Nurses in cancer care—Stress when encountering existential issues
Section snippets
Theoretical framework
The theoretical framework for this study consists of coping theory from the field of psychology of religion (Ekedahl, 2001; Lazarus and Folkman, 1991; Pargament, 1997) and nursing theory (Ekedahl, 2001; Eriksson, 1987; Eriksson and Barbosa Da Silva, 1991). Central to the theoretical framework are people seeking significance (Pargament, 1997), which means caring for something. This “something” can be objects of significance. Events become stressful when they influence things that people care
Purpose of study
The purpose of this paper is to study the stress of health care staff, specifically oncology nurses, according to the model developed by Ekedahl (2001).
Analytical strategies and categories
After five interviews, the analytical process revealed three pairs of concepts were a few that were developed categories and subcategories The first pair was diversity and team cohesion. Diversity and the differences in the nurse group were evident, and the cultural category were introduced by the nurse with a Turkish background. Team cohesion described the unit within the group and the support the nurses gave to each other.
Breathing space and stressors constituted the second pair of concepts.
Stress on Level I, related to the profession
Stress at this level is professionally related, but can also be identified in the private life of the individual nurse. Stress related to the profession concerns issues having to do with caring for patients. The informants report multifaceted stress with an existential dimension when young patients “die too early” or when “all our patients die.” In the latter type of care, it is the health care staff that survives.
For several years when I was there… and it was cancer… they all seemed to die.
Stress on Level I, the private life
Stress is present in the exchange between work and personal time and actualizes the transitional area between work and personal time. The transition between the two different worlds—work in the close vicinity of death and real life—is perceived as problematic. The working world and the personal world can be described in terms of the presence or lack of an existential dimension.
Sometimes it is impossible to cope with the transitions. At times, the contrasts are so big that it is impossible to
Stress at the group level, Level II
Stressors with existential components are identified at this level. Major holidays, such as Christmas, which actualizes a boundary, in this case, birth in the Christian context, may become a recurring annual stressor interpreted as social stress with existential dimensions. Stress related to the group level has a dynamic relationship to cultural components. A lack of understanding of their different cultural backgrounds can cause cultural clashes among the health care personnel within cancer
Stress at the organizational level, Level III
Stress at Level III concerns reorganization in health care.
I have been through several new organizations at the A-clinic-I think it we have had five or six through the years.
When different work structures from two wards are to merge, the nurse is affected at both the individual and group level. Another example concerns decisions made at the organizational level when the focus of care is to change from hospice to palliative care, which demands a new form of nursing care and other resources. This
Stress at a cultural level, Level IV
At the workplace, a number of cultures that encompass several codes, with expectations on the nurse, exist. In the culture, complex routine systems contribute to create meaning in the nurse's daily work. Different care philosophies can be included at the cultural level and can be stressors when it is impossible to integrate or change different care philosophies. This type of stress is interpreted as psychological stress concerning the outlook of the different care paradigms. To care
Discussion
As researchers, we have approached the material from two different theoretical foundations—the psychology of religion and a nursing theoretical perspective. There are also clinical experiences from the multidisciplinary teams that have contributed to broad reflection concerning stress with existential components, which nurses in cancer care meet in their daily practice. Stress on different levels, and the significance in the nurses profession have been presented in this article. The results
Acknowledgments
This study was generously supported by The Cancer Society of Stockholm, Grant no. 02-142.
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