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PLoSOne 21(1): e0339674. [https://doi.org/10.1371/](https://doi.org/10.1371/)[ ](https://doi.org/10.1371/)[journal.pone.0339674](journal.pone.0339674)  \nEditor: Vinit Kumar Ramawat, Noida International University, INDIA  \nReceived: December 9, 2024  \nAccepted: December 10, 2025  \nPublished: January 6, 2026  \nPeer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0339674  \nCopyright: © 2026 Kiarie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution,  \nRESEARCH ARTICLE  \nPatient death and nurses’ coping strategies: Perception of nurses at a tertiary referral hospital in Kenya  \nPeris Wategi Kiarie1*, Gabriel Okombo1, Wambui Makobu2, Joel Ambikile3, Mary B. Adam2,4,5  \n1 College of Health Sciences, AIC Kijabe Hospital-Kiambu, Kenya, 2 Community Health, Maternal and NewBorn, AIC Kijabe Hospital-Kiambu, Kenya, 3 School of Nursing, Muhimbili University of Health and Allied Sciences, Tanzania, 4 Department of Research, AIC Kijabe Hospital-Kiambu, Kenya, 5 The African Consortium for Quality Improvement Research in Frontline Healthcare (ACQUIRE), Nairobi, Kenya  \n* [wategiperis46@gmail.com](wategiperis46@gmail.com)  \nAbstract  \nIn healthcare facilities, patient deaths are a common occurrence, exposing nurses to diverse behavioral and emotional reactions, particularly within the context of resource constraints in Kenyan healthcare settings. This study aimed to investigate the experiences of nurses at AIC Kijabe Hospital in Kenya regarding patient death and their coping strategies. The focus group discussions sought to understand factors influencing nurses’ reactions to death, assessing the adequacy of their basic training in preparing them for coping, exploring the determinants of their coping strategy choices, and gathering recommendations for enhancing coping mechanisms. Employing qualitative research, six focus group discussions were conducted with 50 nurses from various hospital departments, including the emergency department, medical and surgical wards, intensive care unit, and maternity ward. After data collection, the information was transcribed verbatim and analyzed using a thematic analysis approach with inductive coding. Two researchers independently coded the data. A code was an identifying term for a specific part with emphasis on the aspect being investigated. Subsequently, the research team met to compare the codes and reached a consensus on the best interpretation of the data codes. The coding was then categorized into themes and Subthemes. The study findings revealed four overarching themes:  \nindividual process, institutional process, work team relationships, and educational gaps. In the individual process, nurses disclosed factors influencing their reactions to and feelings about death, encompassing Stress injuries, views of life (pessimism or optimism), cultural background, religious beliefs, and self-drive/self-management. Nurses expressed immediate emotional responses to the word “death” and conveyed the emotional toll of losing patients. The institutional process delved into how the hospital assisted nurses in coping with patient deaths, revealing a lack of support or guidance in selecting coping mechanisms. Nurses advocated for psychological  \nPLOS One | [https://doi.org/10.1371/journal.pone.0339674](https://doi.org/10.1371/journal.pone.0339674) January 6, 2026 1 / 23  \nand reproduction in any medium, provided the original author ","cbCailPrw9J9OUMt","https://ap.wps.com/l/cbCailPrw9J9OUMt","pdf",485965,23,"English","# Abstract\n## Study aim and setting\n## Methods\n## Data analysis\n## Key findings\n# Introduction\n## Patient death as an unavoidable reality","[{\"question\":\"What was the study aimed to investigate?\",\"answer\":\"The study investigated nurses’ experiences related to patient death at AIC Kijabe Hospital and how nurses cope, including factors influencing their reactions and coping strategy choices.\"},{\"question\":\"How was the study conducted?\",\"answer\":\"Six focus group discussions were conducted with 50 nurses from multiple hospital departments, including emergency, medical and surgical wards, intensive care unit, and maternity ward.\"},{\"question\":\"What were the study’s main themes?\",\"answer\":\"The findings identified four overarching themes: individual process, institutional process, work team relationships, and educational gaps.\"}]","Patient death and nurses’ coping strategies: Perception of nurses at a tertiary referral hospital in Kenya | PDF",1790709999,58]