First Encounters With Mortality: A Qualitative Study of Novice Nurses’ Experiences With a Patient’S Death Under Their Care in Iran Publisher



Shahzeydi A ; Dianati M ; Kalhor F ; Jazi ZH ; Ghohroudi MF
Source: BMC Nursing Published:2025

Abstract

Background: Patient death is an inescapable and emotionally demanding reality in nursing, frequently causing significant stress, particularly for novice nurses. Their limited experience often leaves them psychologically vulnerable to the distress associated with patient mortality and unprepared for sensitive end-of-life communication. Existing research predominantly focuses on experienced nurses, leaving a gap in understanding the unique challenges faced by novice nurses, especially within culturally distinct contexts like Iran, where cultural and religious frameworks profoundly shape grief and death perceptions. This qualitative study aimed to deeply explore the experiences of novice Iranian nurses when encountering patient death in clinical practice. Methods: A qualitative content analysis, guided by Graneheim and Lundman (2004), was used. Twenty novice nurses (less than 36 months clinical experience) were purposively recruited from Iranian hospitals. Data were collected through in-depth, semi-structured interviews. Transcribed interviews underwent rigorous analysis: identifying meaning units, condensation, coding, categorization, and theme development. MAXQDA 2020 facilitated the process. Trustworthiness was ensured via credibility (member checking), dependability (audit trail), confirmability (team discussions), and transferability (thick description). Results: The analysis revealed a significant disconnect between the nurses’ intense personal experiences and the lack of institutional support. Six major themes emerged, detailing their journey from the initial Emotional Turmoil and grappling with Ethical Paradoxes, to identifying significant Systemic Gaps in support and education. This journey prompted a challenging Professional Transformation, forcing nurses to engage in Cultural-Spiritual Meaning-Making and a personal search for Seeking Balance. Conclusion: Novice nurses are left to navigate the trauma of patient death within a system that fails to adequately prepare or support them. The findings highlight an urgent need for healthcare organizations to implement structured support, such as mandatory debriefing and ethics consultations, and for nursing curricula to integrate practical, high-fidelity training in end-of-life care. Supporting novice nurses is essential for fostering resilience, ensuring compassionate care, and strengthening the nursing profession. Clinical trial number: Not applicable. © 2025 Elsevier B.V., All rights reserved.