|Year : 2015 | Volume
| Issue : 2 | Page : 130-134
Potential stressors in cancer care: Perceptions of oncology nurses in selected teaching hospitals in Southwest Nigeria
Chinomso U Nwozichi, Foluso O Ojewole
Department of Adult Health Nursing, School of Nursing, Babcock University, Ilishan Remo, Ogun State, Nigeria
|Date of Web Publication||21-Nov-2015|
Chinomso U Nwozichi
Department of Adult Health Nursing, School of Nursing, Babcock University, Ilishan Remo, Ogun State
Source of Support: None, Conflict of Interest: None
Background: Oncology nurses are posed with issues that are potential sources of stress to them. Aim: To identify the potential sources of stress in cancer care for Nigerian oncology nurses. Materials and Methods: This was a descriptive cross-sectional study involving nurses working in the oncology units of three selected Nigerian teaching hospitals. Consenting oncology nurses were recruited. The tool for data collection was a self-administered structured questionnaire. Result: Eighty-six (86) nurses participated. High workload (mean = 5.34 ± 0.59), taking care of critically ill patients (mean = 5.12 ± 0.78), strict organizational rules (mean = 5.05 ± 0.66), lack of organizational support (mean = 4.91 ± 0.87), and challenges of caring for dying patients (mean = 4.66 ± 0.97) were the major potential sources of stress perceived by oncology nurses. Conclusion: A number of stress-generating situations have been identified, and appropriate strategies and interventional programs are needed to address them.
Keywords: Burnout, cancer care, issues, oncology nurses, stress, stressors
|How to cite this article:|
Nwozichi CU, Ojewole FO. Potential stressors in cancer care: Perceptions of oncology nurses in selected teaching hospitals in Southwest Nigeria. Afr J Med Health Sci 2015;14:130-4
|How to cite this URL:|
Nwozichi CU, Ojewole FO. Potential stressors in cancer care: Perceptions of oncology nurses in selected teaching hospitals in Southwest Nigeria. Afr J Med Health Sci [serial online] 2015 [cited 2019 Aug 19];14:130-4. Available from: http://www.ajmhs.org/text.asp?2015/14/2/130/170186
| Background|| |
Caring for cancer patients appears to be very complex and demanding, not only for nursing students but also for professional nurses.  As nursing care becomes more technical and complex, stress becomes increasingly more significant to the physical and emotional well-being of nursing staff. In oncology, nurses care for many critically ill and dying patients and should be able to tackle the numerous needs and questions of families. It is well established that oncology nursing is perceived as a setting that is personally and professionally demanding. Zander et al.  reported that, given the high level of stress among pediatric oncology nurses, resilience is a major factor that could mediate stress in this setting. In a survey by Kulkarni et al.  at Cipla Palliative Care Centre, Pune, India, the overall stress level among caregivers was 5.18 on a scale of 0-10 and that 62% of them were ready to ask for help to cope with the stress.
Nurses play significant roles in cancer care because they are always with the patients and families to attend to all their needs. However, due to the nature of their roles, nurses experience varying degrees of stress, which could eventually affect the quality of care they render. In an exploratory, qualitative study by Watts and colleagues,  nurses were found to be faced with frustration, difficulty to look after themselves, inadequate communication processes, and anger. However, despite the availability of support mechanisms, most nurses did not access these services. It was also stated that the effectiveness of care depends on the nurses' training, skills, attitude, and beliefs.
There has been increasing interest in the attitudes health care providers hold toward cancer and cancer care and the effect they have on the quality of care. Corner (2006)  in his report stated that the attitudes of both the general public and health care professionals are largely negative and stereotyped, and that cancer has been considered more devastating than other life-threatening diseases. Furthermore, Kash et al.  studied 261 house staff, nurses, and medical oncologists in a cancer research hospital in USA and showed that nurses experienced more physical symptoms than did house staff and medical oncologists.
Compus et al.  showed that work organization, relationships with other staff members, and care restriction were issues that stressed oncology nurses. However, Schraub and Marx  also added emotional exhaustion and depersonalization. In addition, they showed that stress is higher in oncology care than in acquired immunodeficiency syndrome (AIDS) care and that insufficient time, a sense of failure, poor management, and difficult staff relationships are common stressful situations.
A handful of studies have described the stress and stressful situations in oncology nursing, most of them originating from developed nations. There are some relevant data on stress among oncology nurses in developing countries, but no earlier study reported potential situations that oncology nurses perceive as stressful.
This study, therefore, was conducted to identify potential sources of stress as perceived by nurses in cancer care in Nigeria.
| Materials and Methods|| |
This descriptive, cross-sectional study was conducted in the oncology units of three Teaching Hospitals in Southwest Nigeria. The three teaching hospitals were selected for their proximity and the availability of oncology nursing services. Consenting nurses were consecutively recruited in each of the selected hospitals. Ethical clearance was obtained from the hospitals. The tool for data collection was a self-administered, structured questionnaire constructed based on themes derived from literature review. The instrument was pretested on 12 oncology nurses from different hospitals with 0.72 reliability using the Spearman-Brown prophecy formula. The first section of the questionnaire included participants' demographic variables 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 were analyzed using Statistical Package for Social Sciences (SPSS) version 18.0 (Chicago, Il, USA) at an alpha level of 0.05. The analysis included both descriptive and correlation analyses, and the t-test, Pearson's correlation, and analysis of variance (ANOVA) were conducted.
| Results|| |
Eighty-six (86) nurses participated in the study. [Table 1] shows that the mean age of the participants was 43.4 years (±2SD). The majority of the participants were from UCH (41.9%), were female (81.4%), were married (73.3%), and had 4-6 years of working experience (36%).
[Table 2] 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 had the highest standardized mean of 4.31. Generally, high workload (mean = 5.34 ± 0.59), taking care of critically ill patients (mean = 5.12 ± 0.78), strict organizational rules (mean = 5.05 ± 0.66), lack of organizational support (mean = 4.91 ± 0.87), and challenges of caring for dying patients (mean = 4.66 ± 0.97) were the major sources of stress as perceived by oncology nurses. The lowest stressor identified was working with uncooperative coworkers (mean = 2.35 ± 0.91).
[Table 3] shows the scores of the issues perceived by nurses according to the nurses' years of professional experience. It is shown that nurses who had 4-6 years of working experience scored the highest on the issue with organization, with a 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 = 0.000 and P = 0.003, respectively).
|Table 3: Issues perceived by nurses according to their years of working experience|
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| Discussion|| |
This study's results indicated that increased workload and taking care of critically ill patients were the major stressors among oncology nurses. Other sources of stress named included lack of support from the institution/organization and challenges in the care of dying patients. This is in line with the findings of Terakado and Matsushima,  who identified that nurses taking care of the dying experience tension, confusion, anxiety, and fatigue. In a review conducted by Peters et al.,  there was no strong evidence that palliative care/hospice nurses experience higher levels of stress than nurses in other disciplines. They reported that common sources of stress were the work environment, role conflict, and issues with patients and families. On the contrary, health care professionals working in cancer and palliative care settings were found to experience more stress than their counterparts in other specialties.  However, the findings of Peter et al. showed that issues with patients and their families are an important source of stress to nurses, which corroborates the findings of the present study showing that issues with the patients and relatives were perceived by nurses to be the highest source of stress in oncology nursing [Table 2]. There was also a similar finding in a qualitative study conducted among urban and rural community nurses working with palliative-care clients in homes in Australia.  This is an important finding because nurses are always dealing with families.
Organizational support plays a major role in helping nurses cope with the level of stress they encounter in cancer care. A finding from the present study shows that nurses viewed the lack of support from the management of the health care organization as a major stressor, with a mean of 4.91. This situation has been of major concern among oncology nurses. Willard and Luker  in their study describe the strategies used by specialist cancer nurses in the UK to implement their role within a multiprofessional team. Their findings revealed that acceptance, especially by doctors, was the main problem facing specialist cancer nurses. In addition, they experienced insufficient organizational support for their role. Difficulties with acceptance impair a nurse's ability to provide supportive care to cancer patients. It is possible that this factor reduces a nurse's motivation in cancer care.
In the present study, findings showed that nurses who had 4-6 years of experience had the highest overall mean score and that there was a significant relationship between their years of experience and their perception of sources of stress [Table 2]. The majority of the oncology nurses were relatively young in the profession, as shown in [Table 1], and they were of the opinion that poor organizational settings could contribute significantly to the stress experienced by nurses. This is in harmony with the report of Sa et al.  that younger oncology nurses are three times more likely to have a high effort-reward imbalance compared to older nurses. There was also a similar finding in a cross-sectional epidemiological study conducted by Al-Makhaitaet,  that young age was the only predicting factor for work-related stress at the 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.
The present study found that the nurses perceived effort-reward imbalance as a major stressor, with a mean (standard deviation) of 4.64 (0.88). Stressors at work are health risks, so organizations should consider dealing effectively with such a situation in oncology. Work overload is usually due to shortage of nurses, which makes the available nurses experience increased demands on the job to meet the high needs of cancer patients. Invariably, nurse shortage forms an important factor that causes oncology nurses to be overwhelmed with work-related activities. Toh et al.  found a positive, bidirectional relationship between nurse shortage and stress, which has led to a rise in the number of oncology nurses leaving the specialty, thereby compounding the problem further. A major finding from this study was that caring for dying patients was 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.  Oncology nurses find the best in the worst situations and participate in the cancer experience fully by embracing their patients' heartaches. Of note: Nurses' perceptions of work stress were also related to many other factors at play in the nursing workplace. Organizational factors has been reported to hinder the reporting of chemotherapy administration errors among oncology nurses. 
This study is limited by its small sample size, which represents a small fraction of the nurses working in different oncology settings in Nigeria. Further, the study focused on a particular region in Nigeria, which could reduce the generalizability of its findings to other regions.
| Conclusion and Recommendation|| |
A great proportion of oncology nurses reported work overload as the major source of stress in cancer care, which corroborates findings from previous studies. Another important stress-generating situation is working with difficult patients and their relatives and also lack of support from the management.
It is therefore recommended that administrators and managers of cancer settings should ensure sufficient staffing in oncology settings in order to ensure that quality patient care is provided. Moreover, appropriate strategies and interventional programs to identify and relieve sources and effects of stress should be developed. A nationwide study should be conducted with a larger sample size to assess the opinions of all oncology nurses in Nigeria and other regions in Africa.
| Acknowledgment|| |
Our profound gratitude goes to the nurses who devoted their time to participate in this study, despite their tight schedules. We cannot fail to appreciate Mrs. P.E Ahuchuba for her unconditional support.
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[Table 1], [Table 2], [Table 3]
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