Abstract, Terms, and Background
Abstract
Generally considered a philosophy of care rather than a place, hospice is a unique blend of services that addresses the needs of dying persons and those close to them. Frontline workers are critical to the success of hospice, so it follows that the level of stress and general well-being felt by these workers is centrally important. An overly stressed, demoralized, or alienated direct service staff is unlikely to personify hospice caring or deliver high-quality, compassionate care for the terminally ill and their families, which epitomizes the hospice caliber philosophy of care. The purpose of this study was to determine the perceived stress factors of inpatient and home hospice nurses and their correlation to perceived self-efficacy. The top stressors perceived by participating hospice nurses were "making a mistake when treating a patient," "insufficient personnel to handle workload," "fellow workers not doing their job," "inadequate support from supervisor/manager," "disagreement with a medical professional concerning treatment of patient," and "personal insult from patients or families." Statistically significant relationships exist between some of the stressors surveyed in different areas and the stressors' total and general perceived self-efficacy score. In the statistically significant relationships with perceived self-efficacy, the direction is negative, indicating a high ranking of the stressor or the total correlates to a lower score on perceived self-efficacy. Analysis was also done on the relationship of stress to age, education level, and years of experience in healthcare. This study used the research approach of a quantitative cross-sectional descriptive study using the method of survey research. Nurses working in 14 hospice organizations in Midwest United States were surveyed to learn about perceived sources of stress and perceived self-efficacy. The importance of this study is the identification of perceived occupational stressors among hospice nurses, combined with an understanding of the relationship to perceived self-efficacy. This identification of perceived stress factors in hospice nurses can lead to a better understanding of the needs of hospice nurses as it relates to hiring, education, in-services, and retention of personnel in this unique area of healthcare.
Terms
For consistency of interpretation, the following terms are defined:
Hospice: concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented care. Hospice care contrasts with curative care because it is not designed to cure an illness or lengthen life but emphasizes the management of all symptoms of a disease, with a special emphasis on controlling a patient's pain and discomfort. Hospice deals with the emotional, social, and spiritual impact of the disease on the patient and the patient's family and friends.
Home hospice: Hospice care provided while a patient continues to live at home or the place they called home at the time of enrollment. The family or significant others are generally able to handle the needs and care of the patient, with assistance from the hospice team, including a hospice nurse.
Inpatient hospice: hospice care provided 24 hours per day in a facility (hospital, hospice residence, or nursing home) for symptoms or crises that cannot be managed in the patient's home. For the purpose of this study, inpatient hospice generally will refer to a freestanding hospice facility.
Background
Although efforts to understand the abstract concept of stress abound in the literature, stress remains a somewhat elusive concept. The manner in which nurses contend with the stress and strain of the professional role has been of interest to both researchers and healthcare administrators over the past 30 years. A great deal of information has been obtained and disseminated. Occupational stress is recognized as a key reason for poor work quality and subsequent ill health. However, because of the massive changes that have occurred and that continue to occur in healthcare systems throughout the world, this area of research remains of interest to members of the healthcare industry.
Hospice is an area of healthcare that presents both old and new stressors where the nebulous concept of stress might be further explained when specific pieces of the puzzle are first understood. The literature, however, tends to combine both home hospice care and inpatient hospice nurses in discussions and research about hospice nurses. Although similar, the two areas assist patients at different levels of acuity and may require different skills; thus, the stresses experienced by the two types of hospice nurses may be different. Furthermore, the concept of perceived general self-efficacy has been shown to play a role in the levels of perceived stress in individuals. Adding this component to the study of stress in hospice nurses adds a new factor that may help to discover how individuals deal with the inherent stress of dealing with dying patients on a day-to-day basis.
As nurses with varying abilities and backgrounds migrate into hospice work, it is important to determine the factors that predict their success and, conversely, mitigate their failure to succeed. This research study was an attempt to further discern the factors that cause stress in inpatient and home hospice nurses and investigate the role that perceived self-efficacy has in these factors.
The research methodology used to resolve the questions addressed by the study was that of a quantitative cross-sectional descriptive study. In the study of work-related stress among nurses, the Nursing Stress Scale (NSS) is the best known and most widely used scale. The NSS, originally developed in 1981, is a 34-item, four-point Likert scale that was developed to measure the frequency and major sources of stress experienced by nurses on hospital units. The NSS consists of items containing typical stressors specific to nurses based on a number of research studies. Gray-Toft and Anderson reviewed the literature and conducted interviews with nurses, physicians, and chaplains. This original instrument contains 34 items divided into three subscales.
Because the NSS was designed for hospital nurses, and because of the inclusion of home hospice nurses, the NSS was slightly modified for this study. The questions cover the eight variables of workload, uncertainty about treatment, conflict with physicians, death and dying, inadequate preparation, conflict with other nurses, lack of support, and family interactions. However, only two questions regarding each variable were asked using the NSS as a reference. The Likert scale was expanded to 6 points to allow a larger range of choices. A pilot survey distribution of this modified NSS was developed and tested before being used to collect data. The study also used collected demographic data to study the possible relationships between perceived stress, perceived general self-efficacy, and age, level of education, and years of work experience. Data generated by the survey were subsequently interpreted by the online data collection service and cross-checked in SPSS (SPSS, Chicago, IL) through the analysis techniques of univariate analysis including frequency distribution, measures of central tendency and measures of spread, range and SD and bivariate analysis of t test, and Pearson r correlation coefficient and multivariate analysis.