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


General Characteristics

With regard to the participants' age and sex, 40.6% (n = 73) were younger than 25 years, and 97.8% (n = 176) were female. As for their marital status and religion, 82.8% (n = 149) were unmarried, and 56.8% (n = 104) were nonreligious, whereas 17.8% (n = 32) were Buddhist, and 16.1% (n = 29) were Catholic. With regard to their education and clinical career, 78.9% (n = 142) had an associate degree, and 50.6% (n = 91) had a clinical career of less than 3 years. With regard to nursing care experience for end-of-life cancer patients, 76.6% (n = 138) had less than 3 years of experience, and 27.8% (n = 50) had end-of-life care-related education experience. As for leisure activities, 70.6% (n = 127) did not engage in any.

Cancer Care Stress and Coping Methods

Cancer care stress among clinical nurses scored, on average, 3.85 out of 5 points. Among the 16 stress factors, cancer care stress caused by excessive workloads was the highest with 4.17 points, followed by inappropriate compensation and interpersonal conflicts with physicians. Cancer care stress among nurse aides was the lowest at 3.41 points. In addition, stress caused by an unsatisfactory relationship with supervisors and unfair opportunities (promotions, benefits, etc) was low. Among the measures used to cope with nursing stress, the top 5 highest-scoring items were "sleeping" (average, 4.2 points), "asking close confidants for help" (family, friends, colleagues, supervisors, and supporters; average, 3.76 points), "engaging in leisure activities" (traveling, mountain climbing, fishing, listening to music, watching movies, reading books, watching TV, etc; average, 3.71 points), and "not trying to cause personal stress" (average, 3.61 points). The 5 lowest-scoring items were "taking medication" (average, 2.06 points), "generally avoiding getting along with people" (average, 2.23 points), "enjoying gambling and entertainment" (average, 2.25 points), "getting deeply involved in religious life" (average, 2.23 points), and "writing a diary" (average, 2.25 points). The average stress score of coping methods for cancer patient care was 3.03 points. The problem-focused coping method had an average score of 3.17, whereas that of the emotion-focused coping method was 2.93 (Table 1).

Differences in Cancer Care Stress and Coping According to Participants' Characteristics

The results on the differences in cancer care stress based on the general characteristics and related factors of clinical nurses revealed a significant difference according to age (F = 2.722, P = .046). Cancer care stress was highest among those 40 years or older, followed by those in the age group of 25 to 39 years and those younger than 25 years. Coping strategies to manage cancer care stress according to nurses' general characteristics revealed statistical significance with regard to age (F = 2.659, P = .050), religion (F = 2.821, P = .040), highest education level (F = 4.780, P = .003), clinical career (F = 4.419, P = .002), end-of-life cancer care career (F = 5.324, P = .002), hospice education experience (t = 2.729, P = .008), job satisfaction (F = 3.789, P = .024), and leisure activities (t = 2.024, P = .44). With regard to age and education, those who were 40 years or older and had a graduate degree or higher educational level were more effective in coping with cancer care stress than others. With regard to the participants' clinical careers, those with 3 to 4 years of experience were the most effective in coping with cancer care stress, whereas those with less than 2 years or more than 10 years of experience showed the lowest coping effectiveness. In addition, clinical nurses with 3 to 4 years of experience in end-of-life cancer care facilities displayed effective coping with regard to cancer care stress. When participants had hospice education experience and high job satisfaction and were engaged in leisure activities, their cancer care stress coping strategies were high (Table 2).

Correlation Between Stress and Coping Methods in Cancer Patient Care

The results of a correlation analysis between stress and coping methods revealed that higher cancer care stress was related to higher emotion-focused coping (r = 0.201, P = .007) and problem-focused coping (r = 0.270, r < .001). Because there was a positive correlation between stress in the "professional role conflicts," "interpersonal issues," "treatment and care conflicts with physicians," "psychological burdens regarding limited medical care," "inappropriate treatment," "unsatisfactory relationship with supervisors," and "unsatisfactory relationship with nurse aides" areas and coping strategies, high-stress nurses in the area showed high use of coping strategies (Table 3).