Health status of poor, older urban adults compared with key health indicators from the 2023 Korea National Health and Nutrition Examination Survey in the Republic of Korea: a cross-sectional comparati

Nurses caring for dying patients reportedly feel powerless owing to their inability to alter the course of their patients' deaths, fear of handling postmortem procedures, anxiety stemming from the connection between the patients’ death and their mortality, and a profound sense of unsettlement in their values []. According to the American Nurses Association, nurses are obligated to apply their knowledge and skills to end-of-life care and cooperate with other healthcare providers to help patients and their caregivers feel comfortable during end-of-life care []. An end-of-life care attitude is defined as the consistent provision of physical, emotional, social, and spiritual care to patients and their families as they approach the end of life []. Previous research has shown that factors associated with nurses' end-of-life care attitudes include death awareness [], number of end-of-life care encounters, religion, end-of-life care education experience, and spiritual well-being scores []. Nurses with more positive death awareness exhibit more positive end-of-life nursing attitudes []. In addition, nurses who value religion are more likely to have a positive awareness of death []. The more positive a nurse's attitude, the higher their level of end-of-life care performance []. Nurses who recognize the significance of spiritual care are 4.7 times more likely to assess a patient's religious background and four times more likely to incorporate spiritual care into their practice than those who do not [,]. According to the previous study, the nurses’ spiritual well-being was important to those nurses, which also has implications for enhancing the delivery of spiritual care interventions []. This suggests the critical importance of providing training in spiritual care and ensuring that it is provided by healthcare staff. Even among Korean intensive care unit (ICU) nurses who frequently care for terminally ill patients, the level of spiritual care practice was found to be low []. Factors hindering nurses from engaging in spiritual care include feeling unprepared [] and a lack of confidence due to inadequate spiritual nursing education []. In fact, it has been reported that there is a perception that spiritual nursing education is unnecessary in universities and medical institutions [] and that the responsibility for spiritual healing of patients is limited to religious individuals []. In addition, it was reported that Korean nurses’ attitudes toward end-of-life care and its influencing factors differ depending on the department [,,]. ICU nurses are frequently summoned into action before death awareness manifests fully, resulting in high levels of end-of-life care stress []. In comparison, ward nurses experience role overload owing to their heavy workload, compounded by the decision-making and technical aspects of caring for dying patients []. In particular, internal medicine patients are significantly older and have higher severity of patient illness scores than surgical patients []. Therefore, it is necessary to closely investigate whether end-of-life nursing attitudes of nurses differ according to the department.