Factors influencing nurses’ attitudes towards caring for dying patients in oncology settings in the Western Cape Metropole

De Kock, Freda (2011-03)

Thesis (MCur)--University of Stellenbosch, 2011.

Thesis

ENGLISH ABSTRACT: The National Cancer Association of South Africa estimates that over 80,000 of South Africans currently die from cancer each year, whilst statistics show an increase in newly diagnosed cancer cases. Despite an improvement in cure rates, cancer, because of its association with pain, suffering and death, still affects human beings in their totality. It has been demonstrated that effective psychosocial care, as provided by oncology nurses, improve the outcomes for cancer patients. Therefore, nurses’ attitudes towards caring for patients that are dying are of vital importance to the quality of care provided to these patients. Attitudes towards caring for patients that are dying may be influenced by the demographic factors of oncology nurses, such as age, workplace and years of experience in oncology. It may also depend on the degree of work satisfaction and by the nature of the work environment, particularly regarding the level of support being offered to the nurse. The purpose of this study hence was to explore the influences of demographic and work environment factors on nurses’ attitudes towards caring for patients that are dying in oncology settings in the Western Cape Metropole. The objectives of this study were to determine oncology nurses’ attitudes towards caring for patients that are dying, to determine the degree of work satisfaction experienced by these nurses, to determine the perceived supportive nature of their work environments, and to establish and examine any relationships between oncology nurses’ attitudes towards caring for patients that are dying and demographic factors, work satisfaction and a supportive work environment. This study was theoretically underpinned by Paterson and Zderad’s (quoted in Praeger, 2002) humanistic nursing theory and Peplau’s (quoted in Belcher & Brittian Fish, 2002) interpersonal relations in nursing theory, because of their relevance to palliative care. A quantitative research approach, with a descriptive design, was selected to conduct the study. The target population was all the oncology nurses, caring for patients that are dying in palliative and oncology settings in the Western Cape Metropole. A convenience sample of 127 oncology nurses was selected in three different, but typical oncology settings, namely a state hospital, a private hospital and three hospices. Data was collected by means of a selfreporting questionnaire. A pilot study was done, in order to assure the validity and reliability of the data collection instrument. Ethical approval was obtained in advance from the Ethical Research Committee of the Faculty of Health Sciences of the University of Stellenbosch. Written consent was obtained beforehand from the managers of the three oncology settings where the research was conducted, as well as from the participants. The main findings of this study were that the majority of the respondents displayed positive attitudes towards caring for patients that are dying. In addition, most of the respondents experienced a high degree of work satisfaction and also regarded their work environments as supportive. Significant relationships were found between positive attitudes towards caring for patients that are dying and: • hospice settings; • higher age and; • rank of the professional nurse. The overall recommendation that was made was that continuing education in all aspects of palliative care be regarded as an essential strategy in maintaining and further enhancing positive attitudes amongst oncology nurses towards caring for patients that are dying. In addition, coping strategies needed to be widely implemented to help oncology nurses cope with their emotions and anxieties.

AFRIKAANSE OPSOMMING: Die Nasionale Kankervereniging van Suid-Afrika beraam dat meer as 80,000 Suid-Afrikaners huidig jaarliks aan kanker sterf, terwyl statistieke ‘n toename in die aantal nuwe gevalle van kanker toon. Ten spyte van ‘n toename in die sukses van behandeling, beïnvloed kanker, weens sy assosiasie met pyn, lyding en die dood, steeds die mens in sy totaliteit. Dit is bewys dat effektiewe psigososiale versorging deur onkologiese verpleegkundiges die uitkomstes van pasiënte met kanker verbeter. Daarom is die ingesteldhede van verpleegkundiges, jeens die versorging van pasiënte wat sterwend is, van kardinale belang in die kwaliteit van versorging wat aan hierdie pasiënte gebied word. Sodanige ingesteldhede mag deur demografiese faktore, soos ouderdom, werkplek, en jare ondervinding in onkologie, beїnvloed word. Dit mag ook van die mate van werksbevrediging en van die aard van die werksomgewing, spesifiek met betrekking tot die mate van ondersteuning wat aan die verpleegkundige gebied word, afhang. Die doel van hierdie studie was dus om die invloed van demografiese en werksomgewingsfaktore op die ingesteldhede van onkologiese verpleegkundiges, jeens die versorging van pasiënte wat sterwend is in onkologiese afdelings in die Wes-Kaapse Metropool, te ondersoek. Die doelwitte van hierdie studie was om die ingesteldhede van verpleegkundiges jeens die versorging van pasiënte wat sterwend is te bepaal, om hulle mate van werksbevrediging te bepaal, om hul persepsie van die ondersteunende aard van hul werksomgewing te bepaal, en om enige verband tussen onkologiese verpleegkundiges se ingesteldhede jeens die versorging van pasiënte wat sterwend is en demografiese faktore, werksbevrediging en die aard van ‘n ondersteunende werksomgewing te bepaal en te ondersoek. Hierdie studie is teoreties, vanweë hul relevansie tot palliatiewe sorg, deur Paterson en Zderad (aangehaal in Praeger, 2002) se humanistiese teorie en Peplau (aangehaal in Belcher & Brittian Fish, 2002) se interpersoonlike verhouding in verplegingsteorie, onderskraag. ‘n Kwantitatiewe navorsingsbenadering, met ‘n beskrywende ontwerp, is gekies om die studie mee uit te voer. Die populasie het al die onkologiese verpleegkundiges, wat sterwende en palliatiewe pasiënte in kankerafdelings in die Wes-Kaapse Metropool versorg, ingesluit. ‘n Gerieflikheidsteekproef van 127 onkologiese verpleegkundiges, in drie verskillende, maar tipiese kankerinstellings, is gekies, naamlik ‘n staatshospitaal, ‘n privaathospitaal en drie hospitiums. Datainsameling is deur middel van ‘n self-gerapporteerde vraelys gedoen. ‘n Loodsstudie is uitgevoer om die geldigheid en betroubaarheid van die vraelys te verseker. Etiese goedkeuring is vooraf vanaf die Etiese Navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch verkry. Skriftelike toestemming is ook vooraf vanaf die bestuur van die instellings, waar die navorsing gedoen is, sowel as van die deelnemers verkry. Die hoofbevindings van hierdie studie was dat die meerderheid van die respondente positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is openbaar het. Boonop het die meeste respondente ’n hoë mate van werksbevrediging ervaar en hul werksomgewing as ondersteunend beskou. Beduidende verbande is getrek tussen positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is, en: • versorging in hospitiums; • hoër ouderdom en; • rang van professionele verpleegkundige. Die algemene aanbeveling wat gemaak kon word was dat deurlopende opleiding in alle aspekte van palliatiewe sorg, as ‘n grondliggende strategie beskou moet, ten einde positiewe ingesteldhede ten opsigte van die versorging van pasiënte wat sterwend is onder onkologiese verpleegundiges te behou en verder aan te moedig. Voorts behoort strategieë geïmplementeer te word om onkologiese verpleegkundiges te help met die hantering van hul emosionale behoeftes en vrese.

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