The purpose of this study hence was to explore the influences of demographic and work environment factors on nurses’ attitudes towards caring for patients that are dying in oncology settings in Rivers state. The objectives of this study were to determine oncology nurses’ attitudes towards caring for patients that are dying, to determine the degree of work satisfaction experienced by these nurses, to determine the perceived supportive nature of their work environments, and to establish and examine any relationships between oncology nurses’ attitudes towards caring for patients that are dying and demographic factors, work satisfaction and a supportive work environment. This study was theoretically underpinned by Paterson and Zderad’s (quoted in Praeger, 2002) humanistic nursing theory and Peplau’s (quoted in Belcher &Brittian Fish, 2002) interpersonal relations in nursing theory, because of their relevance to palliative care. A quantitative research approach, with a descriptive design, was selected to conduct the study. The target population was all the oncology nurses, caring for patients that are dying in palliative and oncology settings in Rivers state. Data was collected by means of a self- reporting questionnaire. A pilot study was done, in order to assure the validity and reliability of the data collection instrument.
The main findings of this study were that the majority of the respondents displayed positive attitudes towards caring for patients that are dying. In addition, most of the respondents experienced a high degree of work satisfaction and also regarded their work environments as supportive. Significant relationships were found between positive attitudes towards caring for patients that are dying and:
- Hospice settings;
- higher age and;
- rank of the professional nurse.
The overall recommendation that was made was that continuing education in all aspects of palliative care be regarded as an essential strategy in maintaining and further enhancing positive attitudes amongst oncology nurses towards caring for patients that are dying. In addition, coping strategies needed to be widely implemented to help oncology nurses cope with their emotions and anxieties.
TABLE OF CONTENTS
CHAPTER ONE: INTRODUCTION
Background of the study
Aim of the study
Significance of the study
Scope of the study
Definition of Operational Terms
CHAPTER TWO: LITERATURE REVIEW
CHAPTER THREE: RESEARCH METHODOLOGY
Population and Sampling
Inclusion and exclusion criteria
Contents of the questionnaire
Reliability and validity of the study
Limitations of the study
CHAPTER FOUR: DATA ANALYSIS AND INTERPRETATION OF RESEARCH FINDINGS
Data analysis method
Description of statistical analysis
CHAPTER FIVE: DISCUSSION OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS
Discussion and Conclusions
Implication of findings to nursing
Limitations of the study
LIST OF TABLES
Table 4.1: Age distribution
Table 4.2: Marital status
Table 4.3: Respondents having children
Table 4.4: Workplace
Table 4.5: Professional ranking
Table 4.6: Years of experience in oncology nursing
LIST OF FIGURES
Figure4.1: Oncology nurses’ experiences of nursing care to patients that are dying.
Figure4.2: Oncology nurses’ experiences of death as the worst thing that can happen to a person.
Figure4.3: Oncology nurses’ experiences of talking about impending death with the patient that is dying.
Figure4.4: Oncology nurses’ experiences of emotional care towards the patient’s family.
Figure4.5: Oncology nurses’ experiences of being assigned to the care of a patient that is dying.
Figure4.6: Oncology nurses’ experiences of talking about death with the person that is dying.
Figure 4.7: Oncology nurses’ experiences of frustration regarding the length of time required to give nursing care to a patient that is dying.
Figure4.8: Oncology nurses’ experiences of caring for patients who give up hope of getting better.
Figure4.9: Oncology nurses’ experiences of forming close relationships with the family of a person that is dying.
Figure4.10: Oncology nurses’ experiences of times that the person that is dying welcomed death.
Figure4.11: Oncology nurses’ experiences of changing the subject to something cheerful when a patient asks if he / she is dying.
Figure 4.12: Oncology nurses’ experiences of feeling like running away, should the person actually die.
Figure 4.13: Oncology nurses’ experiences of the family’s need for emotional support to accept the changes in behavior of the person that is dying.
Figure4.14: Oncology nurses’ experiences of withdrawing from the patient as the patient nears death.
Figure4.15: Oncology nurses’ experiences of families’ concern about helping their dying member make the best of his / her remaining life.
Figure 4.16: Oncology nurses’ experiences of not allowing the person that is dying to make decisions about his / her physical care.
Figure4.17: Oncology nurses’ experiences of the family maintaining a normal environment for the dying member.
Figure4.18: Oncology nurses’ experiences of the benefit of patients that are dying being allowed to verbalize their feelings.
Figure 4.19: Oncology nurses’ experiences that nursing care should be extended to the patient’s family.
Figure 4.20: Oncology nurses’ experiences that they should permit flexible visiting schedules for patients that are dying.
Figure4.21: Oncology nurses’ experiences that the person that is dying and his / her family should be the main decision makers.
Figure4.22: Oncology nurses’ experiences of the involvement of the family in the physical care of the person that is dying.
Figure 4.23: Oncology nurses’ experiences of hope that the patients they were caring for would die when they are not present.
Figure 4.24: Oncology nurses’ experiences of fear to befriend a person that is dying.
Figure4.25: Oncology nurses’ experienced concern about pain relieving medication when dealing with a person that is dying.
Figure 4.27: Oncology nurses’ experiences of giving honest answers to the person that is dying about his / her condition.
Figure 4.28: Oncology nurses’ experiences regarding educating families about death and dying not being a nursing responsibility.
Figure 4.29: Oncology nurses’ experiences regarding family members interfering with professionals’ care of the patient.
Figure 4.30: Oncology nurses’ experiences that it should be possible for nurses to help patients prepare for death.
Figure 4.31: Respondents experiencing work satisfaction with working as oncology nurses.
Figure 4.32: Respondents who would again choose oncology nursing as an occupation.
Figure4.33: Respondents who would recommend oncology nursing as an occupation to their children.
Figure 4.34: Respondents who would recommend oncology nursing as an occupation to a good friend.
Figure 4.35: Respondents who sensed their work as meaningful and important.
Figure4.36: Respondents who would again choose their current role as oncology nurse.
Figure 4.37: Respondents who would continue in the field of oncology for the next two years.
Figure 4.38: Respondents experiencing support and guidance from their supervisors.
Figure 4.39: Respondents feeling valued and respected in their job.
Figure 4.40: Respondents feeling part of a team.
Figure4.41: Respondents who felt that a good relationship with the patient would benefit a supportive work environment.
Figure 4.43: Respondents who felt that regular debriefing groups would benefit a supportive work environment.
Figure 4.44: Respondents who experienced their workplace as supportive.
Figure4.45: Respondents who had taken an emotional burden home at the end of their shift.
- 1.1 Background of the study
Cancer, of which there are more than 200 different kinds, is a life threatening disease that affects everyone; men and women, young and old, rich and poor (CANSA, 2008a). Some kinds are relatively easy to detect and treat, while others spread quickly and cannot be cured (CANSA, 2008a). The statistics of the Cancer Association of Nigeria (CANSA) show that there is an increase in newly diagnosed cancer cases and that it currently is one of the leading causes of patient deaths in Nigeria. CANSA estimates that over 80,000 Nigerians die each year from cancer (CANSA, 2008b).
Despite improvements in cure rates, there are still many uncertainties about cancer management. Cancer has a profound effect on the physical, psychological, social and spiritual aspects of life, because it is often associated with suffering and death (Maree, 2007:887). The period leading to death is characterized by an increasing prevalence of a multitude of physical, psychological, existential and social problems for the patient. Successful management and caring during this phase are thus critical for the patient, and for relatives, friends and care providers (Cherny, Coyle & Foley, 1996:261). Significantly, Botti, Endacott, Watts, Cairns, Lewis and Kenny (2006:309) have found that the provision of effective psychosocial care improves the outcomes of patients having cancer. Effective psychosocial care by oncology nurses is therefore essential to reduce the psychological distress that affects patients with cancer in all aspects of their lives. Such care has been linked to reductions in anxiety and cancer related symptoms (Kenny, Endacott, Botti & Watts, 2007:664). It is reasonable to deduce that the ability to provide effective psychosocial care is closely linked to nurses’ attitudes towards caring for patientsthataredying.Theemotionalburdenofworkinginapalliativecare setting, may have a negative impact on oncology nurses’ attitudes towards caring for such patients. Nurses’ attitudes towards caring for patients that are dying may be influenced by demographic factors, such as their age, workplace and years of experience in oncology and palliative care, as well as the degree of work satisfaction experienced, and the degree of support in their work environment.
Caring, which is defined as showing care and compassion for a fellow human being (Wengström & Ekedahl, 2006:20), is particularly stressful for oncology nurses, due to the complexity of the care required by patients with cancer (Kendall, 2007:119). The impact of caring for patients having cancer, and their families, may prove to be overwhelming if support systems, particularly in the work environment, are not in place (Medland, Howard-Ruben & Whitaker, 2004:48). Nurses are of the opinion that nurse managers play an important role in ensuring care of and facilitation of healing in patients, by creating a healthy and caring management environment (Minnaar, 2003:37). Molzahn (1997, quoted in Minnaar, 2003:37) argues that the key to quality care is a humane culture in health care organizations, in which the human dignity of both patients and staff is preserved.
Work satisfaction relates to one’s emotional evaluation of experiences during work and it plays a major role in an oncology nurse’s decision to remain in the profession (Biton& Tabak, 2002:140). Adams and Bond (2000:537) indicate that work satisfaction is positively associated with greater professional autonomy, greater control over the practice environment and the use of nursing systems that promote accountability and continuity of care. In addition, other factors that contribute to job satisfaction amongst oncology nurses include patient care, organization of service, support from managers, good communication and teamwork (Leung, Spurgeon & Cheung,2007:46).
- Research problem
The fact that cancer is a disease that is on the increase, and that 80,000 Nigerians die each year from cancer, place a significant burden on nursing staff, working in an oncology setting. The researcher’s personal experience has borne witness to the perception that caring for patients with cancer has an emotional impact on nursing staff working in an oncology environment. In addition, nursing staff in oncology settings in the Rivers state are exposed to added work stressors, such as limited resources and staff shortages that may impact on their attitudes towards patients that are terminally ill and dying. These stressors also affect their degree of work satisfaction and their perceptions about the supportive nature of the work environment.
Nurses’ attitudes towards caring for patients that are terminally ill and dying are influenced by working with these patients on a daily basis. Nurses’ attitudes may be positively or negatively influenced by demographic factors (for example age and years of experience in oncology), work satisfaction and the degree of support in the working environment. If one considers that the role of caring and compassionate nursing staff has consistently been recognized as contributing to improvements in functional adjustment and quality of life of the patient with cancer (Kenny et al., 2007:664), the need for research in this field is clear.