Healthcare workers perceptions in the difficult moment of the end of life and coping strategies adopted during the COVID-19 pandemic: an Italian pilot study

Main Article Content

Elsa Vitale
Luana Conte
Angelica dell'Aglio
Antonino Calabrò
Federica Ilari
Lorenzo Bardone
Angelo Benedetto
Cosimo Caldararo
Simone Zacchino
Alessia Lezzi
Martina Giordano
Maicol Carvello
Maurizio Ercolani
Roberto Lupo


death, coping, covid-19, healthcare workers


Background and Aim of the work. In a society that tries so hard to forget and make people forget that death exists, death has never been so close to man in his daily life as during this pandemic. Health care professionals have therefore all too often had to  deal with the death of the people they care for and with related issues such as, for example, the dignity of death, the humanization of death and care for the dying. The aim of the study is to highlight the perceptions of physicians, nurses and health and social workers in the difficult moment of the end of life, also analyzing which coping strategies were implemented by them.

Methods. All Italian healthcare workers were enrolled in this survey. The questionnaire was administered in an online version. Physicians, nurses and support staff (social and health workers) were contacted through social networks.

Results. A total of 512 healthcare workers were enrolled in this survey. No statistical significant differences were recorded among the COPE-NVI- 25 sub dimensions according to sex, profession and to different wards. Additionally, by considering the COPE-NVI-25 sub dimensions according to years of work experience, a statistical significant difference was reported in the Transcendent Orientation sub dimension (p=.047), as healthcare workers with 11-20 years of work experience recorded higher levels than the other two groups. By considering differences in the COPE-NVI-25 sub dimensions according to religion, significant differences were recorded in the transcendent orientation (p=.032), in the positive attitude (p=.030), in the social support (p=.035).

Conclusions. From the evidence in the literature, the quality of end-of-life care performance has a positive correlation with awareness of a good death and attitudes towards end-of-life care.


Download data is not yet available.
Abstract 458 | PDF Downloads 421


1. Ministry of Health. New Coronavirus. Available from: Accessed on: 28 July 2021.
2. Giannantonio Barbieri, La morte ai tempi del coronavirus. Rifessioni sulla cura nel fine vita, Opi of the Province of Bologna, 2020.
3. Vitale E, Galatola V, Mea R. Observational study on the potential psychological factors that affected Italian nurses involved in the Covid-19 health emergency. Acta Biomed for Health Professions 2021; 92(2): e2021007.
4. Vitale E, Galatola V, Mea R. Knowledge on the COVID-19 pandemic and the nursing role influence anxiety and depression levels: a descriptive correlational study between nurses and general population. Journal of Psychopathology 2021; 27:115-121.
5. Bagnasco A, Zanini M, Hayter M, Catania G, Sasso, L. COVID 19 - A message from Italy to the global nursing community. Journal of Advanced Nursing 2020; 76(9): 2212-2214.
6. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, Xia L, Liu Z, Yang J, Yang BX. Health care providers' experiences during the covid-19 crisis in China: a qualitative study. The Lancet Global Health 2020; 8(6): e790-e798.
7. Vitale E, Giammarinaro MP, Lupo R, Fortunato S, Archetta V, Caldararo C, Germini F. The quality of patient-nurse communication perceived before and during the Covid-19 pandemic: an Italian pilot study. Acta Biomed 2021; 92(2): e2021035.
8. Vitale E, Galatola V, Mea R. Exploring within and between gender differences in burnout levels in Italian nurses engaged in the Covid-19 health emergency: a cohort observational study. Minerva Psychiatr. 2020, 61(4):162-70.
9. Vitale E, Casolaro S. Anxiety, Burnout and Depression levels according to sex and years of work experience in Italian nurses engaged in the care of Covid-19 patients. Journal of Evidenced-Based Psychotherapies 2021; 21(1): 83-96.
10. Vitale E, Mea R, Di Dio F, Canonico A, Galatola V. Anxiety, Insomnia and Body Mass Index scores in Italian nurses engaged in the care of COVID-19 patients. Endocr. Metab. Immune. Disord. Drug Targets 2020: 20:1. Epub ahead of print.
11. Vitale E. The Mindfulness and the Emotional Regulation Skills in Italian Nurses During the COVID-19 Pandemic: A Descriptive Survey-Correlational Study. Journal of Holistic Nursing 2021; 08980101211015804.
12. Carriero MC, Conte L, Calignano M, Lupo R, Calabrò A, Santoro P, Artioli G, Caldararo C, Ercolani M, Carvello M,Leo A. The psychological impact of the Coronavirus emergency on physicians and nurses: an Italian observational study, Acta Biomed for Health Professions 2021; 92(2): e20210300.
13. Jöbges S, Denke C, Kumpf O, Hartog CS. Gesprächsführung mit Angehörigen. Med Klin Intensivmed Notfmed 2019; 114: 122-127.
14. Zhang YY, Han WL, Qin W, et al. Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis. J Nurs Manag. 2018;26: 810-819
15. Kerr F, Wiechula R, Feo R, Schultz T, Kitson A. Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review. JBI Database of Systematic Reviews and Implementation Reports. 2019; 17(2):209-247.
16. Foà C, Tonarelli A, Caricati L, Fruggeri L. COPE-NVI-25: Italian validation of the reduced version of the Coping Orientation to the Problems Experienced (COPE-NVI). Health Psychology 2015; 123-141.
17. Sica C, Magni C, Ghisi M, Altoè G, Sighinolfi C, Chini LR, Franceschini S. An updated instrument for measuring coping styles: the Coping Orientation to the Problems Experienced New Italian Version (COPE-NVI). Cognitive and Behavioural Psychotherapy 2008; 14(1): 27- 54.
18. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Stud 2020; 44(7):393-401.
19. Kuek JTY, Ngiam LXL, Kamal NHA, Chia JL, Chan NPX, Abdurrahman ABHM, Ho CY, Tan LHE, Goh JL, Khoo MSQ, Ong YT, Chiam M, Chin AMC, Mason S, Krishna LKR. The impact of caring for dying patients in intensive care units on a physician's personhood: a systematic scoping review. Philos Ethics Humanit Med. 2020; 15(1):12.
20. Chan WC, Tin AF, Wong KL, Tse DM, Lau KS, Chan LN. Impact of Death Work on Self: Existential and Emotional Challenges and Coping of Palliative Care Professionals. Health Soc Work. 2016; 41(1):33-41. Erratum in: Health Soc Work. 2016 May;41(2):73. Fong, Agnes [corrected to Tin, Agnes Fong].
21. Chan WC, Tin AF. Beyond knowledge and skills: self-competence in working with death, dying, and bereavement. Death Stud. 2012; 36(10):899-913.
22. Brockopp DY, King DB, Hamilton JE. The dying patient: A comparative study of nurse caregiver characteristics. Death Stud 1991; 15: 245-8.
23. Kim SK, Kim SH, Yun HY. Factors that influence end-of-life care provided by nurses in general hospitals. J Korean Med Ethics 2019; 22:53-72.
24. Schwartz CE, Mazor K, Rogers J, Ma Y, Reed G. Validation of a new measure of concept of a good death. J Palliat Med 2003; 6:575-84.
25. Rolland RA, Kalman M. Nurses' attitudes about end-of-life referrals. J N Y State Nurses Assoc 2007; 38:10-2.
26. Noh SS, Lee CK, Sung YH. Predictors of terminal care performance of clinical nurses for cancer patients. J Korean Critical Care Nurs 2016; 9:61-70.
27. Reed PG. Theory of Self-Transcendence. In: Smith MJ, Liehr PR, editors. Middle Range Theory for Nursing. 2nd ed. New York: Springer Publishing Company, LLC; 2008; 105-29.
28. Reed PG. Theory of self-transcendence. In: Smith MJ, Liehr PR, editors. Middle range theory for nursing. 4th ed. New York: Springer Pub; 2018; 119-46.
29. Erikson EH. Childhood and society. New York: W.W. Norton & Company, Inc; 1950.
30. Norberg A, Lundman B, Gustafson Y, Norberg C, Fischer R, Lövheim H. Self-transcendence (ST) among very old people - Its associations to social and medical factors and development over five years. Archives of Gerontology and Geriatrics 2015; 61(2). https://doi:10.1016/j.archger.2015.04.003
31. Hoshi M. Self-transcendence, vulnerability, and well-being in hospitalized Japanese elders.
Tucson: University of Arizona; 2008.
32. Iwamoto R, Yamawaki N, Sato T. Increased self-transcendence in patients with intractable diseases. Psychiatry Clin Neurosci. 2011; 65:638–47.
33. Neill J. Transcendence and transformation in the life patterns of women living with rheumatoid arthritis. Adv Nurs Sci. 2002;24(4):27–47.
34. Ho H-M, Tseng Y-H, Hsin Y-M, Chou F-H, Lin W-T. Living with illness and self- transcendence: the lived experience of patients with spinal muscular atrophy. J Adv Nurs. 2016;72(11): 2695–705.
35. Fanos JH, Gelinas DR, Foster RS, Postone N, Miller RG. Hope in palliative care: from narcissism to self-transcendence in amyotrophic lateral sclerosis. J Palliat Med. 2008;11(3):470–5.
36. McCarthy VL, Ling J, Bowland SE, Hall LA, Connelly J. Promoting self-transcendence and well-being in community-dwelling older adults: a pilot study of a psychoeducational intervention. J Geriatric Nurs. 2015; 36(6):431–7.
37. McCarthy VL, Hall LA, Crawford TN, Connelly J. Facilitating self-transcendence: an intervention to enhance well-being in late life. West J Nurs Res. 2018; 40(6):854-73.
38. Song EH, Lee HK. Effects of good death awareness and spiritual well-being on elderly nursing performance of geriatric hospital nursing providers. J Korean Appl Sci Technol 2019;36:975- 84.
39. Koenig H, King D, Carson VB. Handbook of Religion and Health (2nd ed.). Oxford: Oxford University Press; 2012.
40. McSherry W, Cash K. The language of spirituality: An emerging taxonomy. International Journal of Nursing Studies 2004; 41(2): 151-161.
41. Hill PC, Pargament KI, Hood RW, McCullough JME, Swyers JP, Larson DB, Zinnbauer BJ. Conceptualizing Religion and Spirituality: Points of Commonality, Points of Departure. Journal for the Theory of Social Behaviour 2000; 30: 51-77.
42. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine 2014;, 17(6): 642-656.

Most read articles by the same author(s)

1 2 > >>