Satisfactions and stresses experienced by professional nurses in hospice programs

Abstract

IntroductionConcern about quality care can never be divorced from concern about the caregiver. It is well recognized that nurses caring for the terminally ill are in situations which place them at risk for experiencing high stress. Moreover, we believe that an awareness of the satisfactions experienced by such nurses is important. This study contributes to the understanding of specffic satisfying and stressful work-related experiences that can indirectly enhance or diminish the quality of hospice nursing care.The decade of the 1980s is affirming hospice care as a viable option in the health care system. The role of the nurse on the interdisciplinary hospice team is an important one. Because this is still a relatively new work setting for nurses, much needs to be learned about these caregivers. What do some professional nurses report as their most satisfying and their most stressful experiences in the work setting? Are there any relationships between these reports of satisfying and stressful experiences and other factors? What insights can be gained which would help to sustain professional and personal integrity of nurses in the highly intense hospice context? Could the maximizing ofwork-related satisfactions be a more effective approach to stress reduction than merely minimizing stresses? Might practicalguidelines regarding recruitment, retention, and staff development in hospice programs be suggested by answers to these questions?

Staff stress in hospice/palliative care: a review

“…6,7,10,11,[13][14][15]17,19,20,21,[24][25][26][27]29,32 In assessing the data in the Appendix, the reader is reminded that the major studies being reviewed are listed chronologically from reference 6 to reference 34. Any issue that was initially identified, and continues to be noted, reflects an area that is recognized as a continued stressor.…”

“…34 The nature of the system involved problems with constant exposure to dying patients and their family members,20 and frustration with perceived threats to quality care as reimbursement and funding became major issues. 17,75 Inadequate resources included financial concerns,15,20 frustration with the perceived incompetency of care given,17 staff shortages29,32 and a lack of volunteer availability.23 Unrealistic expectations of the system: When funds were limited and there were staffing shortages, the organization often expected staff to volunteer their services or to work extended hours for little or no pay. 20 Staff reported stress caused by difficult work schedules and on-call scheduleslo; some reported work overload,29 while others found that a home care programme allowed for a more reasonable work-load than did inpatient oncology units.3a…”

“…16,2°S upport from colleagues is very important for hospice workers. 9,10,12,1--,-- 17,20,24,26 In the early days of the hospice movement, support from colleagues and family and friends was considered to be important, but more recently support from colleagues to deal with work-related stress has been found to be more effective. Sixty-seven per cent of palliative care nurses used 'talking things over with a colleague' as a coping mechanism, compared with 18% who talked with people at home.…”

“…A variety of instruments have been used; therefore direct comparison is generally not possible. Many authors have developed their own instruments, often basing them on the work of OtherS.6~~~10, [12][13][14]16,17,19,23,25,26,31,34 Usually, httle or no information is given about the reliability or validity of the instruments used.…”

Psychiatry and Terminal Illness

“…An environment with unrealistic workload expectations or a lack of resources to carry out the work itself can also result in caregiver stress (40). In general, it appears that older caregivers (that is, over age 55 years) are less likely to experience burnout than are their younger colleagues (41)(42)(43)(44). While one study reported 22% ofhospice nurses admitting that dealing with the dying was a major stress (45), another demonstrated that, in addition to intractable pain, psychiatric symptoms in patients and dealing with relatives were the major sources ofwork-related stress (46).…”