Oncology Nurses’ Perceptions of Potential Stressors in Cancer Care

Nwozichi C.U and Ojewole F.O

School of Nursing, Babcock University. Ogun State. P.M.B 21244 Ikeja Lagos, Nigeria

*Corresponding Author Email: nwozichichinomso@gmail.com

ABSTRACT:

Nurses working in oncology settings are posed with issues that are potential sources of stress to them. The main objective of this study was to identify the potential issues that are considered sources of stress among oncology nurses. This descriptive study was conducted among 86 nurses working in oncology units in three selected teaching hospitals. A convenient sampling technique was adopted to select the participants. The tool for data collection was a self structured questionnaire constructed based on themes derived from literature review. Study result indicated that increased workload and taking care of critically ill patients are the major sources of stress among oncology nurses. Other sources include lack of support from the organization the nurses work with and challenges with caring for dying patients and relatives. Administrators, managers and individuals interested in furthering the goals of oncology care, including nurses themselves, are therefore challenged to create and maintain mutually supportive environment for providing optimal care to patients and families.

KEYWORDS: Stress, Oncology nurses, issues.

BACKGROUND:

Cancer is a group of diseases characterized by uncontrollable and unregulated growth of the cells of the body. Cancer is a major health problem that occurs in people of all ethnicities.^[1] Over the years, cancer is considered the disease of aging with the majority of cases (76%) diagnosed in those over the age of 5 years but it could also occur in people of all ages.^[2]

Caring for cancer patients appears to be very complex and demanding not only for nursing student but even for professional nurses.^[3] Over the past decades studies have increasingly focused on stress and burn out experienced by nurses working in cancer care and its negative consequences.^[4] As nursing care becomes more technical and complex, stress becomes increasingly more significant to the physical and emotional wellbeing among nursing staff.

In cancer care, nurses are expected to care for many critically ill and dying patients and be able to confront the numerous needs and questions of families. These have been identified as sources of stress. ^[5][6] Coupled with these, the psychological burden increases when personal problems, poor support or organizational difficulties are added.

It is well established that oncology nursing is perceived as a setting that is personally and professionally demanding. Zander et.al ^[7] in their literature review reported that despite the high level of stress among pediatric oncology nurses, resilience is a major factor that could mediate stress in oncology setting. There are reported evidences that caregivers of cancer patients encounter relatively high levels of stress. It was reported in a study^[8] that the overall stress level among nurses was 5.18 on a scale of 0-10. It was concluded that stress among nurses will ultimately affect the quality of care they provide. Optimal care for cancer patients involves the provision physical and psychological care. Nurses are considered key providers of care to cancer patients because they are always with the patients and families to attend to all their needs. Nurses need to be effectively trained to render this critical care. A study reported that effectiveness of care depends on the nurses’ training, skills, attitude and beliefs.^[9] It was also reported by a previously cited study that inadequate knowledge about cancer care giving is a potential source of stress.^[8] Stress could possibly affect the attitude of nurses towards the care of cancer patients.

Studies have been conducted to assess the attitude of nurses towards cancer care. There has been increasing interest in the attitude healthcare providers hold towards cancer and cancer care and the effect they have on the quality of care. Corner (2006) ^[10] found that the attitude of healthcare professionals are largely negative and stereotyped and cancer was expressed as being more devastating than other life threatening diseases.

Still on the issue of stress and burnout in cancer care, a study was conducted by Kash et.al^[11]and findings revealed that nurses experiences burnout, psychological distress and physical symptoms. The result also showed that nurses reported more physical symptoms than other health workers. Another study reported that work organization, relationship with other staff members and care restriction were the identified situations that posed stress on nurses.^[12] However, Schraub and Marx^[13] reported that emotional exhaustion and depersonalization are more prevalent than low personal accomplishment. The findings of Schraub and Marx also showed that burnout and stress is higher in oncology care than AIDS care. They also identified insufficient time, sense of failure, poor management, difficult staff relationship as common causes of burnout. This study therefore was conducted to identify sources of stress as perceived by nurses in cancer care.

MATERIALS AND METHODS:

This descriptive study was conducted among 86 nurses working in oncology units in three selected teaching hospitals. A convenient sampling technique was adopted to select the participants. After receiving the required permission and ethical clearance from the ethical committee, the purpose of the study was explained to the participants and they gave their consent to be included in the study. The tool for data collection was a self structured questionnaire constructed based on themes derived from literature review. The first section of the tool included participants demographic variable and the second measured the sources of stress as perceived by the nurses with items constructed on a scale of 1(strongly disagree) to 6(strongly agree). Data was analysed using SPSS 18.0 at an alpha level of 0.05. The analysis included both descriptive and correlation analysis, t-test , pearson correlation and analysis of variance (ANOVA) were conducted.

RESULT:

The response level was 100%. The mean age of the participants was 43.4 years. Majority of the participants (81%) were female.

Table 1 shows certain issues perceived by nurses as sources of stress during the course of their professional practice. Among the three categories identified, issues with patients and relatives were the major sources of stress perceived by oncology nurses with a standardized mean of 4.24. The next issues perceived by nurses were issues with organization with a standard mean of 4.24.

Generally, issues with high workloads ranked the highest with mean (standard deviation) of 5.34(0.59). The next specific issue perceived by nurses was issue of taking care of cancer patients who are critically ill with mean (Standard deviation) of 5.12(0.78). The least issue constituting stress among oncology nurses was issue co-workers and specifically when co-workers are not cooperative with mean (Standard deviation) of 2.35(0.91)

Table 1: Issues perceived as sources of stress among oncology nurses

Items	Std^© mean	Group mean (SD)	Item mean (SD)
Issues Perceived as sources of stress	3.93	70.75(4.23)
Subscales
ISSUES WITH ORGANIZATION. Effort – Reward imbalance Materials provided are inadequate Nurses are assigned to too many cancer patients/ high workload Lack of in-service training on current trends Nurses are considered inferior among other healthcare professionals Nurses are not given adequate holiday to attend to personal issues There is no appreciation or psychological motivation from supervisors Lack of support Strict organizational rules	4.24	38.21(2.44)	4.64(0.88) 4.45(0.85) 5.34(0.59) 2.98(0.95) 3.64(0.97) 2.93(0.86) 4.22(0.83) 4.91(0.87) 5.05(0.66)
ISSUES WITH PATIENTS AND RELATIVES When the patients are critically ill When there are too many complaints from patients’ relatives Challenges with caring for dying patients Patients need constant monitoring and attention	4.31	17.25(1.9)	5.12(0.78) 4.60(0.89) 4.66(0.97) 3.01(1.13)
ISSUES WITH CO-WORKERS Co-workers are not cooperative Working with incompetent nurses Poor interpersonal relationship with other workers Frequent dispute among healthcare workers Lack of support from co workers	3.06	15.3(2.72)	2.35(0.91) 4.22(1.33) 2.66(0.91) 3.01(1.08) 3.03(0.98)

Table 2. Issues perceived by nurses according to their years of working experience

ISSUES	1-3years	4-6 years	7-9 years	≥10 years	F ratio	P value
ISSUES	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	F ratio	P value
Issues with management	37.22(2.38)	39.48(2.45)	37.83(1.81)	37.94(2.53)	10.03	0.000*
Issues with patients and relatives	18.09(1.83)	16.69(1..99)	17.27(1.73)	17.23(1.96)	4.72	0.003*
Issues with co-workers	15.65(1.90)	15.5 (3.37)	15.14(2.74)	15.00(2.02)	0.75	0.522
Total	70.97(4.57)	71.68(5.17)	70.25(3.44)	70.17(3.53)	1.82	0.143

*significant

Table 2 shows the scores of the issues perceived by nurses according to the nurses’ years of professional experience. It is shown that nurses who are having 4-6 years of working experience scored the highest on the issue with organization with mean (standard deviation) of 39.48(2.45). On the whole, the same group of nurses had the highest total mean score of 71.68 (standard deviation of 5.17). There was a statistically significant relationship between the nurses’ years of experience and their perception of issues with organization and issues with patients and relatives as sources of stress (P value of 0.000 and 0.003 respectively) Considering P≤0.05 as significant.

DISCUSSION:

Study result indicated that increased workload and taking care of critically ill patients are the major sources of stress among oncology nurses. Other sources include lack of support from the organization they work with and challenges with caring for dying patients. This is in line with the findings of Terakado and Matsushima ^[14] who identified that nurses taking care of the dying experience tension, confusion, anxiety and fatigue. Finding from this study showed that nurses who have 4-6 years of experience had the highest overall mean score (Table 2). These nurses are relatively young in the profession and they perceive that certain issues with the organization result into stress. This is in harmony with the report of Sa et.al.^[15] that younger oncology nurses are three times more likely to have high Effort-Reward imbalance when compared to older nurses. This present study found that the nurses perceive Effort-reward imbalance as a major stressor with mean (standard deviation) of 4.64(0.88). There was also a similar finding in a cross-sectional epidemiological study conducted by Al-Makhaitaet ^[16]to assess the predictors of work-related stress among 637 nurses working in primary and secondary care levels in Dammam, Eastern Saudi Arabia. The researchers reported that young age was the only predicting factor to work-related stress in primary care level. Younger and less experienced nurses should be provided with adequate support to help them manage the stress that may arise from their nursing duties and to assist them in adjusting to the requirements of working in the oncology settings. Stressors at work are health risks, so organizations should consider dealing effectively with such a situation in oncology. A major finding from this study was that caring for dying patients is a source of stress to nurses. Oncology nurses deal with patients and relatives under stressful condition. They encounter pain, suffering and death as part of their daily lives. ^[17]. Findings from this study revealed that nurses perceive that they are somewhat inferior in the healthcare setting compared to other healthcare professionals. It is necessary that other members of the healthcare team recognize the values that oncology nurses continue to place on participation in patients’ daily care. Oncology nurses find the best in the worst situations, live fully the cancer experience by embracing their patients heartaches.

CONCLUSION AND RECOMMENDATION:

This study has identified the potential sources of stress as perceived by oncology nurses. Caring for the dying person with cancer is the most difficult aspect of oncology nursing practice and being present in the moment of death is the most rewarding and ubiquitous caring behavior of oncology nurses. The sources of stress identified by oncology nurses should be addressed with immediate effect in order to promote their satisfaction and invariably promote quality of care they render to the cancer patients. Oncology nurses have emotional needs in response to the demands of caring for cancer patients. They should be motivate in order to promote efficiency in their skills. Administrators, managers and individuals interested in furthering the goals of oncology care, including nurses themselves, are therefore challenged to create and maintain mutually supportive environment for providing optimal care to patients and families.

CONFLICT OF INTEREST:

The author has no conflict of interest to declare

ACKNOWLEDGEMENT:

Our profound gratitude goes to the nurses who devoted their time to participate in this study, despite their tight schedules. We wont fail to appreciate Mrs P.E Ahuchuba for her unconditional support.

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Received on 26.09.2014 Modified on 16.10.2014

Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 248-251