Attachment Styles and Empathy in Trainee Nurses: the Mediating and Moderating Roles of Attitudes Toward Death

Overview

Journal Front Psychol

Date 2024 Aug 20

PMID 39161685

Authors

Ting Wei

Meiyi Guo

Huanle Jin

Bingren Zhang

Affiliations

Soon will be listed here.

Abstract

Aim: A growing body of evidence has shown that attachment styles and death attitudes have a significant impact on empathy. This study aimed to explore the precise role of death attitudes in the relationship between attachment styles and empathy levels among trainee nurses.

Methods: A total of 626 Chinese trainee nurses with different attachment types were enrolled, and their attachment styles, death attitudes, and empathy levels were assessed using the Revised Adult Attachment Scale, the Death Attitude Profile-Revised, and the Jefferson Scale of Empathy-Healthy Professionals, and finally, data from 566 participants were included for statistical analysis.

Results: We found that among trainee nurses with secure attachment type, fear of death, approach acceptance, escape acceptance, and neutral acceptance (-) mediated the relationships between attachment-related avoidance/anxiety and their overall empathy levels and all its dimensions; in the preoccupied type, only neutral acceptance (-) mediated the relationships between attachment-related avoidance and their overall empathy levels and compassionate care; and in the fearful type, only fear of death mediated the relationship between attachment-related avoidance and compassionate care. Furthermore, in the secure type, neutral acceptance attenuated the negative predictions of attachment-related avoidance on overall empathy level and perspective taking.

Conclusion: Attitudes toward death played different mediating and moderating roles in the relationship between attachment styles and empathy among trainee nurses with different attachment types. In addition to acculturated empathy-specific training, targeted education related to death for trainee nurses with different attachment types is needed to prevent their compassion fatigue.

Citing Articles

Influence of psychological resilience on compassion fatigue in nurses in the operating room: a cross-sectional study in China.

Fu C, Wang Y, Shi X, Wang Y, Liu W, Wang G BMC Nurs. 2025; 24(1):90.

PMID: 39856686 PMC: 11762101. DOI: 10.1186/s12912-025-02728-3.

References

Ozeren G . The correlation between emotion regulation and attachment styles in undergraduates. Perspect Psychiatr Care. 2021; 58(2):482-490. DOI: 10.1111/ppc.12902. View

Schaufel M, Nordrehaug J, Malterud K . Hope in action-facing cardiac death: A qualitative study of patients with life-threatening disease. Int J Qual Stud Health Well-being. 2011; 6(1). PMC: 3061819. DOI: 10.3402/qhw.v6i1.5917. View

Scheffold K, Philipp R, Koranyi S, Engelmann D, Schulz-Kindermann F, Harter M . Insecure attachment predicts depression and death anxiety in advanced cancer patients. Palliat Support Care. 2017; 16(3):308-316. DOI: 10.1017/S1478951517000281. View

Medina-Fernandez J, Torres-Soto N, Casco-Gallardo K, Ruiz-Lara A, Martinez-Ramirez B, Fuentes-Fernandez E . Fear and Coping with Death in Intensive Care Nurses: a Structural Model Predictor of Compassion Fatigue. Invest Educ Enferm. 2023; 41(1). PMC: 10152909. DOI: 10.17533/udea.iee.v41n1e12. View

Perez-Chacon M, Chacon A, Borda-Mas M, Avargues-Navarro M . Sensory Processing Sensitivity and Compassion Satisfaction as Risk/Protective Factors from Burnout and Compassion Fatigue in Healthcare and Education Professionals. Int J Environ Res Public Health. 2021; 18(2). PMC: 7828252. DOI: 10.3390/ijerph18020611. View

Mikulincer M, Shaver P . Attachment orientations and emotion regulation. Curr Opin Psychol. 2018; 25:6-10. DOI: 10.1016/j.copsyc.2018.02.006. View

Garnett A, Hui L, Oleynikov C, Boamah S . Compassion fatigue in healthcare providers: a scoping review. BMC Health Serv Res. 2023; 23(1):1336. PMC: 10693134. DOI: 10.1186/s12913-023-10356-3. View

Lo Cricchio M, Musso P, Lo Coco A, Cassibba R, Liga F . The Relation Between Empathy and Aggression: The Role of Attachment Style. Eur J Psychol. 2022; 18(3):319-336. PMC: 9632554. DOI: 10.5964/ejop.4509. View

Wells-English D, Giese J, Price J . Compassion Fatigue and Satisfaction: Influence on Turnover Among Oncology Nurses at an Urban Cancer Center. Clin J Oncol Nurs. 2019; 23(5):487-493. DOI: 10.1188/19.CJON.487-493. View

10.

Decety J . Empathy in Medicine: What It Is, and How Much We Really Need It. Am J Med. 2020; 133(5):561-566. DOI: 10.1016/j.amjmed.2019.12.012. View

11.

Chachula K . A comprehensive review of compassion fatigue in pre-licensure health students: antecedents, attributes, and consequences. Curr Psychol. 2020; 41(9):6275-6287. PMC: 7558253. DOI: 10.1007/s12144-020-01122-3. View

12.

Harrison K . Compassion Fatigue: Understanding Empathy. Vet Clin North Am Small Anim Pract. 2021; 51(5):1041-1051. DOI: 10.1016/j.cvsm.2021.04.020. View

13.

Coulehan J, Platt F, Egener B, Frankel R, Lin C, LOWN B . "Let me see if i have this right...": words that help build empathy. Ann Intern Med. 2001; 135(3):221-7. DOI: 10.7326/0003-4819-135-3-200108070-00022. View

14.

Kural A, Kovacs M . The association between attachment orientations and empathy: The mediation effect of self-concept clarity. Acta Psychol (Amst). 2022; 229:103695. DOI: 10.1016/j.actpsy.2022.103695. View

15.

Nitschke J, Bartz J . The association between acute stress & empathy: A systematic literature review. Neurosci Biobehav Rev. 2022; 144:105003. DOI: 10.1016/j.neubiorev.2022.105003. View

16.

Chen D, Pahilan M, Orlander J . Comparing a self-administered measure of empathy with observed behavior among medical students. J Gen Intern Med. 2009; 25(3):200-2. PMC: 2839329. DOI: 10.1007/s11606-009-1193-4. View

17.

Amir K, Okalo P . Frontline nurses' compassion fatigue and associated predictive factors during the second wave of COVID-19 in Kampala, Uganda. Nurs Open. 2022; 9(5):2390-2396. PMC: 9348371. DOI: 10.1002/nop2.1253. View

18.

Servaty H, Krejci M, Hayslip Jr B . Relationships among death anxiety, communication apprehension with the dying, and empathy in those seeking occupations as nurses and physicians. Death Stud. 1996; 20(2):149-61. DOI: 10.1080/07481189608252747. View

19.

Gama G, Barbosa F, Vieira M . Factors influencing nurses' attitudes toward death. Int J Palliat Nurs. 2012; 18(6):267-73. DOI: 10.12968/ijpn.2012.18.6.267. View

20.

Green J, Berry K, Danquah A, Pratt D . The role of psychological and social factors in the relationship between attachment and suicide: A systematic review. Clin Psychol Psychother. 2020; 27(4):463-488. DOI: 10.1002/cpp.2445. View