Exploring work stress in palliative care staff

Abstract

SYSTEMATIC REVIEW:

Abstract

Background: Work stress can impact on palliative care andhospice healthcare professionals (HCPs) well-being. Elevated and prolongedperiods of work stress can lead to burnout. Research has struggled to capturethe prevalence of burnout and it has been reported that hospice HCPs presentwith less symptoms of burnout than palliative care HCPs working in otherhealthcare settings. Research has not yet provided an explanation for thesefindings. The current review aimed to identify and synthesise qualitativeresearch to explore the strategies hospice HCPs use to promote adaptation inresponse to work stress.

Methods: A systematic search strategy was applied to fourdatabases (PsycINFO, Web of Science, MEDLINE and CINAHL). The review findingswere analysed using Thomas and Harden’s approach to thematic synthesis and theconfidence in the review findings was assessed using GRADE CERQual.

Results: Ten studies were included in the synthesis andanalysis led to the development of four analytical themes: the sanctity of thehospice, regaining agency, the journey to self-care and the identification ofmeaning and purpose.

Conclusions: The review demonstrates that hospice HCPs haveidentified strategies that they use in response to work stress that developwith personal and professional experience in hospice care. The hospice settingis influential for HCPs adaptation to work stress as it promotes thedevelopment of psychological safety amongst staff. The findings highlight theimportance of the participant to researcher relationship during data collectionand that staff support should be provided by individuals who understand hospicecare. The findings highlight that hospice HCPs could benefit from organisationsallowing for the co-production of organisational support.

EMPIRICAL STUDY:

Abstract: Background: Palliative care HCPs are regularlyexposed to emotionally challenging situations, such as patient suffering anddeath. These sources of stress can impact on the psychological well-being ofstaff. Research has struggled to capture what mitigates the work stressexperienced by palliative care HCPs. The need for palliative care is predictedto increase, making it vital to support the palliative care workforce.Psychological flexibility, self-compassion and team climate have been identifiedas moderators of stress in other populations, however limited research hasexplored these in relation to work stress in palliative care staff.

Methods: The current study aimed to gain insight into thelevels and sources of work stress in palliative care HCPs and whether levels ofwork stress differed between occupational groups. The study used a crosssectional design to also explore the potential relationships betweenpsychological flexibility, self-compassion and team climate with work stress inthis population.

Results: In total, 46 responses were analysed. Mostrespondents were staff nurses (48%), with 96% of respondents working ininpatient hospice settings. Almost half of the respondents had been working inpalliative care for over five years (49%). Key sources of stress reported wereorganisational factors and HCPs perception that palliative care had become moremedicalised in recent years. Self-compassion, collective ownership of goals andteam collaboration were related to work stress in palliative care HCPs.

Conclusions: Research has demonstrated the challenges ofcapturing what promotes and maintains staff well-being within this uniquepopulation. In consideration of support for palliative care HCPs, this couldinvolve the promotion of self-compassion, as well as team-based approaches, topromote HCPs management of work stress. An area for future research would bethe development of a quantitative measure to capture sources of work stress,specific to palliative care HCPs.