positive attitude towards death among nurses, doctors, and the general population (Braun et al., 2010; Cevik & Kav, 2013; Fehring et al., 1997). Nursing students who embrace the belief of ‘ultimate justice’ assume that justice will eventually prevail, either in this world or in the hereafter, even though the suffering of their patients may seem unjust in the present (Maes & Schmitt, 1999; Maes & Kals, 2002). Subsequently, they may develop different attitudes towards death. Nursing students’ beliefs in a just world and their attitudes towards death can affect how they provide care to their patients. In literature, it was determined that the first death experience of student nurses significantly affects their approach to patients during their clinical practice, their attitudes towards death, and the nursing care they provide to a dying patient (Ustundag et al., 2019). It was also reported that being religious affects attitudes towards death (Cevik & Kav, 2013; Iranmanesh et al., 2008; Khader et al., 2010). Limited studies exist that reveal the relationship between the belief of a just world and attitudes towards death among nursing students who will become members of the nursing profession. Therefore, the aim of this study was to first evaluate nursing students' belief in a just world and their attitudes towards death and second, to evaluate their perspectives about life. It is envisaged that the results of this study will contribute to the improvement of the nursing education curriculum by increasing awareness.

Methods

Study Design

The research was conducted using a descriptive and cross-sectional analysis to examine the relationship between nursing students’ beliefs in a just world and their attitudes towards death. The research data was collected using an online survey system between April and June 2021 completed by nursing students of the Faculty of Health Sciences of a university.

Research Population and Sample

The research sample included 482 nursing students receiving their education at a nursing department of the Faculty of Health Sciences of a university located in the Black Sea region of Turkey. The sample population was determined using a frequency of occurrence formula in cases where the population is known (n = 214). Criteria for inclusion considered nursing students who were enrolled in the nursing department of the Faculty of Health Sciences. Exclusion criterion was never specified based on welcoming all students who voluntarily consented to participate. Two hundred and 70 nursing students who voluntarily agreed to participate in the research were included in the research.

Data Collection Tools

The data of the study was collected using a Descriptive Characteristics Questionnaire, the General Belief in a Just World Scale, and the Attitude towards Death Scale.

Descriptive Characteristics Questionnaire

The research team prepared a 12-question survey to garner what the sample believed to be the introductory characteristics of the nursing students. The intent of the questionnaire was to determine if such nursing students' introductory characteristics affect the scores of the Just World Belief Scale and Attitude Towards Death Scale.

Belief in a Just World Scale

In this study, the General Belief in a Just World Scale (GBJWS) and the Personal Belief in a Just World Scale (PBJWS), which were developed by Dalbert (1999) and adapted into Turkish by Göregenli (2003), were used to measure participants’ belief in a just world. GBJWS is a 5-point Likert-type scale consisting of six items. Dalbert (1999) found that the reliability coefficient was .78 for GBJWS. Göregenli (2003) determined that the reliability coefficient of the scale was .69 in the Turkish sample. The scale measures how just the world is according to the general population. The highest score obtainable from the scale is 30 and the lowest score is 6. PBJWS, on the other hand, is a 5-point Likert-type scale consisting of seven items. Dalbert (1999) calculated that the reliability coefficient of PBJWS was .86. Göregenli (2003) reported that the reliability coefficient of the scale was .85 in the Turkish sample. The scale measures how just people evaluate the events they experience. A high score from the scale indicates a high personal belief in a just world.

Attitude towards Death Scale

The Attitude towards Death Scale (ATDS) was developed by Wong et al., (1994) to determine an individual’s attitude towards death and was adapted for Turkey by Işık et al. (2009). It consists of 26 items and each item is ranked on a 7-point Likert type scale. A high mean score on the entire scale and subscales indicates a positive attitude towards death. Nursing students who frequently encounter patients whose death is approaching have a key role in meeting the physical and psychosocial needs of these patients. For this reason, it was used to determine the attitudes of nursing students towards death.

Data Analysis

The data obtained in the research was analyzed using the IBM SPSS for Windows V 22.0 software. Number, percentage, mean and standard deviation descriptive statistics were used to evaluate the data. The Kolmogorov-Smirnov test was used to determine whether the data showed a normal distribution. The t-test was used to compare quantitative continuous data between two independent groups and the one-way ANOVA test was used to compare quantitative continuous data of more than two independent groups. Cronbach’s α coefficients were calculated for validity and reliability. The eta squared and Cohen’s d coefficients were used to calculate the effect size. Both Pearson correlation and linear regression analysis were applied to determine the relationship between the mean scale scores. The findings were evaluated at a confidence interval of 95% and a significance level of 5%.

Ethical Aspect of Research

Written permission was obtained from the ethics committee of the university (Decision No:3/1, Decision Date: 10.03.2021) and from the Faculty of Health Sciences where the research was conducted. The nursing students of the Faculty of Health Sciences were informed that their data would be kept confidential and that they could withdraw from the study at any time without penalty; it was clearly stated that participation was voluntary. Written consent was obtained from the nursing students who agreed to participate. Information revealing the identity of the nursing students was removed/coded to protect their confidentiality including not sharing any information in publicly accessible environments. The data will be kept in a double locked and password protected file in this research team’s library for 5 years

Results

Descriptive Characteristics of the Participants

Of the participants, 76.3% were female and 28.1% were in the first grade level of their studies. Mothers of 57.8% of the participants and fathers of 33.3% of them were primary school graduates; 65.9% had a moderate economic status; 73.7% had a nuclear family; 37.0% had four or more siblings; 92.6% did not have a chronic disease; 59.3% had thought about their own death from time to time; 65.2% had lost a loved one; 53.3% evaluated that their living conditions were at a moderate level in general; and 39.6% stated the place where they had lived the longest as the XYZ province. (Table 1)

Table 1.

Descriptive Characteristics of Nursing Students (n = 270).

Variable		N	%
Gender	Female	206	76.3
Gender	Male	64	23.7
Grade level	First	76	28.2
	Second	51	18.9
	Third	73	27.0
	Fourth	70	26.9
Education level of mother	Illiterate	16	5.9
	Primary school	156	57.8
	Secondary school	35	13.0
	High school	45	16.6
	University	18	6.7
Education level of father	Primary school	93	34.4
	Secondary school	56	20.7
	High school	72	26.7
	University	49	18.2
Economic level	High	67	24.8
	Moderate	178	65.9
	Low	25	9.3
Family type	Nuclear family	199	73.7
	Extended family	60	22.2
	Broken family	11	4.1
Number of siblings	1	8	3.0
	2	79	29.3
	3	83	30.7
	4 and above	100	37.0
Chronic disease	Yes	20	7.4
Chronic disease	No	250	92.6
Frequency of contemplating your own death	Usually	31	11.5
	Sometimes	160	59.3
	Rarely	79	29.3
Losing a loved one	Yes	176	65.2
Losing a loved one	No	94	34.8
General living conditions	Good	96	35.6
	Moderate	144	53.3
	Bad	30	11.1
Living place	Metropolis	49	18.1
	City	107	39.6
	County	72	26.7
	Village/Town	42	15.6

Participants’ Scores on Belief in a Just World Scale and Attitude Towards Death Scale Subscales

The participants’ mean scores were at moderate levels for neutral and approach acceptance (57.79 ± 17.62), escape acceptance (18.31 ± 7.31), the fear of death and death avoidance (28.27 ± 11.23) subscales, as well as for total ATDS (104.37 ± 27.23) and mean scores on PBJWS (19.46 ± 5.73), GBJWS (17.01 ± 4.93), and total BJWS (36.47 ± 9.72). As a result of the study data, it was determined that the scales were reliable (Table 2).

Table 2.

Distribution of Students’ Scores on Belief in a Just World Scale, Attitude Towards Death Scale, and Subscales (n = 270).

	Median	Mean	Sd	Min–max	Cronbach’s α
Neutral acceptance and approach acceptance	62.00	57.79	17.62	12–84	0.64
Escape acceptance	19.00	18.31	7.31	5–35	0.74
Fear of death and death avoidance	27.00	28.27	11.23	9–63	0.75
Total ATDS	109.00	104.37	27.23	26–182	0.66
PBJWS	20.00	19.46	5.73	7–35	0.75
GBJWS	18.00	17.01	4.93	6–30	0.75
Total BJWS	38.00	36.47	9.72	13–65	0.74

Participants’ Belief in a Just World Scale Subscale Scores According to their Descriptive Characteristics

There was no significant difference between the participants’ mean BJWS subscale scores and the variables of gender, parental education, family type, number of siblings, thinking about their own death, having lost a loved one, and place of residence (p: 0.65-0.82).

There was no significant difference between the grade level of the participants and their mean scores on the BJWS subscale (p > .05). There was no significant difference between the economic level of the participants and their mean scores on the GBJWS and BJWS subscales (p > .05). However, there was a weak statistically significant difference between the economic level of the participants and their mean scores on the PBJWS subscale (p < .05; eta-square:0.023). The lowest scores belonged to the participants with low economic levels (Table 3).

Table 3.

Distribution of Mean Belief in a Just World Scale Subscale Scores According to Students’ Descriptive Characteristics (n = 270).

Variable	N	PBJWS	GBJWS	Total BJWS
Variable	N	Mean ± SD	Mean ± SD	Mean ± SD
Years of education
First	76	18.66 ± 5.53	17.14 ± 4.92	35.80 ± 9.50
Second	51	19.16 ± 5.79	16.63 ± 4.95	35.78 ± 9.92
Third	73	20.01 ± 5.49	16.78 ± 5.00	36.79 ± 9.41
Fourth	70	19.99 ± 6.15	17.37 ± 4.91	37.36 ± 10.25
F/p		0.966/0.409	0.297/0.827	0.423/0.737
Economic level
High	67	20.43 ± 5.87	18.03 ± 5.11	38.46 ± 10.06
Moderate	178	19.43 ± 5.49	16.63 ± 4.69	36.07 ± 9.25
Low	25	17.08 ± 6.60	16.92 ± 5.82	34.00 ± 11.49
F/p/η2		3.169/0.044/.023*	1.968/0.142	2.391/0.093
General living conditions
Good	96	21.63 ± 4.24	18.67 ± 4.04	40.29 ± 7.09
Moderate	144	18.71 ± 5.73	16.10 ± 4.97	34.81 ± 9.84
Bad	30	16.17 ± 7.41	16.03 ± 5.99	32.20 ± 12.39
F/p/η2		14.314/0.000/.097*	8.944/0.000/.063*	13.562/0.000/.092*
Chronic disease
Yes	20	16.15 ± 6.52	14.35 ± 5.09	30.50 ± 10.93
No	250	19.73 ± 5.60	17.22 ± 4.86	36.95 ± 9.48
t/p/Cohen’s d		-2.716/0.007/.059*	-2.531/0.012/.058*	-2.893/0.004/.063*

*p < .05.

There was a moderate statistically significant difference between the general living conditions of the participants and their mean scores on BJWS subscales (p < .05; eta-square:0.063-0.097). The mean scores of participants with good general living conditions were higher compared to the others (Table 3).

There was a moderate statistically significant difference between the chronic disease status of the participants and their mean scores on the BJWS subscales (p < .05; Cohen’s d:0.058-0.063). The mean scores of participants who had no chronic disease were higher compared to the others (Table 3).

Participants’ Attitude Towards Death Scale Subscale Scores According to their Descriptive Characteristics

There was no significant difference between participants’ mean scores on the ATDS subscales and the variables of parental education, economic level, family type, chronic disease, and place of residence (p:0.10-0.98).

There was no significant difference between the grade level of the participants and their mean scores on the ATDS subscale (p > 0.05). There was also no significant difference between the participants’ mean neutral and approach acceptance subscale scores and their status on losing a loved one (p > .05). However, a weak significant difference was found between the frequency of thinking about their own death, participants’ general living conditions and gender (p < .05). The scores of participants with three siblings, who think about their own death occasionally, with good living conditions, and who were female were higher compared to the others (Table 4).

Table 4.

Distribution of Mean Attitude Towards Death Scale Subscale Scores According to Students’ Descriptive Characteristics (n = 270).

Variable	n	Neutral Acceptance and Approach Acceptance	Escape Acceptance	Fear of Death and Death Avoidance	Total ATDS
Variable	n	Mean ± SD	Mean ± SD	Mean ± SD	Mean ± SD
Years of education
First	76	56.88 ± 17.65	17.64 ± 7.95	29.32 ± 10.38	103.84 ± 26.56
Second	51	55.94 ± 18.08	18.24 ± 7.22	28.98 ± 12.12	103.16 ± 28.56
Third	73	58.03 ± 16.79	18.97 ± 6.59	26.85 ± 10.17	103.85 ± 25.49
Fourth	70	59.89 ± 18.23	18.41 ± 7.45	28.09 ± 12.50	106.39 ± 29.13
F/p		0.586/0.624	0.414/0.743	0.681/0.564	0.178/0.911
General living conditions
Good	96	61.38 ± 17.44	17.94 ± 7.21	27.25 ± 11.39	106.56 ± 25.89
Moderate	144	56.80 ± 16.82	18.62 ± 7.18	29.14 ± 10.88	104.56 ± 26.78
Bad	30	51.10 ± 19.83	18.07 ± 8.38	27.33 ± 12.33	96.50 ± 32.63
F/p/η2		4.493/0.012/.033*	0.268/0.765	0.931/0.395	1.575/0.209
Gender
Female	206	59.33 ±16.51	18.26 ± 6.94	28.82 ± 11.18	106.41 ± 25.58
Male	64	52.83 ± 20.13	18.48 ± 8.45	26.50 ± 11.29	97.81 ± 31.29
t/p/Cohen’s d		2.609/0.010/.035*	-0.212/0.832	1.444/0.150	2.223/0.027/.030*
Losing a loved one
Yes	176	58.26 ±17.21	19.11 ± 7.47	28.28 ± 11.32	105.64 ± 26.64
No	94	56.93 ± 18.41	16.83 ± 6.80	28.24 ± 11.10	102.00 ± 28.28
t/p/Cohen’s d		0.590/0.555	2.463/0.014/.032*	0.023/0.981	1.047/0.296

*p < .05.

There was no significant difference between the participants’ mean escape acceptance subscale score and the frequency of thinking about their own death, their general living conditions, or gender (p > .05). However, there was a weak significant difference with the variable of having lost a loved one (p < .05). The scores of those who lost a loved one were higher compared to the others (Table 4).

There was no significant difference between the participants’ mean fear of death and death avoidance subscale score and the variables of gender, general living conditions, and having lost a loved one (p > .05). However, there was a weak significant difference between the participants’ mean fear of death and death avoidance subscale score and their number of siblings and the frequency of participants thinking about their own death (p < .05). Participants who had three siblings and those who thought about their own death occasionally had higher scores than the others (Table 4).

There was no significant difference between the mean total ATDS score of participants and the variables of general living conditions and having lost a loved one (p > .05). However, there was a weak significant difference with gender (p < .05). The scores of participants who had three siblings, who thought about their own death occasionally, and who were female were higher compared to the others (Table 4).

Correlation Between Participants’ Belief in a Just World Scale and Attitude Towards Death Scale Subscale Scores

There was a weak correlation between the participants’ neutral and approach acceptance subscale score and their scores on the fear of death and death avoidance subscales, and total BJWS and its subscales; there was a moderate correlation between the participants’ neutral and approach acceptance subscale scores and their escape acceptance subscale score; and there was a close and significant correlation between the participants’ neutral and approach acceptance subscale score and their ATDS score. There was little correlation between the escape acceptance and the fear of death and death avoidance subscale scores and a close and significant correlation between the escape acceptance subscale score and the ATDS score. There was a moderate and significant correlation between the fear of death and death avoidance subscale score and the total ATDS and subscales scores. A weak correlation was found between the ATDS score and total BJWS and its subscales (Table 5).

Table 5.

Correlation Between Students’ Belief in a Just World Scale and Attitude Towards Death Scale subscale Scores (n = 270).

		1	2	3	4	5	6	7
Neutral acceptance and approach acceptance	r	1
Neutral acceptance and approach acceptance	p	-
Escape acceptance	r	0.549**	1
Escape acceptance	p	0.00	-
Fear of death and death avoidance	r	0.214**	0.154*	1
Fear of death and death avoidance	p	0.00	0.01	-
Total ATDS	r	0.883**	0.687**	0.593**	1
Total ATDS	p	0.00	0.00	0.00	-
PBJWS	r	0.340**	0.02	0.06	0.248**	1
PBJWS	p	0.00	0.78	0.36	0.00	-
GBJWS	r	0.365*	0.111	0.01	0.271**	0.661**	1
GBJWS	p	0.00	0.07	0.85	0.00	0.00	-
Total BJWS	r	0.386**	0.067	0.039	0.283**	0.925**	0.897**	1
Total BJWS	p	0.00	0.275	0.527	0.00	0.00	0.00	-

**(p < .01), *(p < .05).

There was a strong and significant correlation between the PBJWS and GBJWS subscales and a close and significant correlation between the PBJWS and BJWS scores. Additionally, there was a close and significant correlation between the GBJWS and BJWS scores (Table 5).

Regression Between the Attitude Towards Death Scale and Belief in a Just World Scale Subscale Scores

There was a positive and significant correlation between the ATDS and total BJWS and subscales scores. Neutral and approach acceptance explained 78% of the total change in ATDS, escape acceptance explained 47% and fear of death and death avoidance explained 35%. PBJWS explained 6% of the total change in ATDS, PBJWS explained 7%, and BJWS explained 8%. A single unit increase in neutral and approach acceptance caused an increase of 1.364 in the ATDS score; a single unit increase in escape acceptance caused an increase of 2.560; and a single unit increase in fear of death and death avoidance caused an increase of 1.437. A single unit increase in PBJWS caused an increase of 1.176 in the ATDS score; a single unit increase in GBJWS caused an increase of 1.496; and a single unit increase in BJWS caused an increase of 0.794 (Table 6).

Table 6.

Regression Between Attitude towards Death Scale and Belief in a Just World Scale Subscale Scores (n = 270).

Model	ATDS
Model	B	Sd	β	T	P	R²
Neutral acceptance and approach acceptance	1.364	0.044	0.883	30.767	0.000	0.779
Escape acceptance	2.560	0.165	0.687	15.485	0.000	0.472
Fear of death and death avoidance	1.437	0.119	0.593	12.042	0.000	0.351
PBJWS	1.176	0.281	0.248	4.187	0.000	0.061
GBJWS	1.496	0.325	0.271	4.607	0.000	0.073
Total BJWS	0.794	0.164	0.283	4.839	0.000	0.080

Discussion

People need to believe in a just world to appropriately deal with uncontrollable or unexplained life events. Belief in a just world facilitates the ability to cope with these events by developing a sense of control. Perceiving an event as unjust may increase anger and anxiety by damaging the inner peace of an individual (Krehbiel & Cropanzano, 2000), where, on the contrary, it may also trigger helping behaviors (Zuckerman, 1975). Belief in a just world within a professional group, such as the nursing profession, who provide care to sick individuals, witness positive and negative experiences of people, and frequently encounter death, can affect their attitudes towards death. Thus, this study was conducted to examine the relationship between nursing students’ beliefs in a just world and their attitudes towards death. The findings of the study were discussed in line with literature.

Belief in a just world plays a key role in choosing how to react to negative events that may occur throughout an individual’s lifetime and in preventing negative consequences that may compromise the individual’s well-being so that s/he can view life with confidence and protect his/her mental health (Dalbert, 1999, 2002). Several studies reported that a strong belief in a just world helps to cope with factors that cause stress such as death, while a weak belief in a just world has a negative effect (Ehlers & Clark, 2000; McMillen et al., 2002; Powell & Penick, 1983). Landau et al. reported that people with a high belief in a just world are more sensitive to death. In this study, it was determined that as nursing students’ beliefs in a just world increased, they developed positive attitudes towards death. In the study conducted by Zheng et al. (2016) with nurses, it was stated that spirituality, one of the coping strategies against death, affects attitudes towards death. This finding is similar to the relevant findings in the literature.

Belief in a just world consists of two sub-dimensions: general belief and personal belief. Personal belief in a just world is related to how just the events that happen to a person are perceived (Dalbert, 2002). The general belief in a just world is related to how just the events that happen to others are perceived. In this study, personal belief in a just world was low among the nursing students who defined their economic level as low, whereas the level of belief in a just world was high in the nursing students who evaluated their living conditions as good. In this study, it was expected that nursing students who perceived their economic level, an important survival factor, as low, and those who evaluated their general living conditions as good, personally had a high level of belief in a just world.

Individuals may lose their belief that the world is a just place because of negative life experiences. Studies on people’s basic beliefs reported that these beliefs may change if individuals are exposed to traumatic experiences (Janoff-Bulman & Wortman, 1977; Lerner and Miller, 1978; Epstein, 1990). Chronic diseases are life experiences that negatively affect individuals’ lives. In this study, the belief in a just world was found to be high in nursing students without a chronic disease. The result of this study supports the relevant literature findings.

Neutral and approach acceptance, which are among the sub-dimensions of attitudes towards death, are defined as believing that death is an inevitable part of life and life after death. Escape acceptance is defined as believing that death will save one from the physical or psychological harms of life. The fear of death and death avoidance are concepts defined as avoiding thinking or talking about death to reduce the fear that an individual feels when approaching death and the anxiety caused by it. When the attitude towards death subscales were examined, it was determined that neutral and approach acceptance had the highest mean score and that the escape acceptance subscale had the lowest mean score. This finding shows that nursing students believed that death is a real phenomenon. Likewise, in the study of Kumar et al. (2014), neutral and approach acceptance had the highest mean score whereas escape acceptance had the lowest mean score. Ozveren et al. (2022) examined the nursing students’ attitudes towards death prior to providing death education to these students and determined that the lowest score was obtained on the fear of death subscale and that the highest score was obtained on the neutral acceptance subscale. Contrary to this study, in the study conducted by Tuzer et al. (2020) with nursing students, research participants had the highest score for the fear of death subscale.

In this study, the mean score was found to be high on the escape acceptance subscale of the nursing students who lost a loved one. Likewise, Ustundag et al. (2019) reported that the escape acceptance subscale score was found to be higher in nursing students who experienced death in their immediate environment compared to nursing students who did not have this experience. The results of this study are consistent with literature.

In this study, it was determined that females developed positive attitudes towards death. In the study conducted by Alicilar et al. (2021) with nurses, female scores on the attitude towards death scale were found to be higher than men. Contrary to this study, some studies reported that gender does not affect the attitude towards death scale score (Bilge et al., 2013). It is thought that the result of this study was due to the high number of female nursing students that participated in the study.

Conclusion

The nursing profession is a professional group that encounters and provides care to terminally ill patients. The death and suffering of others evoke various emotions in all people (Bermejo et al., 2018). The awareness of death and the process of coping with death are important for nurses since they deal with dying patients and encounter death daily (Edo-Gual et al., 2015). It is important for nurses to have a high level of belief in a just world, which is stated to increase sensitivity to death, the sense of helping, and the ability to cope with death. Nurses with a high belief in a just world can thus better understand their patients and provide more effective care. Raising nurses’ beliefs in a just world, raising awareness on their feelings about death, and developing positive attitudes towards death by organizing education programs on the topic, will contribute to the provision of quality care to dying patients and provide effective coping mechanisms for nurses.

Footnotes

Acknowledgments

The authors wish to thank all participants for engaging in this study.

Authors’ Contributions

MDI: Study conception, designed data analysis, wrote of the manuscript, approved final version to be published. GUK: Data analysis, approved final version to be published.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Informed Consent

Informed consent was obtained from all participants in this study.

ORCID iD

Mahinur Durmus Iskender

Author Biographies

Gülşen ULAŞ KARAAHMETOĞLU, is an assistant professor of Fundamentals of Nursing at the Kastamonu University, Turkey. Her primary research focuses on the nursing practice, and nursing education. Her research uses both qualitative and quantitative tecniques.

Mahinur DURMUŞ İSKENDER, PhD, RN, is an assistant professor of Fundamentals of Midwifery at the Kastamonu University, Turkey. She is interested in ethics issues on end of life, ethics education, nursing pratice and nursing education. Her research uses both qualitative and quantitative tecniques.

References

Alıcılar

H.E.

Aylaz

Güneş

Çöl

(2021). Hemşirelerin Ölüme Karşı Tutumları ve İlişkili Faktörler: Farklı İki Hastane Örneği. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 74(2), 149–155. https://doi.org/10.4274/atfm.galenos.2021.07742

Bermejo

J.C.

Villacieros

Hassoun

(2018). Actitudes hacia el cuidado de pacientes al final de la vida y miedo a la muerte en una muestra de estudiantes sociosanitarios. Medicina Paliativa, 25(3), 168–174. https://doi.org/10.1016/j.medipa.2017.02.004

Bilge

Embel

Kaya

F.G.

(2013). Sağlık Profesyoneli Olacak Öğrencilerin Ölüme Karşı Tutumları, Ölüm Kaygıları arasındaki İlişki ve bunları etkileyen değişkenler. Psikiyatri Hemşireliği Dergisi, 4(3), 119–124. https://doi.org/10.5505/phd.2013.08108

Braun

Gordon

Uziely

(2010). Associations between oncology nurses' attitudes toward death and caring for dying patients. Oncology Nursing Forum, 37(1), E43–E49. https://doi.org/10.1188/10.ONF.E43-E49

Janoff-Bulman

Wortman

C. B.

(1977). Attributions of blame and coping in the "real world": Severe accident victims react to their lot. Journal of Personality and Social Psychology, 35(5), 351–363. https://doi.org/10.1037/0022-3514.35.5.351

Byeon

D. H.

Park

M.H.

(2017). Effects of death preparation education on nursing students' perceptions about the meaning of life, death and well-dying and hospice. Journal of the Korea Academia-Industrial Cooperation Society, 18(5), 169–176. https://doi.org/10.5762/KAIS.2017.18.5.169

Cevik

Kav

(2013). Attitudes and experiences of nurses toward death and caring for dying patients in Turkey. Cancer Nursing, 36(6), E58–E65. https://doi.org/10.1097/NCC.0b013e318276924c

Dalbert

(1999). The world is more just for me than generally: About the personal belief in a just world scale's validity. Social Justice Research, 12(2), 79–98. https://doi.org/10.1023/A:1022091609047

Dalbert

(2002). Beliefs in a just world as a buffer against anger. Social Justice Research, 15(2), 123–145. https://doi.org/10.1023/A:1019919822628

10.

Edo-Gual

Monforte-Royo

Tomás-Sábado

(2015). Afrontar el sufrimiento y la muerte: Desafíos para el cuidado en el siglo xxi [Coping with suffering, dying and death: Challenges for care in the 21st century]. Enfermeria Clinica, 25(1), 42–43. https://doi.org/10.1016/j.enfcli.2014.10.002

11.

Ehlers

Clark

D. M.

(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/s0005-7967(99)00123-0

12.

Epstein

(1990). Cognitive-experimental self theory. In Pervin

(Ed.), Handbook of personality theory and research (pp. 165–192). Guilford Press.

13.

Fehring

R. J.

Miller

J. F.

Shaw

(1997). Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncology Nursing Forum, 24(4), 663–671.

14.

Göregenli

(2003). Şiddet, kötü muamele ve İşkenceye İlişkin değerlendirmeler, tutumlar ve deneyimler. İşkencenin Önlenmesinde hukukçuların rolü projesi raporu. İzmir Barosu Yayınları.

15.

Iranmanesh

Savenstedt

Abbaszadeh

(2008). Student nurses' attitudes towards death and dying in south-east Iran. International Journal of Palliative Nursing, 14(5), 214–219. https://doi.org/10.12968/ijpn.2008.14.5.29488

16.

Işık

Fadıloğlu

Ç.

Demir

(2009). Ölüme Karşı Tutum Ölçeğinin Türkçe Çevirisinin Hemşire Popülasyonunda Geçerlik ve Güvenilirlik Çalışması. Hemşirelikte Araştırma Geliştirme Dergisi, 11(2), 28–43.

17.

Khader

Jarrah

Alasad

(2010). Influences of nurses’ characteristics and education on their attitudes towards death and dying: A review of literature. International Journal of Nursing and Midwifery, 2(1), 1–9. https://doi.org/10.5897/IJNM.9000024

18.

Krehbiel

P. J.

Cropanzano

(2000). Procedural justic, outcome favorability, and emotion. Social Justice Research, 13(4), 339–360. https://doi.org/10.1023/A:1007670909889

19.

Kumar

S. P.

Chris

Pais

Sisodia

Kumar

K. V.

(2014). Nursing students’ perceived attitudes towards death: A cross-sectional survey. Indian Journal of Forensic Medicine and Pathology, 7(1), 5–15.

20.

Lerner

(1980). The belief in a just world: A fundamental delusion. Plenum Press.

21.

Lerner

M. J.

Miller

D. T.

(1978). Just world research and the attribution process: Looking back and ahead. Psychological Bulletin, 85(5), 1030–1051. https://doi.org/10.1037/0033-2909.85.5.1030

22.

Maes

Kals

E. J.

(2002). Beliefs in school: Distinguishing ultimate and immanent justice. Social Justice Research, 15(3), 227–244. https://doi.org/10.1023/A:1021010512478

23.

Maes

Schmitt

(1999). More on ultimate and immanent justice: Results from the research project “Justice as a problem within reunified Germany. Social Justice Resarch, 12(2), 65–78. https://doi.org/10.1023/a:1022039624976

24.

Mcmillen

North

CS.

Mosley

Smith

EM.

(2002). Untangling the psychiatric comorbidity of posttraumatic stress disorder in a sample of flood survivors. Comprehensive Psychiatry, 43(6), 478–485. https://doi.org/10.1053/comp.2002.34632

25.

Özveren

Gülnar

Çalışkan

(2022). Effect of storytelling Technique on the attitudes of nursing students toward death. OMEGA - Journal of Death and Dying, 84(3), 870–883. https://doi.org/10.1177/0030222820921026

26.

Powell

B. J.

Penick

E. C.

(1983). Psychological distress following a natural disaster: A one-year follow-up of 98 flood victims. Journal of Community Psychology, 11(3), 2692–3276. https://doi.org/10.1002/1520-6629(198307)11:3<269::AID-JCOP2290110311>3.0.CO;2-5

27.

Robinson

Epps

(2017). Impact of a palliative care elective course on nursing students' knowledge and attitudes toward end-of-life care. Nurse Educator, 42(3), 155–158. https://doi.org/10.1097/NNE.0000000000000342

28.

Rubin

ve Peplau

(1975). Who believes in a just world? Journal of Social Issues, 31(3), 65–89. https://doi.org/10.1111/j.1540-4560.1975.tb00997.x

29.

Tüzer

Kırca

Özveren

(2020). Investigation of nursing students’ attitudes towards death and their perceptions of spirituality and spiritual Care. Journal of Religion Health, 59(4), 2177–2190. https://doi.org/10.1007/s10943-020-01004-9

30.

Üstündağ

Babadağ Savaş

Yıldırım

Usta Yeşilbalkan

Ö.

(2019). Hemşirelik Öğrencilerinin Ölüme Karşı Tutumlarının İncelenmesi. Türkiye Klinikleri Tıp Etiği-Hukuku Tarihi Dergisi, 27(3), 269–276. https://doi.org/10.5336/mdethic.2019-65931

31.

Wong

P. T.

Reker

G. T.

Gesser

(1994). Death attitude profile--revised (DAP-R) [database record]. APA PsycTests. https://doi.org/10.1037/t17237-000

32.

Yiğit

(2020). İslâm Filozoflarına Göre Ölümün Mahiyeti” [the definition of death according to the Muslim Philofophers]. Pamukkale Üniversitesi İlahiyat Fakültesi Dergisi-Pamukkale University Journal of Divinity Faculty, 7/1, 717–741.

33.

Ren

Huang

Wang

(2018). Undergraduates’ belief in a just world and subjective well-being: The mediating role of sense of control. Social Behavior and Personality: An International Journal, 46(5), 831–840. https://doi.org/10.2224/sbp.6912

34.

Zheng

Lee

S. F.

Bloomer

M. J.

(2016). How new graduate nurses experience patient death: A systematic review and qualitative meta-synthesis. International Journal of Nursing Studies, 53, 320–330. https://doi.org/10.1016/j.ijnurstu.2015.09.013

35.

Zuckerman

(1975). Belief in a just world and altruistic behavior. Journal of Personality and Social Psychology, 31(5), 972–976. https://doi.org/10.1037/h0076793