Impact of WeChat public platform-based education and training on community nurses' attitudes toward death and death coping skills: a prospective multicenter single-group pre-post study.

OBJECTIVE: Death education is relevant to end-of-life nursing care, yet community nurses in primary care often receive little structured preparation in this area. This study developed a WeChat public platform-based death education program through expert consultation and evaluated changes in community nurses' attitudes toward death and death coping skills before and after the program. METHODS: We conducted a prospective before-and-after study in 10 community health centers in Chengdu, China, using a single-group design. The program was developed through two rounds of Delphi consultation and delivered through the WeChat public platform over 2 months. Participants completed the Death Attitude Profile-Revised (DAP-R) and Coping with Death Scale (CDS) before and after training. For paired pre-post comparisons, variables with normally distributed difference scores were examined with paired-samples t-tests, and variables with non-normal difference scores were examined with Wilcoxon signed-rank tests. RESULTS: Seven experts completed both Delphi rounds, with response rates of 100% and authority coefficients of 0.922 and 0.929, respectively. The final program comprised five modules and 32 items. A total of 129 community nurses completed the two-month WeChat-based death education program and both the pretest and posttest assessments. After training, fear of death and death avoidance scores were lower (both p < 0.001). In contrast, natural acceptance (p = 0.054), approach acceptance (p = 0.339), and escape acceptance (p = 0.082) showed no statistically significant change. The CDS mean item score increased from 4.02 ± 0.67 to 4.20 ± 0.60 (p < 0.001; r = 0.72). Self-acceptance of death, death-coping ability, expression of death-related thoughts, life reflection, and ability to discuss death improved (p < 0.001). Funeral handling ability (p = 0.119) and coping with loss (p = 0.141) did not change significantly. CONCLUSION: The WeChat-based program was associated with reduced fear and avoidance of death and improvements in several dimensions of perceived death-coping ability. The absolute increase in the overall CDS mean item score was modest, and the single-group design prevents causal attribution. Controlled studies with longer follow-up and performance-based outcomes are needed.