Psychological Empowerment as a Moderator in the Pathway From Attitudes Toward Care of the Dying to Palliative Care Competency Among Nursing Students: A Serial Mediation Model of Self-Efficacy and Resilience

Why It Matters

Enhancing empowerment and resilience in nursing education can dramatically improve palliative care readiness, addressing the growing end‑of‑life demand worldwide.

Key Takeaways

• 996 Chinese nursing interns surveyed across 42 hospitals
• Attitudes toward dying boost competence (β=0.594)
• Empowerment strengthens attitude‑self‑efficacy link (β=0.076)
• Self‑efficacy and resilience mediate 60% of effect

Pulse Analysis

The global surge in elderly populations is stretching health systems and creating an urgent need for competent palliative care providers. Nursing students serve as the pipeline for this workforce, yet their readiness hinges on both cognitive attitudes toward death and the psychological resources they can draw upon. By quantifying how positive attitudes toward the dying translate into measurable competence, the study underscores that affective dispositions are not peripheral but central to clinical preparedness.

The research reveals a nuanced chain of influence: attitudes first boost self‑efficacy, which then enhances resilience, together driving competence. The moderated mediation model shows that psychological empowerment—students’ sense of autonomy, impact, and meaning—intensifies the attitude‑self‑efficacy connection, albeit with a modest coefficient (β = 0.076). Still, this amplification translates into a substantial indirect effect, explaining over half of the total variance. Such findings validate the theory that empowerment acts as a catalyst, unlocking the full potential of positive attitudes and personal efficacy.

For educators and policymakers, the implications are clear. Curriculum designers should embed empowerment‑building activities—such as reflective simulations, decision‑making autonomy, and mentorship—to reinforce self‑efficacy and resilience. Institutional support structures that nurture psychological safety can further solidify these gains. As other regions confront similar demographic shifts, adopting evidence‑based empowerment strategies could accelerate the development of a palliative‑ready nursing workforce, ultimately improving end‑of‑life care quality worldwide.