Studying the Stress-Response Sequence in pediatric oncology nursing

C O N S E N S U S STATEMENTS

Studying the Stress-Response Sequence in Pediatric Oncology Nursing Patricia J. Hollen, PhD, RN; Pamela S. Hinds, PhD, RN, CS; Laura Clarke-Steffen, PhD, RN; Kathy Forte, MS, RN, CPNP, CPON; Ida M. (Ki) Moore, PhD, RN; and Ernest Katz, PhD MONG HEALTH PROFESSIONALS, oncology nurses are considered to be a group that is particularly vulnerable to jobrelated stressors (Hinds et al., 1990). The pediatric oncology nurse is constantly challenged by the dissonance between the role of humanizing the cancer experience for the child and family and supporting care that often e n c o m p a s s e s new drugs and technology (Foley & Fergusson, 1993). High-level stress m a y result in professional burnout, a b s e n t e e i s m , e m p l o y e e turnover, m o o d swings, decreased coping, job dissatisfaction, errors in patient care, and patient neglect (Cronin-Stubbs & Rooks, 1985; GrayToft & Anderson, 1981; J a c o b s o n , 1983; Stewart, Meyerowitz, Jackson, Yarkin, & Harvey, 1982). Nurses adversely affected by work-related stress m a y exit the specialty having received little or no intervention or a misguided intervention. Strategies are often not available to help highly stressed nurses to (a) understand the stressors, (b) provide guidance in their decision making, (c) help them remain in the specialty and prevent

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From the School of Nursing, Northeastern University, Boston, MA; St. Jude Children's Research Hospital, Memphis, TN; the College of Nursing, Arizona State University, Tempe, AZ; AFLAC Cancer Center; Children's Healthcare of Atlanta at Egleston, Atlanta, GA; the College of Nursing, University of Arizona, Tucson, AZ; and the Behavioral Sciences Section, Children's Center for Cancer and Blood Diseases, Children's Hospital, Los Angeles, CA. Address reprint requests to Patricia J. Hollen, PhD, RN, Chair, APON Research Committee, Associate Professor, School of Nursing, Northeastern University, 360 Huntington Ave, Boston, MA 02115 © 2000 by Association of Pediatric Oncology Nurses 1043-4542/00/1702-000753.00/0 doi: 10.1053/jg.2000.5294

further burnout, and (d) if necessary, assist their transition to another specialty. Despite continual stressors, many pediatric oncoiogy nurses find meaning in their work that sustains their job satisfaction (Olson et al., 1998). Capturing the p h e n o m e n o n of finding meaning in a stressful environment is the focus of a program of research by Hinds, Quargnenti, Hickey, and Mangum (1994) related to a stress-sequenced model for pediatric oncology nursing. Findings from five studies during the past decade provide the basis for expanding this program of research. The following consensus statements related to the stress-response s e q u e n c e in pediatric oncology nurses can be used to direct future research in this area: 1. No current stress-response sequence model has significantly explained rolerelated stress and its c o n s e q u e n c e s in pediatric oncology nurses. Therefore, testing of revised, competing, or new models is recommended. 2. Research on role-related stress-responses in pediatric oncology nurses needs to incorporate the characteristics of the nurse, such as years of practice in the specialty, marital status, and site of practice (i.e., outpatient, inpatient, intensive care). This information will assist in identifying nurses who are at higher risk for negative outcomes of the stress-response. 3. The presence of a supportive senior nurse as an intervention or as a mediator in the stress-response s e q u e n c e needs further study.

Journal of Pediatric Oncology Nursing, Vol 17, No 2 (April,), 2000: pp 81-82

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. For research on role-related stressr e s p o n s e s in pediatric o n c o l o g y nurses to be c o m p r e h e n s i v e , the relations h i p s a m o n g nurse characteristics, health care setting characteristics, patient characteristics, and patient care o u t c o m e s all n e e d to be included in the

s a m e s t u d y and m e a s u r e d concurrently. 5. Research studies on specific stressors (rather than o n general role-related stressors) are r e c o m m e n d e d b e c a u s e s u c h studies m a y represent more definitive tests of s t r e s s - r e s p o n s e models.

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