Sources of Stress in Nursing Terminal Patients in a Hospice

Abstract

A study was undertaken in the hospice unit at a large, midwestern community hospital to investigate the sources of stress experienced by hospice nurses. The case material reported in this article is based on observations, interviews with nurses, written stressful incident reports completed by nurses, and support group discussions. A number of sources of stress experienced by hospice nurses are identified. Physical characteristics of the unit as well as staffing policies designed to improve the quality of care resulted in conflict and feelings of alienation from other hospital personnel. Procedures followed in admitting patients to the hospice created stress when they were not fully supported by hospital administrators and physicians. Other policies related to the preparation of meals and open visitation increased the nurse's work load. At the same time, greater involvement with the patient and family during the dying process resulted in increased emotional demands on the nurse. Nurses experienced a sense of loss when a patient they had grown attached to died or was discharged to another institution. Stress also resulted from the nurse's exclusive involvement with terminally ill patients. Continual involvement with dying patients precipitated anxiety and superstitions concerning the nurse's own vulnerability and was particularly stressful when the nurse had experienced the death of someone close to her outside of the hospital.