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P178 Survey on Needs and Job Satisfaction of Nurses Working in Palliative Care Settings in Singapore
Vol. 52 No. 6 December 2016
Selected Abstracts
their family members living under the same roof. However, that has gradually become more difficult. We decided to clarify the relationship between the mental health of elderly patients with terminal cancer and family care. Methods: We studied patients with terminal cancer aged 65 or older that were cared by their family members. Through anonymous self-administered questionnaires, we examined the background of the study participants and their main caregivers and whether study participants were supported by their family members in terms of housekeeping, eating, excretion, cleanliness, movement, medical care, and finances. Mental health was assessed with the General Health Questionnaire-12 (GHQ-12), which uses a 4stage Likert scale. We performed t-tests after confirming that GHQ-12 scores were normally distributed. This study was performed after approval by the Epidemiological Research Ethics Committee of University A and the ethics review committees of the participating facilities. Results: Questionnaires were collected from 38 individuals (collection rate, 60.3%), who consisted of 14 men and 24 women. The average age was 77.8 7.6 years. Regarding housekeeping, eating, excretion, cleanliness, movement and medical care, those who received care from their family members had lower GHQ-12 scores than those who did not, but there was no significant difference. In terms of finances, those who received care had significantly lower GHQ-12 scores than those who did not (p¼0.035). Conclusions: This study demonstrates that those who receive care from their family members tend to have better mental health than those who do not, and that those who are economically supported by their families have better mental health.
P177 Assistant Nurses’ Experiences and Perceptions of Palliative Care Situations in Residential Care Camilla Udo, Maria Neljesj€ o, Ingegerd Str€ omkvist, Marie Elf, Dalarna University, Dalarna, Sweden Objectives: The aim of this study was to gain a deeper understanding of assistant nurses’ (AN) experiences and perceptions of residential palliative care for older people. Methods: In this qualitative study, critical incidents were collected through eight face-to-face interviews. The data was analyzed using qualitative content analysis.
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Results: Through critical incident technique, 40 incidents were collected, containing real care events. The analysis resulted in the following categories; Being part of a team, Presence and provision of psychosocial support, and Care environment. ANs experienced lack of support in complex palliative care situations. They especially wished increased cooperation with the registered nurses (RNs), to whom they were expected to turn to when in need of expertise. However, due to the consultative structure in the organisation, teamwork was perceived as difficult to achieve. The ANs were uncertain when it was the right time to consult the RN, and when they tried it was often difficult since the RN had many patients to attend in a large geographical area. The consultative organisation led to ANs having unmet expectations of other professionals, mainly referring to the RNs. Conclusions: There is a need for further discussions about the benefits and disadvantages of the consultative structure for palliative care in residential care. Since residential care involves complex palliative care situations for which the unlicensed professionals often lack education this is an important issue, especially if support from the licensed professionals is lacking. There is a need to evaluate whether laws, guidelines and palliative care philosophy are being followed in practice, and if high quality palliative care is accomplished in the consultative organisation.
P178 Survey on Needs and Job Satisfaction of Nurses Working in Palliative Care Settings in Singapore
Katherine Lim Ci Hui1,2, Wang Wen-ru1, Chow Yeow Leng1, Lee Jing Ru2, Premarani Kannusamy1 1 National University of Singapore, Singapore, Singapore 2 Dover Park Hospice, Singapore, Singapore As Singapore faces an aging population, it is imperative to identify and address the needs of palliative nurses in order to increase their job satisfaction and retain them in the workforce. This cross-sectional questionnaire survey study aimed to investigate needs and job satisfaction of palliative nurses in Singapore. The study was conducted at six palliative settings in Singapore, including hospices, nursing homes and community hospitals with inpatient palliative services. 210 registered, enrolled nurses and healthcare assistants who have at least six months of working experience were recruited. A validated self-developed survey questionnaire was used to measure participants’ needs and job satisfaction. The results indicate that palliative nurses were satisfied with their job. Their most relevant need is the
e114
Selected Abstracts
Vol. 52 No. 6 December 2016
need for manpower whereas the least relevant need is the need to be comfortable physically with dying patients. Differences in job satisfaction were observed among nurses in different settings, with different opinions and satisfactory levels regarding training/education. For needs, differences were observed among nurses with different years of experience in current workplace. Both job satisfaction and needs are correlated.
Discussion: The results of this study about the mental distress before/after diagnosis is coherent to previous studies. It is sure that the needs of nursing intervention just after diagnosis is higher than that of before diagnosis. However raw score as of before diagnosis is not negligible. It is necessary to reveal various distress and anxiety before diagnosis by other methodology such as through qualitative interviews.
Keywords: Palliative, nurse, job satisfaction, needs, stress
P180 Guiding the Process of Dying: The Personal Impact on Nurses
P179 The Different Levels of Mental Distress Between Before and After Diagnosis Among Patients with Breast Cancer in Japan
Masami Karube1, Yoko Setoyama2, Masami Yamakawa1, Mariko Hishinuma1, Tomomi Nanami1, Takashi Fujita1 1 Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan 2 Tokyo Medical University, Shinjuku, Shinjuku, Japan Background: Mental distress just after diagnosis is severe among cancer patients, so it is natural to need nursing intervention since just after diagnosis. However it is not clear whether people have also high distress in the period between suspicion of cancer and its diagnosis. Objectives: In order to search the necessity of nursing intervention even before their diagnosis, this research aims to demonstrate to compare the levels of mental distress between before and after diagnosis among patients with breast cancer in Japan. Methods: 165 women (81 women were before diagnosis, 84 women were after diagnosis) were asked to answer a questionnaire about mental distress before or after their diagnosis about breast cancer. Other demographic data (age, marriage, families, job, and insurance as economic status) and disease related data (medical histories) were collected from clinical records. We conducted multivariate liner regression analysis. Results: The raw scores of distress level was 4.302.41 as of before diagnosis, and 5.392.10 as of after diagnosis on a scale of one to ten. After adjusted demographic and disease-related variables (age, job, and medical histories), there was even significant differences between the levels of mental distress between before and after diagnosis among patients (b¼-.157, p¼.040).
Dianne White1,2, Mary Ann Meeker1 1 University at Buffalo, The State University of New York, Buffalo, NY, United States 2 State University of New York, Empire State College, Saratoga Springs, NY, United States Objectives: Acute care nurses regularly care for patients during transition from curative to comfortfocused care. The purpose of this secondary analysis was to explore the personal impact on nurses of caring for dying patients and their strategies for self-support and development of competence. Method: Data collected in a study of acute care nurses’ views of caring for patients and families during transition to comfort care were analyzed using the constant comparative coding techniques of grounded theory to develop and characterize categories. The data were derived from twenty-six semi-structured, audio-recorded, and transcribed interviews. Results: Nurses experienced moral distress in situations of continuing treatment when a cure was very unlikely. Treatment appeared to be a source of patient suffering with little or no benefit. In managing symptoms for patients at end of life (EOL), nurses struggled to foster an often tenuous balance of patient comfort and calm, with as much alertness as possible. In addition, they were challenged to manage the competing demands of a workload including patients receiving curative care juxtaposed with those focused on comfort care. Nurses navigated these challenges through support from nurse colleagues and managers and also called upon interdisciplinary guidance from palliative care clinicians, social workers, and ethics committees. Nurses reflected on their fears as new nurses caring for EOL patients, the inadequacy of their preparation for this role, and their distress when the care provided felt inadequate to them. They identified mentoring and experience as important to development of expertise. They also recommended enhanced educational preparation. Many reflected on the unique satisfaction possible when caring well for dying patients.
Selected Abstracts
their family members living under the same roof. However, that has gradually become more difficult. We decided to clarify the relationship between the mental health of elderly patients with terminal cancer and family care. Methods: We studied patients with terminal cancer aged 65 or older that were cared by their family members. Through anonymous self-administered questionnaires, we examined the background of the study participants and their main caregivers and whether study participants were supported by their family members in terms of housekeeping, eating, excretion, cleanliness, movement, medical care, and finances. Mental health was assessed with the General Health Questionnaire-12 (GHQ-12), which uses a 4stage Likert scale. We performed t-tests after confirming that GHQ-12 scores were normally distributed. This study was performed after approval by the Epidemiological Research Ethics Committee of University A and the ethics review committees of the participating facilities. Results: Questionnaires were collected from 38 individuals (collection rate, 60.3%), who consisted of 14 men and 24 women. The average age was 77.8 7.6 years. Regarding housekeeping, eating, excretion, cleanliness, movement and medical care, those who received care from their family members had lower GHQ-12 scores than those who did not, but there was no significant difference. In terms of finances, those who received care had significantly lower GHQ-12 scores than those who did not (p¼0.035). Conclusions: This study demonstrates that those who receive care from their family members tend to have better mental health than those who do not, and that those who are economically supported by their families have better mental health.
P177 Assistant Nurses’ Experiences and Perceptions of Palliative Care Situations in Residential Care Camilla Udo, Maria Neljesj€ o, Ingegerd Str€ omkvist, Marie Elf, Dalarna University, Dalarna, Sweden Objectives: The aim of this study was to gain a deeper understanding of assistant nurses’ (AN) experiences and perceptions of residential palliative care for older people. Methods: In this qualitative study, critical incidents were collected through eight face-to-face interviews. The data was analyzed using qualitative content analysis.
e113
Results: Through critical incident technique, 40 incidents were collected, containing real care events. The analysis resulted in the following categories; Being part of a team, Presence and provision of psychosocial support, and Care environment. ANs experienced lack of support in complex palliative care situations. They especially wished increased cooperation with the registered nurses (RNs), to whom they were expected to turn to when in need of expertise. However, due to the consultative structure in the organisation, teamwork was perceived as difficult to achieve. The ANs were uncertain when it was the right time to consult the RN, and when they tried it was often difficult since the RN had many patients to attend in a large geographical area. The consultative organisation led to ANs having unmet expectations of other professionals, mainly referring to the RNs. Conclusions: There is a need for further discussions about the benefits and disadvantages of the consultative structure for palliative care in residential care. Since residential care involves complex palliative care situations for which the unlicensed professionals often lack education this is an important issue, especially if support from the licensed professionals is lacking. There is a need to evaluate whether laws, guidelines and palliative care philosophy are being followed in practice, and if high quality palliative care is accomplished in the consultative organisation.
P178 Survey on Needs and Job Satisfaction of Nurses Working in Palliative Care Settings in Singapore
Katherine Lim Ci Hui1,2, Wang Wen-ru1, Chow Yeow Leng1, Lee Jing Ru2, Premarani Kannusamy1 1 National University of Singapore, Singapore, Singapore 2 Dover Park Hospice, Singapore, Singapore As Singapore faces an aging population, it is imperative to identify and address the needs of palliative nurses in order to increase their job satisfaction and retain them in the workforce. This cross-sectional questionnaire survey study aimed to investigate needs and job satisfaction of palliative nurses in Singapore. The study was conducted at six palliative settings in Singapore, including hospices, nursing homes and community hospitals with inpatient palliative services. 210 registered, enrolled nurses and healthcare assistants who have at least six months of working experience were recruited. A validated self-developed survey questionnaire was used to measure participants’ needs and job satisfaction. The results indicate that palliative nurses were satisfied with their job. Their most relevant need is the
e114
Selected Abstracts
Vol. 52 No. 6 December 2016
need for manpower whereas the least relevant need is the need to be comfortable physically with dying patients. Differences in job satisfaction were observed among nurses in different settings, with different opinions and satisfactory levels regarding training/education. For needs, differences were observed among nurses with different years of experience in current workplace. Both job satisfaction and needs are correlated.
Discussion: The results of this study about the mental distress before/after diagnosis is coherent to previous studies. It is sure that the needs of nursing intervention just after diagnosis is higher than that of before diagnosis. However raw score as of before diagnosis is not negligible. It is necessary to reveal various distress and anxiety before diagnosis by other methodology such as through qualitative interviews.
Keywords: Palliative, nurse, job satisfaction, needs, stress
P180 Guiding the Process of Dying: The Personal Impact on Nurses
P179 The Different Levels of Mental Distress Between Before and After Diagnosis Among Patients with Breast Cancer in Japan
Masami Karube1, Yoko Setoyama2, Masami Yamakawa1, Mariko Hishinuma1, Tomomi Nanami1, Takashi Fujita1 1 Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan 2 Tokyo Medical University, Shinjuku, Shinjuku, Japan Background: Mental distress just after diagnosis is severe among cancer patients, so it is natural to need nursing intervention since just after diagnosis. However it is not clear whether people have also high distress in the period between suspicion of cancer and its diagnosis. Objectives: In order to search the necessity of nursing intervention even before their diagnosis, this research aims to demonstrate to compare the levels of mental distress between before and after diagnosis among patients with breast cancer in Japan. Methods: 165 women (81 women were before diagnosis, 84 women were after diagnosis) were asked to answer a questionnaire about mental distress before or after their diagnosis about breast cancer. Other demographic data (age, marriage, families, job, and insurance as economic status) and disease related data (medical histories) were collected from clinical records. We conducted multivariate liner regression analysis. Results: The raw scores of distress level was 4.302.41 as of before diagnosis, and 5.392.10 as of after diagnosis on a scale of one to ten. After adjusted demographic and disease-related variables (age, job, and medical histories), there was even significant differences between the levels of mental distress between before and after diagnosis among patients (b¼-.157, p¼.040).
Dianne White1,2, Mary Ann Meeker1 1 University at Buffalo, The State University of New York, Buffalo, NY, United States 2 State University of New York, Empire State College, Saratoga Springs, NY, United States Objectives: Acute care nurses regularly care for patients during transition from curative to comfortfocused care. The purpose of this secondary analysis was to explore the personal impact on nurses of caring for dying patients and their strategies for self-support and development of competence. Method: Data collected in a study of acute care nurses’ views of caring for patients and families during transition to comfort care were analyzed using the constant comparative coding techniques of grounded theory to develop and characterize categories. The data were derived from twenty-six semi-structured, audio-recorded, and transcribed interviews. Results: Nurses experienced moral distress in situations of continuing treatment when a cure was very unlikely. Treatment appeared to be a source of patient suffering with little or no benefit. In managing symptoms for patients at end of life (EOL), nurses struggled to foster an often tenuous balance of patient comfort and calm, with as much alertness as possible. In addition, they were challenged to manage the competing demands of a workload including patients receiving curative care juxtaposed with those focused on comfort care. Nurses navigated these challenges through support from nurse colleagues and managers and also called upon interdisciplinary guidance from palliative care clinicians, social workers, and ethics committees. Nurses reflected on their fears as new nurses caring for EOL patients, the inadequacy of their preparation for this role, and their distress when the care provided felt inadequate to them. They identified mentoring and experience as important to development of expertise. They also recommended enhanced educational preparation. Many reflected on the unique satisfaction possible when caring well for dying patients.