Palliative Cancer Care Stress and Coping Among Clinical Nurses Who Experience End-of-Life Care

Hyunju Kim, MSN, RN; Kisook Kim, PhD, RN


Journal of Hospice and Palliative Nursing. 2020;22(2):115-122. 

In This Article



This is a cross-sectional descriptive study intended to identify the cancer care stress and coping strategies of palliative cancer care nurses.

Participants and Data Collection

The participants were clinical nurses working in the oncology department of a religiously affiliated hospital in Korea. This hospital was founded by a Catholic foundation and is the country's leading hospice and end-of-life care facility. The inclusion criteria were nurses who agreed to voluntarily participate in this study and who had more than 6 months of experience in both cancer patient care and end-of-life care. In addition, they were registered nurses who were currently employed in oncology units, palliative units, or hospices to care for cancer patients. Before starting the research, approval was granted by the institutional review board of the institution to which the researchers belong. Subsequently, the researchers briefly explained the purpose and method of the study to the participants, obtained written consent, and distributed the questionnaire. They were required to sign the study participation agreement before filling out the paper-based self-report questionnaire, which took approximately 30 minutes.

The distributed questionnaires were collected, and the participants completed and filled out the envelopes. The data collection period was from October 21, 2013, to October 31, 2013. Of the 185 questionnaires that were distributed, 180 were collected for final data analysis; 5 were discarded because of insufficient data. The response rate was 97.3%. The number of participants for this study was calculated using the sample size calculation program G*Power 3.1.2. On the basis of a correlation at a significance level of .05, a power (1 − β) of 0.95, and a moderate effect size of 0.3, 138 participants were recommended. This research was conducted based on the Strengthening the Reporting of Observational Studies in Epidemiology checklist for observational research.

Ethical Considerations

This study was conducted after receiving approval (institutional review board no. 13–10) from the ethics review committee of the general hospital to which the researchers belong. All participants provided voluntary written consent before completing the survey. The consent form described the purpose of the study, included a guarantee of anonymity, and indicated that the participant could withdraw from the study at any point.


Cancer Care Stress. In this study, we used the cancer care stress measuring instrument developed by Kim and Gu[13] for use among clinical nurses and widely used in research on Korean nurses. It was modified to measure the stress of Korean oncology nurses.[14] A total of 53 items comprised 16 stress factors of palliative cancer patient care, which were excessive workloads, lack of expertise and skills, professional role conflicts, interpersonal issues, interpersonal conflicts with physicians, treatment and care conflicts with physicians, psychological burdens regarding limited medical care, unfair opportunities, unsatisfactory relationship with supervisors, inappropriate compensation, unsatisfactory relationship with nurse aides, inappropriate environment of work units, work responsibilities, unfamiliar psychological situations with family and colleagues, type of work, and medication issues. Each item was rated on a 5-point Likert scale, from 1 indicating "not at all" to 5 indicating "strongly agree." Higher points indicated higher stress in providing nursing care for cancer patients. In a previous study,[2,13] the Cronbach α was .90, whereas in this study, it was .94.

Cancer Care Stress Coping Method. In this study, we used the instrument developed by Lazarus and Folkman[15]—"Ways of Coping"—which was modified in a previous study[16] for Korean nurses to determine the stress coping methods they used in cancer patient care. High scores indicated more effective coping by using various strategies. The stress factors were divided into 16 and 25 questions on problem-focused and emotion-focused coping strategies, respectively. Each item was scored on a 5-point Likert scale ranging from 1 indicating "not at all" to 5 indicating "very strongly agree." Higher scores indicated higher degrees of use of each countermeasure. The reliability of the instrument at the time of development as determined by Cronbach α was .85, and in this study, it was .88.

Data Analysis

General characteristics, cancer care stress, and stress coping methods among clinical nurses in cancer care were analyzed using frequency, percentage, average, and standard deviation. A t test and an analysis of variance were conducted to identify the stress and coping methods of nurses in cancer patient care according to their general characteristics. Finally, Pearson correlation coefficients were calculated to determine the relationship between stress and coping methods in cancer patient care.