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 study was conducted to identify the characteristics of cancer care stress, coping strategies, and the relationship between the 2 among cancer care nurses. Stress among nurses has been associated with occupational grief, which can be a physical or emotional symptom related to burnout or compassion fatigue.[17] In particular, hospice nurses tend to neglect their own feelings of bereavement while providing bereavement support to cancer patients and their families.[2,18] The results of this study corresponded to those of a previous study that showed that higher stress among cancer care nurses aged 40 years or older is associated with an increase in fatigue and burnout because of the higher number of years of nursing experience among Chinese oncology nurses.[1] This study suggests that the stress faced by clinical nurses who care for cancer patients is a factor that needs to be managed separately from their nursing competency and experience to improve their quality of life.

In addition, stress among clinical nurses was found to be highest in terms of working conditions and conflicts with physicians, including "inappropriate compensation" and "excessive workloads." These findings seem to be related to the nurse ratio and compensation systems, which are much lower in Korea than in other advanced member countries of the Organization for Economic Co-operation and Development.[19] These issues need to be considered as an important matter requiring a health care policy approach.

Oncology nurses were more likely to use problem-focused coping than emotion-focused coping, a finding similar to that of a previous study.[16] There are 2 main types of coping strategy: problem-focused coping, such as planned problem solving and social support seeking, and emotion-focused coping, such as thinking-avoidance, self-blame, and positive reappraisal. Most people cope with stress by combining these 2 coping strategies.[20] The coping strategies for nurses' stress and burnout vary from study to study. Among newly hired oncology nurses, problem-focused coping was negatively correlated with occupational stress,[21] and problem-focused coping was the most commonly used strategy among psychiatric nurses.[22] In addition, using such strategies to resolve negative situations such as stress, burnout, and posttraumatic stress disorder among health care professionals is likely to lead to significant changes in problematic situations. On the other hand, emotion-focused coping may not contribute to solving problems owing to the persistent feelings of an uncontrolled, chronic problem environment.[23]

The findings of this study also suggest that nurses caring for cancer patients are more likely to cope well depending on various demographic and occupational characteristics such as age (being older than 40 years), religion, education level (beyond graduate school), clinical career (3–4 years of experience), end-of-life care (3–4 years of experience), hospice education (those with experience), job satisfaction (those who were satisfied), and leisure activities (those who engaged in them). Therefore, these findings could be applied to the development of customized interventions for coping strategies to reduce stress among clinical nurses who care for cancer patients.

In recent years, the need for nursing care for cancer patients has increased,[12] and because oncology nurses are exposed to higher levels of stress, psychological strategies may assist them in coping with stress and promoting compassion satisfaction.[2] Moreover, cancer care nursing is perceived as personally and professionally demanding. Developing effective coping skills and resilience in nurses has been associated with better health and well-being, work longevity, and improved quality of palliative cancer patient care.[12] Stress can negatively affect the physical and emotional health of oncology nurses, which can cause compassion fatigue.[2] Furthermore, compassion satisfaction, compassion fatigue, and burnout were all shown to be related to training programs and to the psychological adjustment of nurses.[1] Nurses who provide end-of-life care actually experience suffering by witnessing patients' suffering, but they continue to provide and maintain their passions through coping processes that soothe their inner selves and induce a shift in mindset.[24] Therefore, it is essential to develop effective training programs and implement effective coping strategies to reduce the stress of clinical nurses caring for cancer patients.

The increasing number of cancer survivors and prolonged periods of illness have led to an increase in not only the stress of nurses who are providing palliative care for cancer patients but also the various problems they face. These findings could contribute to the development of interventions to reduce clinical nurses' stress by providing evidence of their stress and coping methods. In addition, it is necessary to devise a supportive nursing policy that can provide nursing care to reduce the compassion fatigue of nurses considering the stress and coping strategies involved in offering palliative nursing care to cancer patients. If nurses' job quality and job satisfaction are improved based on the creation of health policies, it will lead to the improvement of the quality of cancer nursing care.

This study has limitations in that it is difficult to generalize the results to all worldwide clinical nurses caring for cancer patients because it was conducted at a single general hospital and the data were influenced by the characteristics of 1 country, South Korea. In addition, this study could not identify any outstanding differences in the stress and coping strategies of the clinical nurses caring for cancer patients in religious establishment hospitals when compared with other types of medical institute.