Stress, burnout and coping among nurses working on acute medical wards and in the community: A quantitative study.

BACKGROUND: Psychological distress can cause burnout, which affects mental and physical well-being. It is important to identify factors associated with psychological distress and physical discomfort and how nurses deal with these problems. AIM: The aim was to investigate distress, burnout and coping among community nurses (CN) and hospital nurses (HN). APPROACH AND METHODS: In this cross-sectional study, 409 nurses completed three questionnaires: Perceived Stress Scale (PSS), Copenhagen Burnout Inventory (CBI) and Ways of Coping (WOC). FINDINGS: Participants younger than 40 demonstrated significantly more distress and burnout than those older than 40 years. Participants who had moderate and high distress on the PSS were significantly more at risk for experiencing personal, work-related and patient-related burnout. A significant positive correlation was found between distress and behavioural escape-avoidance, cognitive escape-avoidance and distancing. Significant positive correlations were also seen between all the subscales of the CBI and behavioural escape-avoidance, cognitive escape-avoidance and distancing. Positive significant correlation was also obtained between staff resources and distress and personal-related and work-related burnout. Negative correlation was demonstrated between staff resources and patient-related burnout. Participants with longer work experience were less likely to report moderate or high distress, and those who scored higher on personal burnout and behavioural escape-avoidance were more likely to have moderate or high distress. CONCLUSION: The results of this study call for increased attention to the younger generation in the nursing profession. The results also validate the need to investigate further the correlation between distress, burnout and coping and how these issues might influence each other among nurses working in the community and hospitals. Findings should be taken with precaution, they do not describe in detail what underlying factors contribute to distress and discomfort found in this study, they do, however, indicate certain coping strategies nurses use to deal with distress and burnout.

Family caregivers' experiences of end-of-life care in the acute hospital setting. A qualitative study.

BACKGROUND: Acute hospital settings are generally not considered adequate places for end-of-life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future. AIM: The aim of this study was to investigate family caregivers' experiences of end-of-life care in an acute community hospital in Iceland. METHODS: Fifteen in-depth qualitative semi-structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis. FINDINGS: Findings indicated that the acute hospital setting is not a suitable environment for end-of-life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end-of-life care; (3) The dying process. Each of the themes encompassed a variety of subthemes. CONCLUSIONS: Findings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers' well-being. Acknowledging and appreciating the meaning of respect and dignity at the end-of-life from family caregivers' perspective is vital.

Experiences of cancer rehabilitation among patients in rural areas in northern Iceland: physical and psychosocial well-being, coping, quality of life, and satisfaction with care. A qualitative study.

Physical rehabilitation and psychosocial support are a part of cancer patients well-being and their ability to cope. Physical geography and healthcare provider barriers may have negative influences on patients' health outcomes. To explore the perceptions and experiences of cancer rehabilitation in a rural area in northern Iceland. A further aim was to explore patients' physical and psychosocial well-being, coping and satisfaction with care. A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 21 patients at a tertiary hospital in northern Iceland. Three main themes emerged: 1) Rehabilitation - the need for improved access support and continuity; 2) Coping and quality of life - balancing life as it was before cancer against the present situation in order to achieve normality; 3) Satisfaction - encountering caring behaviours enhances satisfaction and well-being. Specifically targeted rehabilitation programmes need to be included in the treatment options for cancer patients. Survival instinct, coping mechanisms and a strong urge to maintain general functionality are of paramount importance intertwined with patients' ability to cope with the disease and treatment, and their satisfaction with care.

Family Caregivers' Satisfaction With Specialized End-of-Life Care Provided at Home: Assessment of the Psychometric Characteristics of the Icelandic Version of the Family Assessment of Treatment at the End of Life Questionnaire.

Several studies have highlighted the significant role of families in end-of-life care. Carers' well-being may depend on how they experience the care and support provided to their loved ones. This study was conducted to investigate family caregivers' assessment of specialized end-of-life care in a sample of 119 close family members in Iceland. The response rate was 58.8% (n = 70). Furthermore, the aim was to assess the psychometric characteristics of the Icelandic version of Family Assessment of Treatment at the End of Life (FATE). Descriptive statistics were used to describe the characteristics of the data. Results indicate that good communication and understanding of all parties concerned are the foundation for family caregivers' satisfaction with end-of-life care. Participants were generally satisfied with the care provided, whereas some important aspects of care were rated as excellent. Evaluation of management of symptoms reported in this study should be given specific attention in future studies considering its unsatisfactory outcomes. Nurses need to be aware of the impact that physical suffering of the patient might have on the family caregivers. The Icelandic version of the Family Assessment of Treatment at the End of Life instrument is a psychometrically sound instrument useful for measuring caregivers' satisfaction with service provided at the end of life, although modifications would improve the instrument for use on this population.

Communication is more than just a conversation: family members' satisfaction with end-of-life care.

AIM:: The main aim of this study was to investigate family member's experiences of communicating with health professionals (HP) during end-of-life care in acute medical wards and a nursing home. METHODS:: A qualitative approach using 19 semi-structured interviews to collect data was used. The text was analysed using a content analysis methodology, extracting content that reflected family member's experiences of end-of-life care in acute medical wards, and a nursing home in Iceland. RESULTS:: Four themes were identified as contributing to favourable communication with HPs in end-of-life care: establishing a relationship; flow of information; environment; acceptance at the time of death. CONCLUSION:: Findings suggested that the context of communication in end-of-life care is more than just a conversation. It includes health professional's appearances, decision-making and respect. Satisfactory communication is a necessary factor of quality of care and the fundamental aspect of the establishment of a positive interpersonal relationship.

Satisfaction with care in oncology outpatient clinics: psychometric characteristics of the Icelandic EORTC IN-PATSAT32 version.

AIM AND OBJECTIVES: To assess the psychometric characteristics of the Icelandic European Organisation for Research and Treatment of Cancer IN-PATSAT32 (EORTC IN-PATSAT32) version and to compare satisfaction with care between gender and different age groups. BACKGROUND: The majority of patients with cancer receive either chemotherapy or radiotherapy on an outpatient basis. There is a need to evaluate satisfaction with care and service for these patients using reliable and valid instruments. DESIGN: Cross-sectional comparative study. METHOD: Participants (n=217) who received treatment for cancer as outpatients answered the EORTC IN-PATSAT32 questionnaire. Participants were 22-91 years old and 57% of them were female. RESULTS: Overall high satisfaction was found with communication, information and care that patients receive from doctors and nurses. Principal component analysis extracted four factors: 'satisfaction with nurses' conduct', 'satisfaction with doctors' conduct', 'satisfaction with information' and 'satisfaction with service and care organisation'. Patients were most satisfied with nurses' conduct but least satisfied with service and care organisation. Cronbach's alpha for the four factors ranged from 0·95-0·67. CONCLUSION: Although the validity of this instrument including its sensitivity to patients' level of dissatisfaction as well as satisfaction with care and service was evident, this needs to be further explored in future studies. The psychometric strengths of the EORTC IN-PATSAT32 are its internal consistency and its construct validity, but there are several issues indicating a need to change and develop the instrument and specifically adopting it to outpatient care. RELEVANCE TO CLINICAL PRACTICE: Outpatient treatment options offered to cancer patients have increased, and this calls for knowledge of their satisfaction with care and service. Sparse studies are available, and there is a need for further development of reliable instruments. Our study indicates that outpatients with cancer are quite satisfied with the care they receive. Findings may contribute to improvement in outpatients' clinics that provide treatment to patients with cancer.

Psychological distress in Icelandic patients with repeated recurrences of cancer.

AIM: The main aim was to investigate differences between the psychological distress of patients with a first diagnosis of cancer, those experiencing their first recurrence, and those experiencing later recurrences. Little is known about the development of cancer patients' psychological distress and whether it becomes more severe with greater incidence of recurrence. METHOD: A total of 218 patients from 3 oncology outpatient clinics in Iceland were assessed with the Brief Symptom Inventory Scale 18 (BSI 18). RESULTS: Several aspects of cancer patients' psychological distress seem to positively correlate with number of recurrences, and women experience a recurrence of cancer differently to men. CONCLUSION: Health-care professionals need to be aware of patients' likely distress levels at different stages of their illness and the ways in which their gender might affect their psychological state.

Living with cancer and perception of care: Icelandic oncology outpatients, a qualitative study.

AIM: This qualitative study was set out to explore oncology outpatient experiences of having cancer, to illuminate coping strategies and to explore perceptions of care and service provided while treated for cancer. MATERIALS AND METHODS: Thirty patients undergoing chemotherapy or radiotherapy were consecutively selected for the study in three oncology outpatient clinics in Iceland; mean age was 55 years. All participants gave written consent but five dropped out of the study. Twenty-five semi-structured single interviews were conducted and analysed using manifest and latent content analysis. RESULTS: The descriptive level of the text could be understood as: (a) getting cancer: alarming experience; (b) coping: balancing life as it was before cancer against present situation to achieve normality; (c) satisfaction: encountering caring behaviour enhances satisfaction and well being. Each of the categories encompassed variation of subcategories. All the categories were summarised in the core category: "Being in the alarming situation of getting cancer evokes a strong need to maintain normality and keep uncertainty at distance with support from caring and sensitive encounters." This reflected patients' overall experiences of being diagnosed with cancer, how they coped and their perception of quality of care while going through treatment. CONCLUSION: Reactions to the diagnosis of cancer indicate strong emotional reactions. A strong will to handle the situation and determination to maintain normality in life was prominent. Establishment of positive patient-health care professional relationships, caring encounters, faith, believing in treatment and support from family was highly valued as support and giving hope.

Icelandic cancer patients receiving chemotherapy or radiotherapy: does distance from treatment center influence distress and coping?

The aim was to investigate psychologic distress and coping strategies in cancer patients during the time of chemotherapy or radiotherapy treatment and to compare those who lived close to the treatment center and those who had to stay away from home for treatment. Participants were 22 to 91 years old, 57% female patients, from 3 oncology outpatient clinics in Iceland. They were assessed with the Brief Symptom Inventory (BSI 18) and The Ways of Coping-Cancer Version (WOC-CA). Significantly higher scores were only found in somatic symptoms for patients who lived close to the treatment center than those who did not. Women had significantly higher scores on overall psychologic distress, depression, anxiety, social support, and behavioral and cognitive escape-avoidance compared with men. Significantly more depression and anxiety was found in the age group 22-45 years than the age group older than 70 years. Living alone, stress (WOC-CA), behavioral escape-avoidance, and distancing were shown to be significantly associated with psychologic distress. Having to stay away from home for treatment does not seem to affect cancer patients' psychologic well-being or the way they cope, whereas type of treatment has. Psychological distress is higher in female cancer patients than male and in younger patients (22-45 years) compared with older ones (>70 years). Also, findings indicate that coping strategies can influence distress.