A review of the research in the area of staff stress in hospice/palliative care since the start of the modern hospice movement shows that, while high stress was identified as a problem in the early days of the movement, later studies have shown that stress and burnout in palliative care are by no means universal. Staff stress and burnout in hospice/palliative care has been demonstrated to be less than in professionals in many other settings. However, other studies have noted suicidal ideation, increased alcohol and drug usage, anxiety, depression, and difficulty in dealing with issues of death and dying. It is hypothesized that part of the reason that stress may be lower than expected in some settings was the early recognition of the potential stress inherent in this field and the development of appropriate organizational and personal coping strategies to deal with the identified stressors. Staff in hospice/palliative care have been found to have increased stress when mechanisms such as social support, involvement in work and decision-making, and a realistic work-load are not available.
The stress that exists in palliative care is due in large measure to organizational and societal issues, although personal variables were also found to have an influence. Suggestions are given for the direction of future research in the field.
Saunders C.Foreword. In: Doyle D, Hanks GW, MacDonald N eds. Oxford textbook of palliative medicine. Oxford : Oxford University Press, 1993 : v-viii.
2.
Twycross RGHospice care - redressing the balance in medicine. J R Soc Med1980; 73: 475-81.
3.
Hoggatt L., Spilka B.The nurse and the terminally ill patient: some perspective and projected actions . Omega1978-9; 9: 255-66.
4.
Quint JCWhen patients die: some nursing problems. Can Nurse1967; 63(12): 33-36.
5.
Folta JRThe perception of death. Nurs Res1965; 14: 233-35.
6.
Lyall Wal, Rogers J., Vachon Mls.Report to Palliative Care Unit of Royal Victoria Hospital regarding professional stress in the care of the dying. In: Palliative care service report. Montreal, PQ: Royal Victoria Hospital, 1976: 457-68.
7.
Lyall Wal, Vachon M., Rogers J.A study of the degree of stress experienced by professionals caring for dying patients. In: Ajemian I, Mount BM eds. The RVH manual on palliative/hospice care. New York: ARNO Press, 1980: 498-508.
8.
Vachon Mls, Lyall Wal, Freeman Sjj.Measurement and management of stress in health professionals working with advanced cancer patients. Death Educ1978; 1: 365-75.
9.
Chiriboga DA , Jenkins G., Bailey J.Stress and coping among hospice nurses: test of an analytic model. Nurs Res1983; 32: 294-99.
10.
Barstow J.Stress variance in hospice nursing. Nurs Outlook1980; 28: 751-54.
11.
Mount BM, Voyer J.Staff stress in palliative/hospice care. In: Ajemian I, Mount BM eds. The RVH manual on palliative/hospice care. New York: ARNO Press, 1980: 457-88.
12.
Garfield CA , Jenkins GJStress and coping of volunteers counseling the dying and bereaved. Omega1981 -2; 12: 1-13.
13.
Yancik R.Sources of work stress for hospice staff. J Psychosoc Oncol1984; 2(1): 21-31.
14.
Yancik R.Coping with hospice work stress. J Psychosoc Oncol1984; 2(2): 19-35.
15.
Munley A.Sources of hospice staff stress and how to cope with it. Nurs Clin North Am1985; 20: 343-55.
16.
Gotay CC, Crockett S., West C.Palliative home care nursing: nurses' perceptions of roles and stress. Can MentHealth1985; 33: 6-9.
17.
Krikorian DA , Moser DHSatisfactions and stresses experienced by professional nurses in hospice programs. Am J Hosp Care1985; 2(1): 25-33.
18.
Masterson-Allen S., Mor V., Laliberte L., Monteiro L. Staff burnout in a hospice setting . Hosp J1985; 1: 1-15.
19.
Paradis LF, Miller B., Runnion VMVolunteer stress and burnout: issues for administrators. Hosp J1987; 3: 165-83.
20.
Vachon Mls.Occupational stress in the care of the critically ill, the dying and the bereaved . New York; Hemisphere , 1987.
21.
Vachon Mls.Battle fatigue in hospice/palliative care. In: Gilmore A, Gilmore S eds. A safer death. New York: Plenum , 1988: 149-60.
22.
Power KG, Sharp GRA comparison of sources of nursing stress and job satisfaction among mental handicap and hospice nursing staff. J Adv Nurs1988; 13: 726-32.
23.
Paradis LF, Usui WMHospice staff and volunteers: issues for management. J Psychosoc Oncol1989; 7(1-2):121-39.
24.
Woolley H., Stein A., Forrest GC, Baum JDStaff stress and job satisfaction at a children's hospice. Arch Dis Child1989; 64: 114-18.
25.
Finlay IGSources of stress in hospice medical directors and matrons. Palliat Med1990; 4: 5-9.
26.
Alexander DA , Ritchie E.'Stressors' and difficulties in dealing with the terminal patient. J Palliat Care1990; 6(3): 28-33.
27.
Cooper CL, Mitchell S.Nursing the critically ill and dying. Hum Relations1990; 43: 297-311.
28.
Foxall MJ, Zimmerman L., Standley R., Bene' B. A comparison of frequency and sources of nursing job stress perceived by intensive care, hospice and medical-surgical nurses. J Adv Nurs1990; 15: 577-84.
29.
Bene' B., Foxall MJDeath anxiety and job stress in hospice and medical-surgical nurses . Hosp J1991; 7(3): 25-41.
30.
Mallett K., Price JH, Jurs SG, Slenker S.Relationships among burnout, death anxiety and social support in hospice and critical care nurses. Psychol Rep1991 ; 68: 1347-59.
31.
Robbins RADeath anxiety, death competency and self-actualization in hospice volunteers . Hosp J1991; 7(4): 29-35.
32.
Alexander DA , MacLeod M. Stress among palliative care matrons: a major problem for a minority group. Palliat Med1992; 6: 111-24.
33.
McWilliam CL , Burdock J., Wamsley J.The challenging experience of palliative care support-team nursing. Oncol Nurs Forum1993 ; 20: 770-85.
34.
Beck-Friis B., Strang P., Sjoden P-O.Caring for severely ill cancer patients: a comparison of working conditions in hospital-based home care and in hospital . Support Care Cancer1993; 1: 145-51.
35.
Beszterczey A.Staff stress on a newly-developed palliative care service: the psychiatrist's role. Can Psychiatr Assoc J1977; 22: 347-53.
36.
French Jrp, Rodgers W., Cobb S.Adjustment as person-environment fit. In: Coelho GV, Hamburg DA, Adams E eds. Coping and adaptation. New York: Basic Books, 1974: 316-33.
37.
Harrison RVPerson-environment fit and job stress. In: Cooper CL, Payne R eds. Stress at work. Chichester: Wiley , 1979: 175-205.
38.
Lumsden D.Towards a systems model of stress: feedback from an anthropological study of the impact of Ghana's Volta River Project. In: Sarason I, Spielberg C eds. Stress and anxiety, vol. 2. New York: Wiley, 1975: 191-228.
39.
Friel M., Tehan CBCounteracting burn-out for the hospice care-giver. Cancer Nurs1980; 3: 285-93.
40.
Lazarus RS, Schaefer C., Benner P. et al. Ways of coping checklist. (Stress and Coping Project.)Berkeley, CA: University of California , 1977.
Speilberger CD , Gorsuch RL, Luschene REManual for the State- Trait Anxiety Inventory . Palo Alto, CA: Consulting Psychologists Press, 1970.
54.
Crown S., Crisp AHManual of the Crown-Crisp Experiential Index. London: Hodder & Stoughton, 1979.
55.
Horowitz M. , Wilner N., Alvarez W.Impact of event scale: a measure of subjective stress. Psychosom Med1979; 41: 209-18.
56.
Cattell RB, Eber HW, Tatsuoka MMHandbook for the Sixteen Personality Factor Questionnaire (16PF). Champaign, IL: Institute for Personality and Ability Testing, 1970.
57.
Shostrom ELManual for the Personal Orientation Inventory. San Diego, CA: Educational and Industrial Testing Service , 1974.
58.
Bortner RW, Rosenman RHThe measurement of pattern A behaviour. J Chronic Dis1967; 20: 525-33.
59.
Sarason TG, Levine HM, Basham RB, Sarason BRAssessing social support: the social support questionnaire. J Pers Soc Psychol1983; 44: 127-39.
60.
MacBride A.Understanding and managing stress in the workplace . J Methods Time Manage1983;10(2): 15-19.
61.
Antonovsky A.Health, stress and coping. San Francisco, CA: Jossey-Bass, 1979.
62.
Cooper GL, Rout U., Faragher B.Mental health, job satisfaction, and job stress among general practitioners . Br Med J1989; 298: 366-70.
63.
Vachon Mls.Motivation and stress experienced by staff working with the terminally ill . In: Davidson G ed. The hospice: development and administration. New York: Hemisphere, 1978: 113-22.
64.
Amenta MMTraits of hospice nurses compared with those who work in traditional settings . J Clin Psychol1984;40:414-19.
65.
Zerwekh J.Transcending life: the practice wisdom of nursing hospice experts . Am J Hosp Palliat Care1993; 5: 26-31.
66.
Cassidy S.Sharing the darkness. Maryknoll, NY: Orbis Books, 1991.
67.
Amenta MM, Weiner AWDeath anxiety and purpose in life and duration of service in hospice volunteers . Psychol Rep1984; 54: 979-84.
68.
Schneider J.Self-care: challenges and rewards for hospice professionals. Hosp J1987; 3: 255-76.
69.
Scherwitz L., Graham LE, Ornitz D.Self-involvement and the risk factors for coronary heart disease. Advances1985; 2: 6-18.
70.
Larson DGThe helper's journey. Champaign, IL: Research Press, 1993.
71.
Vachon Mls.Emotional problems in palliative medicine: patient, family, and professional . In: Doyle D, Hanks GW, MacDonald N eds. Oxford textbook of palliative medicine. Oxford: Oxford University Press,1993: 577-605.
72.
Hayden WRSupport systems for caregivers: the physician. In: Marshall RE, Kasman C, Cape LS eds. Caring for sick newborns. Philadelphia, PA: Saunders, 1982 : 66-81.
73.
McCue JDThe effects of stress on physicians and their medical practice. N Engl J Med1982; 306: 458-63.
74.
Sargent DA, Jenson VW, Petty TA, Raskin H.Preventing physician suicide. JAMA1977; 237: 143-45.
75.
Hamilton CL , Neubauer BJHospice nursing: serving ambivalent clients . Nurs Health Care1989; 10: 320-22.
76.
Kahn RL, Wolfe DM, Quinn RP, Snoek JDOrganizational stress: studies in role conflict and ambiguity. New York: Wiley, 1981 ; Malabar, FL: Krieger, 1964.
77.
French Jrp.Person role fit. OccupMental Health1973 ; 3: 15-20.
78.
Schmalenberg C., Kramer M.Coping with reality shock: the voices of experience . Wakefield, MA: Nursing Resources1979.
79.
Edelwich J., BrodskyA. Burn-out: stages of disillusionment in the helping professions . New York: Springer, 1980.
80.
Jones JWThe staff burnout scale for health care professionals (SBSHP). Park Ridge, IL: LondonHouse Management Consultants, 1980.
81.
Bram PJ, Katz LFStudy of burnout in nurses working in hospice and hospital oncology settings . Oncol Nurs Forum1989 ; 16: 555-60.
82.
Stout JK, Williams JMComparison of two measures of burnout. Psychol Rep1983; 53: 283-89.
83.
Turnipseed DLBurnout among hospice nurses: an empirical assessment. Hosp J1987; 3: 105-19.
84.
Pines AM, Aronson E.Career burnout: causes and cures. New York: Free Press, 1988.
