Moral distress in oncology nurses: A qualitative study

Özbaş, Azize Atlı; Kovancı, Mustafa Sabri; Köken, Arif Hüdai

doi:10.1016/j.ejon.2021.102038

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…Our study did not examine the experience of oncology nurses between the HS and TS models. Nurses may experience moral distress when patients receive care that is not consistent with their wishes or aligned with their prognosis 33 . Additionally, our limited representation of racial and ethnic minorities did not allow us to analyze discharge disposition by this metric, a factor known to affect end‐of‐life decision‐making, care, and outcomes 34 .…”

Section: Discussionmentioning

confidence: 99%

“…Nurses may experience moral distress when patients receive care that is not consistent with their wishes or aligned with their prognosis. 33 Additionally, our limited representation of racial and ethnic minorities did not allow us to analyze discharge disposition by this metric, a factor known to affect end-of-life decision-making, care, and outcomes. 34 Finally, this study did not evaluate the rate of escalation of care from the medical oncology unit to the medical intensive care or step-down units and subsequent patient outcomes following transfer to higher level of care.…”

Section: Hs Vs Ts P Unadjusted (95% Ci) Adjusted (95% Ci) Amentioning

confidence: 99%

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Oncology hospitalist impact on hospice utilization

Prsic,

Morris,

Adelson

et al. 2023

Cancer

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BackgroundUnplanned hospitalizations among patients with advanced cancer are often sentinel events prompting goals of care discussions and hospice transitions. Late referrals to hospice, especially those at the end of life, are associated with decreased quality of life and higher total health care costs. Inpatient management of patients with solid tumor malignancies is increasingly shifting from oncologists to oncology hospitalists. However, little is known about the impact of oncology hospitalists on the timing of transition to hospice.ObjectiveTo compare hospice discharge rate and time to hospice discharge on an inpatient oncology service led by internal medicine‐trained hospitalists and a service led by oncologists.MethodsAt Smilow Cancer Hospital, internal medicine‐trained hospitalists were integrated into one of two inpatient medical oncology services allowing comparison between the new, hospitalist‐led service (HS) and the traditional, oncologist‐led service (TS). Discharges from July 26, 2021, through January 31, 2022, were identified from the electronic medical record. The odds ratio for discharge disposition by team was calculated by logistic regression using a multinomial distribution. Adjusted length of stay before discharge was assessed using multivariable linear regression.ResultsThe HS discharged 47/400 (11.8%) patients to inpatient hospice, whereas the TS service discharged 18/313 (5.8%), yielding an adjusted odds ratio of 1.94 (95% CI, 1.07–3.51; p = .03). Adjusted average length of stay before inpatient hospice disposition was 6.83 days (95% CI, 4.22–11.06) for the HS and 16.29 days (95% CI, 7.73–34.29) for the TS (p = .003).ConclusionsOncology hospitalists improve hospice utilization and time to inpatient hospice referral on an inpatient medical oncology service.Plain Language Summary Patients with advanced cancer are often admitted to the hospital near the end of life. These patients generally have a poor chance of long‐term survival and may prefer comfort‐focused care with hospice. In this study, oncology hospitalists discharged a higher proportion of patients to inpatient hospice with less time spent in the hospital before discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Hs Vs Ts P Unadjusted (95% Ci) Adjusted (95% Ci) Amentioning

confidence: 99%

Oncology hospitalist impact on hospice utilization

Prsic,

Morris,

Adelson

et al. 2023

Cancer

View full text Add to dashboard Cite

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“…12,28,29 The nurses often expressed their failure to provide holistic care, and this feeling of failure is related to excessive workload, staff shortage, and the obligation to maintain care with limited resources. 29 In South Korea, oncology nurses also want to listen to the dying patients, but it is challenging to devote much time because of the heavy workload. They are in charge of end-of-life and critical patients who require continuous active treatment.…”

Section: Coping With Psychological Burdenmentioning

confidence: 99%

“…Oncology nurses experience exhaustion and moral distress while trying to provide good care and feel stymied in their attempts in the short time they have. 12,28,29 The nurses often expressed their failure to provide holistic care, and this feeling of failure is related to excessive workload, staff shortage, and the obligation to maintain care with limited resources. 29 In South Korea, oncology nurses also want to listen to the dying patients, but it is challenging to devote much time because of the heavy workload.…”

Section: Coping With Psychological Burdenmentioning

confidence: 99%

How Do Oncology Nurses Cope With the Psychological Burden of Caring for Dying Patients?

et al. 2022

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BackgroundCancer is a leading cause of death worldwide, and most patients with cancer in South Korea die in hospitals. Oncology nurses experience physical, emotional, and occupational challenges associated with the psychological burden of caring for dying patients.ObjectiveThis study explored the coping strategies used by oncology nurses to deal with the psychological burden of patient deaths.MethodsIn this descriptive qualitative study, 10 oncology nurses who had recently experienced a patient’s death were recruited via snowball sampling. All were female, with a mean age of 32.9 years (range, 27–44 years), and their mean working duration was 9.9 (range, 3-23) years. Participants were interviewed individually face-to-face 3 times, with each interview lasting 1 to 1.5 hours.ResultsOncology nurses coped with the psychological burden of a patient’s death in the following 4 ways: (a) avoiding patient deaths to the extent possible, (b) reflecting upon the meaning of life and death, (c) suppressing their emotional distress over the patient’s death, and (d) becoming kinder and more caring toward people around them.ConclusionsThe findings suggest that oncology nurses struggle to cope with the psychological burden of patient deaths. Oncology nurses are affected both negatively and positively by experiencing death as they provide end-of-life care.Implications for PracticeOncology nurses need education or counseling to reduce the psychological burden of caring for dying patients with cancer. Hospital administrators need to continuously identify ways to reduce the psychological burden of oncology nurses providing end-of-life care.

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“…Physical and psychological suffering and distress are commonplace in this department, thereby imposing significant stress and pressure on the health-care workers. 1 - 4 Nurses who work in the Department of Oncology experience greater mental stress than those working in other departments 5 and are more prone to psychological distress. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

Psychological Intervention on Reducing Stress of Nurses Caring for Terminally Ill Cancer Patients: A Quasi-Experimental Study

2024

ALPHA PSYCHIATRY

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Objective: The aim of the study was to explore the effect and feasibility of psychological intervention on reducing stress in nurses caring for terminally ill patients in the Department of Oncology. Methods: This quasi-experimental study enrolled oncology nurses at Sir Run Run Shaw Hospital, affiliated to Zhejiang University School of Medicine, between April 2021 and February 2022. Interventions included Soul Moisturizing Hall, Balint group, one-on-one interviews, and routine debriefing sessions. Psychological interventions for the nurses were carried out by a team of psychiatrists and senior clinical nurse specialists. The Work Stressors Questionnaire of Nurses in the Department of Oncology (WSQNDO) was used to measure the stress in nurses before and after intervention. Results: A total of 27 female nurses were enrolled, with the majority of them aged <30 years. Following intervention, the scores in each of the WSQNDO dimensions were all significantly lower ( P < .001) than prior to intervention (social factors and career prospect: 15.18 ± 3.67 vs. 11.11 ± 2.42; working environment and working nature: 20.22 ± 5.03 vs. 17.29 ± 4.87; professional skills: 19.11 ± 3.93 vs. 16.51 ± 3.27; stress from the patient and their family: 11.85 ± 3.07 vs. 10.37 ± 2.45; interpersonal relationship: 9.77 ± 2.54 vs. 8.62 ± 1.62; the problem of oncology specialist nursing: 41.03 ± 8.46 vs. 38.51 ± 6.30). Moreover, the nurses reported alleviation of negative emotions after the psychological intervention. Conclusion: Psychological interventions can reduce the stress experienced by nurses while caring for terminally ill cancer patients.

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Moral distress in oncology nurses: A qualitative study

Cited by 9 publications

References 29 publications

Oncology hospitalist impact on hospice utilization

Oncology hospitalist impact on hospice utilization

How Do Oncology Nurses Cope With the Psychological Burden of Caring for Dying Patients?

Psychological Intervention on Reducing Stress of Nurses Caring for Terminally Ill Cancer Patients: A Quasi-Experimental Study

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