End-of-life care preparedness program for senior nursing students in Türkiye: Effects on attitudes and self-efficacy in a randomized controlled trial

Aim: To evaluate the effectiveness of an online End-of-Life Care Preparedness Program on senior nursing students’ attitudes toward caring for dying patients and their self-efficacy in end-of-life care. Background: Senior nursing students often experience fear and uncertainty when facing death due to insufficient preparation and limited clinical exposure, which may hinder the provision of quality end-of-life care. Structured, culturally adapted educational interventions are therefore needed to enhance readiness and competence. Design: Randomized controlled trial with pre-test, post-test and one-month follow-up assessments. Methods: Sixty senior nursing students from two universities were randomized to either an intervention group receiving the End-of-Life Care Preparedness Program (four weekly 90-minute online sessions via Microsoft Teams) or a control group continuing routine education. Data were collected between April and June 2025 (pre-test in April, post-test in May, follow-up in June). Outcomes were measured using the Frommelt Attitudes Toward Care of the Dying Scale (FATCOD) and the End-of-Life and Postmortem Self-Efficacy Scale (ELPSES). Data were analyzed using repeated-measures GLM with Bonferroni-adjusted comparisons. Results: The intervention group showed a significant increase in attitudes and self-efficacy from pre-test to post-test, sustained at one-month follow-up (p < 00.001). The control group demonstrated a decline. Time × group interactions were significant for attitudes (F = 31.854, p < 00.001, ηp² =.359) and self-efficacy (F = 14.224, p < 00.001, ηp² =.200). Conclusion: The program significantly improved students’ attitudes and self-efficacy with sustained effects, underscoring the need to integrate culturally sensitive, digitally delivered death education into nursing curricula.